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Warnung L, Sattler S, Haiden E, Schober S, Pahr D, Reisinger A. A mechanically validated open-source silicone model for the training of gastric perforation sewing. BMC Med Educ 2023; 23:261. [PMID: 37076839 PMCID: PMC10116820 DOI: 10.1186/s12909-023-04174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/17/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Gastrointestinal perforation is commonly seen in emergency departments. The perforation of the stomach is an emergency situation that requires immediate surgical treatment. The necessary surgical skills require regular practical training. Owing to patient`s safety, in vivo training opportunities in medicine are restricted. Animal tissue especially porcine tissue, is commonly used for surgical training. Due to its limiting factors, artificial training models are often to be preferred. Many artificial models are on the market but to our knowledge, none that mimic the haptic- and sewing properties of a stomach wall at the same time. In this study, an open source silicone model of a gastric perforation for training of gastric sewing was developed that attempts to provide realistic haptic- and sewing behaviour. METHODS To simulate the layered structure of the human stomach, different silicone materials were used to produce three different model layups. The production process was kept as simple as possible to make it easily reproducible. A needle penetration setup as well as a systematic haptic evaluation were developed to compare these silicone models to a real porcine stomach in order to identify the most realistic model. RESULTS A silicone model consisting of three layers was identified as being the most promising and was tested by clinical surgeons. CONCLUSIONS The presented model simulates the sewing characteristics of a human stomach wall, is easily reproducible at low-costs and can be used for practicing gastric suturing techniques. TRIAL REGISTRATIONS Not applicable.
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Affiliation(s)
- Lukas Warnung
- Department of Anatomy and Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria.
- Division of Radiotherapy-Radiation Oncology, University Hospital Krems, Mitterweg 10, Krems, 3500, Austria.
| | - Stefan Sattler
- Department of Surgery, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
| | - Elmar Haiden
- Department of Surgery, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
| | - Sophie Schober
- Medical Science and Human Medicine study programme, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
| | - Dieter Pahr
- Department of Anatomy and Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
- Institute for Lightweight Design and Structural Biomechanics, University of Technology Vienna, Getreidemarkt 9, Wien, 1060, Austria
| | - Andreas Reisinger
- Department of Anatomy and Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria
- Institute for Lightweight Design and Structural Biomechanics, University of Technology Vienna, Getreidemarkt 9, Wien, 1060, Austria
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Dubey AA, Ravi K, Shahin MA, Dhami NK, Mukherjee A. Bio-composites treatment for mitigation of current-induced riverbank soil erosion. Sci Total Environ 2021; 800:149513. [PMID: 34392222 DOI: 10.1016/j.scitotenv.2021.149513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
Mitigation of erosion along the riverbanks is a global challenge. Stabilisers such as cement can control erosion, but it risks the river ecology. This paper presents the erosion characteristics of riverbank soil treated with two biological stabilisers that alleviate the ecological cost. The riverbank soil of one of the largest river systems, Brahmaputra, is treated by bio-polymeric and bio-cement binders and their composite. Moreover, a novel selective bio-stimulation technique has been employed to achieve bio-mineralisation. The soil stabilisation is assessed by needle penetration tests and CaCO3 contents. The specimens were tested in a flow-controlled hydraulic flume subjected to a critical current profile ranging from 0.06 to 0.62 m/s. Soil samples treated up to four cycles of biocementation have been tested at three different slopes (30°, 45° and 53°). The eroded depth and erosion rate are evaluated with image analysis. Up to four-fold reduction in the erosion rate was observed with biocementation treatment. However, cementation beyond a threshold led to the formation of brittle chunks. A bio-composite was devised through a pre-treatment of low-viscosity biopolymer along with biocementation. The bio-composite was found to effectively mitigate the current-induced erosion with 36% lower ammonia production than the equally erosion resistant biocemented counterpart. The dual characteristics of the bio-composite were confirmed with the microstructural analysis. This study unravels the potential of biopolymer-biocement composite as a sustainable erosion mitigation strategy.
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Affiliation(s)
- Anant Aishwarya Dubey
- Department of Civil Engineering, Indian Institute of Technology, Guwahati, Assam 781039, India; School of Civil and Mechanical Engineering, Curtin University, Perth, Western Australia 6152, Australia
| | - K Ravi
- Department of Civil Engineering, Indian Institute of Technology, Guwahati, Assam 781039, India
| | - Mohamed A Shahin
- School of Civil and Mechanical Engineering, Curtin University, Perth, Western Australia 6152, Australia
| | - Navdeep K Dhami
- School of Civil and Mechanical Engineering, Curtin University, Perth, Western Australia 6152, Australia
| | - Abhijit Mukherjee
- School of Civil and Mechanical Engineering, Curtin University, Perth, Western Australia 6152, Australia.
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Irwin T, Speirs A, Merrett C. The effect of skin tension, needle diameter and insertion velocity on the fracture properties of porcine tissue. J Mech Behav Biomed Mater 2021; 123:104660. [PMID: 34329813 DOI: 10.1016/j.jmbbm.2021.104660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 06/06/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022]
Abstract
Using metal needles to penetrate skin tissue is common in medical treatments for the delivery of medication or minimally invasive surgery. In most applications the fracture properties of skin tissue is not important as the human surgeon has full control over the needle. Given that robotically controlled surgeries and self applied medical devices have become increasingly popular, a better understanding of the fracture properties and how to mathematically model the fracture process is needed. Experiments measuring the force required to fracture porcine skin tissue were done while varying the applied skin tension, needle insertion speed and needle diameter. The applied skin tension was found to have the greatest influence on the fracture properties, while the insertion speed was found to have a negligible impact. The variance in experimental results was not well explained by the three independent variables alone, suggesting that additional parameters influence the fracture process.
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Affiliation(s)
- T Irwin
- Carleton University, 1125 Colonel By Drive, Ottawa, Canada.
| | - A Speirs
- Carleton University, 1125 Colonel By Drive, Ottawa, Canada.
| | - C Merrett
- Carleton University, 1125 Colonel By Drive, Ottawa, Canada.
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Tran KD, Crane AM, Flynn HW. Management of inadvertent needle penetration resulting in subretinal triamcinolone acetonide and retinal detachment. Am J Ophthalmol Case Rep 2018; 10:288-289. [PMID: 29780955 PMCID: PMC5956806 DOI: 10.1016/j.ajoc.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/17/2018] [Indexed: 01/28/2023] Open
Abstract
Purpose To report management of inadvertent needle penetration during subtenons triamcinolone acetonide administration resulting in retinal detachment. Observations A 71-year-old female with history of diabetes, hypothyroidism, and mild myopia underwent subtenons triamcinolone acetonide (TA) injection in the right eye for nodular scleritis. There was unexpected patient movement concurrent with the injection resulting in needle penetration, subretinal and intravitreal injection of TA, superotemporal retinal break, and macula-involving retinal detachment. The patient underwent partial subretinal TA removal, successful retinal detachment repair, and recovered 20/25 visual acuity. Conclusions and importance In spite of prominent subretinal TA and retinal detachment, successful repair of retinal detachment and recovery of good visual acuity is possible.
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Affiliation(s)
- Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Ashley M Crane
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
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Mirahmadi F, Koolstra JH, Lobbezoo F, van Lenthe GH, Everts V. Ex vivo thickness measurement of cartilage covering the temporomandibular joint. J Biomech 2016; 52:165-168. [PMID: 28069164 DOI: 10.1016/j.jbiomech.2016.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
Articular cartilage covers the temporomandibular joint (TMJ) and provides smooth and nearly frictionless articulation while distributing mechanical loads to the subchondral bone. The thickness of the cartilage is considered to be an indicator of the stage of development, maturation, aging, loading history, and disease. The aim of our study was to develop a method for ex vivo assessment of the thickness of the cartilage that covers the TMJ and to compare that with two other existing methods. Eight porcine TMJ condyles were used to measure cartilage thickness. Three different methods were employed: needle penetration, micro-computed tomography (micro-CT), and histology; the latter was considered the gold standard. Histology and micro-CT scanning results showed no significant differences between thicknesses throughout the condyle. Needle penetration produced significantly higher values than histology, in the lateral and anterior regions. All three methods showed the anterior region to be thinner than the other regions. We concluded that overestimated thickness by the needle penetration is caused by the penetration of the needle through the first layer of subchondral bone, in which mineralization is less than in deeper layers. Micro-CT scanning method was found to be a valid method to quantify the thickness of the cartilage, and has the advantage of being non-destructive.
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Affiliation(s)
- Fereshteh Mirahmadi
- Department of Oral Cell Biology and Functional Anatomy, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Jan Harm Koolstra
- Department of Oral Cell Biology and Functional Anatomy, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
| | - Frank Lobbezoo
- MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Vincent Everts
- Department of Oral Cell Biology and Functional Anatomy, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
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Wickramaratne D, Wilkinson P, Rao J, Ragavendra N, Sharma S, Gimzewski JK. Fine Needle Elastography (FNE) device for biomechanically determining local variations of tissue mechanical properties. J Biomech 2015; 48:81-8. [PMID: 25468668 DOI: 10.1016/j.jbiomech.2014.10.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/24/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022]
Abstract
Diseased tissues exhibit changes in mechanical properties and thus possess clinical diagnostic significance. We report the design and development of a Fine Needle Elastography (FNE) prototype device integrated with Fine Needle Aspiration Cytology (FNAC) needle that allows for quantitative and sensitive assessment of tissues and materials based on local variations in elastic, friction, and cutting forces on needle insertion. A piezoelectric force-sensor at the base of FNA needle measures the forces opposing needle penetration with micrometer scale resolution. Measurement precision (±5 μm) and axial resolution (~20 μm) of FNE device was tested using control mm size gelatin matrices and unripe pear in assessing needle penetration resistance, force heterogeneity and optimization of needle penetration velocity. Further, we demonstrated the usefulness of FNE in quantitative, biomechanical differentiation of simulated thyroid tumor nodules in an ultrasound neck phantom. Fluid or solid nodules were probed in the phantom study coupled with ultrasound guidance. Our data shows significantly higher force variations (1-D force heterogeneity; HF,a=6.5 mN, HF,q=8.25 mN and stiffness heterogeneity; HS,a=0.0274 kN/m, HS,q=0.0395 kN/m) in solid nodules compared either to fluid nodules or to regions corresponding to healthy thyroid tissue within the ultrasound phantom. The results suggest future applications of in vivo FNE biopsies based on force heterogeneity to diagnose thyroid tumors in areas where ultrasound instrumentation or access to a qualified pathologist for FNAC are unavailable, as well as an ancillary diagnostic tool in thyroid cancer management.
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