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The frozen elephant trunk technique has revolutionized aortic arch repair to enable more extensive arch and descending thoracic aortic treatment in a single setting. We review the current evidence supporting the use of the Thoraflex Hybrid (Terumo Aortic, FL, USA) device and discuss advantages, pitfalls and future design considerations.Lay abstract Disease of the aorta, the biggest blood vessel in the body, is challenging. In recent years, new technologies such as the frozen elephant trunk (FET) have improved the treatment of patients with these complicated diseases. The FET is a hybrid device, made of medical fabrics and a covered metal stent (a tube inserted into the blood vessel to keep it open). In this paper, we provide an in-depth review of a FET device known as Thoraflex Hybrid (Terumo Aortic, FL, USA). We discuss its advantages and pitfalls as well as future areas of research.

Purpose To report the impact of dose and tumor volume metrics at brachytherapy on outcomes for locally advanced cervical cancer treated with tandem and ovoids intracavitary/interstitial brachytherapy. Material and methods FIGO stage IB1-IIIB locally advanced cervical cancer treated with intracavitary/interstitial brachytherapy via a tandem and ovoids hybrid applicator were analyzed. Median high-risk clinical target volume (HR-CTV), rate of tumor volume reduction, EQD2 D90, organ at risk doses, and outcomes were recorded. Univariable and multivariable Cox regression was applied for survival analysis, and logistic regression was used for toxicity analysis. Results Seventy-one patients were identified. Median follow-up was 24.9 months, with a 2-year local control of 83.6%, loco-regional control of 72.0%, and overall survival of 88.6%. Median HR-CTV D90 was 87.4 Gy (IQR = 85.7-90.2). Median HR-CTV D90 > 90 Gy10 showed a trend toward improved local control (LC) (p = 0.19). Median HR-CTV was 37.9 cm3, and median V100 was 86.5%. A median HR-CTV of ≥ 40 cm3 demonstrated worse loco-regional control (LRC) (p = 0.018) and progression-free survival (p = 0.021). Two-year LC and LRC for stage IIB patients with a median HR-CTV < 40 cm3 were significantly improved as compared to ≥ 40 cm3 at 100% and 71.8%, respectively (p = 0.019) and 100% and 56.5%, respectively (p = 0.001). However, this trend was not statistically significant for stage IIIB patients. Higher percent per day reduction in HR-CTV during brachytherapy showed improved LRC (p = 0.045). Four percent of patients experienced acute grade 3 genitourinary toxicity, 1% late grade 3 genitourinary and 1% late grade 3 gastrointestinal toxicity. Conclusions Tandem and ovoids intracavitary/interstitial brachytherapy provides satisfactory outcomes with modest toxicity. Higher HR-CTV D90 coverage demonstrated a trend toward improved tumor control. Tumor volume based on median HR-CTV ≥ 40 cm3 at brachytherapy was prognostic for poor outcomes, even within initial FIGO stage groups warranting caution.

Objective The aim of this study was to assess the efficacy of the “SMARTLock” hybrid system and determine whether it results in fewer intraoperative and postoperative complications compared with placement of intermaxillary fixation (IMF) screws in trauma patients. Study Design This prospective study, which was approved by the institutional review board, compared the results of MMF in mandibular fractures by using the Stryker “SMARTLock” hybrid system versus traditional IMF screws. Patients were recruited and assigned randomly to either group. The 2 groups were compared for placement time, intraoperative complications, loosening of hardware, postoperative complications, and time to device removal. Results We enrolled 32 patients in the study, with 13 patients randomized to the group receiving hybrid MMF (HMMF) with the SMARTLock system and 19 to the group of patients receiving MMF with traditional IMF screws. The mean application time for HMMF was 25.92 minutes compared with 18.28 minutes for IMF screws. After removal, the HMMF was associated with gingival overgrowth and gingival edema. Conclusions This is the first study to compare HMMF with MMF with the use of IMF screws. Hybrid arch bars do require more manipulation for ideal placement compared with individually placed bone screws to achieve ideal MMF. Compared with IMF screws, the hybrid device was associated with gingival edema and overgrowth, but there was decreased incidence of loosening in the postoperative period.

We used the topological insulator (TI) Bi2Te3 and a high-temperature superconductor (HTSC) hybrid device for investigations of proximity-induced superconductivity (PS) in the TI. Application of the superconductor YBa2Cu3O7-δ (YBCO) enabled us to access higher temperature and energy scales for this phenomenon. The HTSC in the hybrid device exhibits emergence of a pseudogap state for T > Tc that converts into a superconducting state with a reduced gap for T c. The conversion process has been reflected in Raman spectra collected from the TI. Complementary charge transport experiments revealed emergence of the proximity-induced superconducting gap in the TI and the reduced superconducting gap in the HTSC, but no signature of the pseudogap. This allowed us to conclude that Raman spectroscopy reveals formation of the pseudogap state but cannot distinguish the proximity-induced superconducting state in the TI from the superconducting state in the HTSC characterised by the reduced gap. Results of our experiments have shown that Raman spectroscopy is a complementary technique to classic charge transport experiments and is a powerful tool for investigation of the proximity-induced superconductivity in the Bi2Te3.

OBJECTIVE To evaluate the accuracy of the InBody BPBIO210 manual auscultatory mercury-free hybrid blood pressure (BP) measuring device for professional office use in a general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). METHODS Subjects were recruited to fulfil the age, sex, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in a general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22-32 (medium) and 32-42 cm (large). RESULTS A total of 94 subjects were recruited and 86 were analysed (mean age 53.7 ± 18.4 [SD] years, 50 men, arm circumference 32.5 ± 4.8 cm, range 22-42 cm). For the validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was -1.0 ± 4.1/-0.7 ± 2.5 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 2.65/1.59 mmHg (systolic/diastolic). CONCLUSIONS The InBody BPBIO210 manual auscultatory hybrid device for professional office BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in a general population and can be recommended for clinical use.

Reimplantation of the supra-aortic vessels can be challenging with Thoraflex Hybrid. A device modification made the vessel lengths more appropriate and the position of the neo-vessels in the chest avoided malpositioning and kinking and facilitated sternum closure; this may improve operating times as well as allowing complete and continuous cerebral trivascular perfusion and corrects positioning of the intrathoracic vessels.

The detection of circulating protein (CP) is very important for the diagnosis and therapeutics of cancer. Conventional techniques based on a specific antibody–antigen interaction are still lacking ...

Solid-state quantum emitters coupled with a single mode fibre are of interest for photonic and quantum applications. In this context, nanofibre Bragg cavities (NFBCs), which are microcavities fabricated in an optical nanofibre, are promising devices because they can efficiently couple photons emitted from the quantum emitters to the single mode fibre. Recently, we have realized a hybrid device of an NFBC and a single colloidal CdSe/ZnS quantum dot. However, colloidal quantum dots exhibit inherent photo-bleaching. Thus, it is desired to couple an NFBC with defect centres in hexagonal boron nitride (hBN) as stable quantum emitters. In this work, we realize a hybrid system of an NFBC and defect centres in hBN nanoflakes. In this experiment, we fabricate NFBCs with a quality factor of 807 and a resonant wavelength at around 573 nm, which matches well with the fluorescent wavelength of the defect centres in hBN, using a helium focused ion beam (FIB) system. We also develop a manipulation system to place hBN nanoflakes on a cavity region of the NFBCs and realize a hybrid device with an NFBC. By exciting the nanoflakes via an objective lens and collecting the fluorescence through the NFBC, we observe a sharp emission peak at the resonant wavelength of the NFBC.

BACKGROUND Radiofrequency is a commonly used method to non-invasively tighten the skin that can be safely applied to any skin type. AIMS The aim of our study was to evaluate the safety and efficacy of the focused radiofrequency and ultrasound hybrid device for face and neck rejuvenation, in terms of improvement of facial wrinkles and jaw sagging. METHODS A total of 158 patients had undergone four weekly sessions of focused radiofrequency and ultrasound to face and neck area. Photodocumentation was obtained before first visit and two weeks after last visit. An independent, blinded dermatologist evaluated the severity of wrinkles and sagging of seven different anatomical regions on a validated scale of 0-4 (0: no lines/sagging, 1: mild, 2: moderate, 3: severe, 4: very severe) before and after the procedure. Patients rated their satisfaction with the result of the treatment on a scale of 1-5 (1: dissatisfied, 2: poorly satisfied 3: satisfied, 4: very satisfied, 5: perfectly satisfied). RESULTS For seven anatomical regions, statistically significant reduction was observed in mean wrinkle/sagging scores (p =

The review article is focused on developments in optical devices, other than laryngoscopes, in airway management and tracheal intubation. It brings information on advantages and limitations in their use, compares different devices, and summarizes benefits in various clinical settings. Supraglottic airway devices may be used as a conduit for fiberscope-guided tracheal intubation mainly as a rescue plan in the scenario of difficult or failed laryngoscopy. Some of these devices offer the possibility of direct endotracheal tube placement. Hybrid devices combine the features of two different intubating tools. Rigid and semi-rigid optical stylets represent another option in airway management. They offer benefits in restricted mouth opening and may be used also for retromolar intubation. Awake flexible fiberoptic intubation has been a gold standard in predicted difficult laryngoscopy for decades. Modern flexible bronchoscopes used in anesthesia and intensive care are disposable devices and contain optical lenses instead of fibers. Endotracheal tubes with an incorporated optics are used mainly in thoracic anesthesia for lung separation. They are available in double-lumen and single-lumen versions. They offer a benefit of direct view to the carina and do not require flexible fiberscope for their correct placement.

A wide range of materials has been considered to repair cranial defects. In the field of cranioplasty, poly(methyl methacrylate) (PMMA)-based bone cements and modifications through the inclusion of copper doped tricalcium phosphate (Cu-TCP) particles have been already investigated. On the other hand, aliphatic polyesters such as poly(&epsilon, caprolactone) (PCL) and polylactic acid (PLA) have been frequently investigated to make scaffolds for cranial bone regeneration. Accordingly, the aim of the current research was to design and fabricate customized hybrid devices for the repair of large cranial defects integrating the reverse engineering approach with additive manufacturing, The hybrid device consisted of a 3D additive manufactured polyester porous structures infiltrated with PMMA/Cu-TCP (97.5/2.5 w/w) bone cement. Temperature profiles were first evaluated for 3D hybrid devices (PCL/PMMA, PLA/PMMA, PCL/PMMA/Cu-TCP and PLA/PMMA/Cu-TCP). Peak temperatures recorded for hybrid PCL/PMMA and PCL/PMMA/Cu-TCP were significantly lower than those found for the PLA-based ones. Virtual and physical models of customized devices for large cranial defect were developed to assess the feasibility of the proposed technical solutions. A theoretical analysis was preliminarily performed on the entire head model trying to simulate severe impact conditions for people with the customized hybrid device (PCL/PMMA/Cu-TCP) (i.e., a rigid sphere impacting the implant region of the head). Results from finite element analysis (FEA) provided information on the different components of the model.

Treatment of transverse maxillary deficiency requires maxillary expansion. Therefore, assessing the midpalatal suture maturation stage through CBCT is essential for treatment choice between RPE, MARPE, and SARPE, although it is not without risk of clinical error. In young adults with a potential suture opening, MARPE can be attempted unless in the following situations, where SARPE is advisable: large expansions (>5 mm) and the necessity of additional maxillary forward or downward movement.

The monitoring of respiratory disorders requires breath sensors that are fast, robust, and convenient to use and can function under real time conditions. A MOF based flexible sensor is reported for the first time for breath sensing applications. The properties of a highly porous HKUST-1 MOF and a conducting MoS2 material have been combined to fabricate an electronic sensor on a flexible paper support for studying sleep apnea problems. Extensive breath sensing experiments have been performed and interestingly the fabricated sensor is efficient in detecting various kinds of breaths such as deep, fast, slow and hydrated breath. The MOF breath sensor shows a fast response time of just ∼0.38 s and excellent stability with no decline in its performance even after a month. A plausible mechanism has been proposed and a smartphone based prototype has been prepared to demonstrate the real time applications of the hybrid device. This work demonstrates great potential for the application of MOFs in healthcare with a special focus on breath sensing and sleep apnea diagnosis.

Reimplantation of the supra-aortic vessels can be challenging with Thoraflex Hybrid. A device modification made the vessel lengths more appropriate and the position of the neo-vessels in the chest avoided malpositioning and kinking and facilitated sternum closure; this may improve operating times as well as allowing complete and continuous cerebral trivascular perfusion and corrects positioning of the intrathoracic vessels.

This research work was supported by the South African Research Chairs Initiative ( SARChI ) of the Department of Science and Technology and the National Research Foundation ( NRF ) of South Africa (Grant No. 61056 ). Faith O. Ochai-Ejeh acknowledges NRF through SARChI in Carbon Technology and Materials, the Department of Physics at the University of Pretoria, the TETFund through the University of Nigeria for financial support.

Introduction Transverse mandibular deficiency has been traditionally managed by orthodontic compensation. However, without resolving the underlying skeletal hypoplasia it leads to high relapse rates. Few studies have reviewed the long-term experience and potential complications of mandibular symphyseal distraction osteogenesis (MSDO) as an alternative treatment method. Materials and method A retrospective review of 20 patients (range: 4–19 years; mean: 11.9 years) treated with a hybrid MSDO device over the period of 1996–2017 was conducted. Epidemiological data, medical and dental history as well as photographic and cephalometric analyses were carried out. Furthermore, pre-operative and long-term post-operative status including dental occlusion and tooth-jaw discrepancies were recorded. Results The distraction amount ranged from 3 mm to 15 mm (mean: 10 mm) with an average distraction period of 30.9 days. In long-term follow-up (mean: 7.3 years), 14 patients presented a class I and 6 patients presented a class II relationship. Correction of overjet, tooth jaw discrepancy and arch length discrepancy were obtained in 18, 20 and 17 cases respectively. A device malfunction was experienced in 6 patients. Conclusion Mandibular widening using a hybrid MSDO device can be efficiently and safely performed in a paediatric population. Further studies confirming our results and analysing facial aesthetic outcomes are warranted.

The Gemini TF64 PET/CT (Philips Medical Systems) is a thirdgeneration hybrid device consisting of a PET scanner with builtin time of flight (TOF) technology that fully operates in threedimensional (3D) mode and a 64-slice Brilliance CT scanner.

The purpose of this study was to evaluate an alleged EEG amplifier’s, the Freer Logic BodyWave, ability to record EEG by comparing its signals to those recorded at the same time by a proven EEG amplifier, the Emotiv EPOC+. The BodyWave’s circuitry is similar to that of an Electro-dermal Activity meter and alleges to record surface-EEG from a limb of the user. The EPOC+ has been proven in previous studies to record signals of high-enough quality to be used in research, whilst the BodyWave is unproven. In order to compare their recordings, both EEGs were worn simultaneously whilst different stimuli induced various brain states. 15 participants were recruited and each subjected to two different experimental paradigms meant to induce increased attention and increased relaxation. Both headsets achieved a classification accuracy well above chance when differentiating between the attention and relaxation tasks. Further testing provided evidence that data from the alpha and beta frequency bands was contributing the most to the classifier’s accuracy. However the total lack of correlation between the signals of the two devices strongly implies that the BodyWave is not measuring EEG. Despite this these results show that in some cases it can be used in place of an EEG to perform a similar function. It also proved to be much more robust against muscle artefacts compared to the EPOC+.

Variations of cerebral blood flow during acute ischemia and total hemoglobin concentration were monitored in rabbit fetuses using a hybrid device based on diffuse correlation spectroscopy and near infrared diffuse optical spectroscopy

Compression therapy is the most important basic treatment modality in venous leg ulcers. The review focusses on the materials which are used: 1. Compression bandages, 2. Compression stockings, 3. Self-adjustable Velcro-devices, 4. Compression pumps, 5. Hybrid devices. Compression bandages, usually applied by trained staff, provide a wide spectrum of materials with different elastic properties. To make bandaging easier, safer and more effective, most modern bandages combine different material components. Self-management of venous ulcers has become feasible by introducing double compression stockings (“ulcer kits”) and self-adjustable Velcro devices. Compression pumps can be used as adjunctive measures, especially for patients with restricted mobility. The combination of sustained and intermittent compression (“hybrid device”) is a promising new tool. The interface pressure corresponding to the dosage of compression therapy determines the hemodynamic efficacy of each device. In order to reduce ambulatory venous hypertension compression pressures of more than 50 mm Hg in the upright position are desirable. At the same time pressure should be lower in the resting position in order to be tolerated. This prerequisite may be fulfilled by using inelastic, short stretch material including multicomponent bandages and cohesive surfaces, all characterized by high stiffness. Such materials do not give way when calf muscles contract during walking which leads to high peaks of interface pressure (“massaging effect”).

Objectives: This report aimed to describe a novel and efficient method of tracheoesophageal puncture using a hybrid device assembled from 2 commercially available puncture kits; to demonstrate the utility of this technique in the performance of primary and secondary procedures, under general and local anesthesia, with and without flap reconstruction; and to evaluate the efficacy of concurrent puncture and valve placement. Methods: Thirty-four patients who underwent either primary or secondary tracheoesophageal puncture for voice restoration. Charts were reviewed retrospectively for complications, time to first valve change, operative time, and blood loss. Results: Using this novel hybrid device, simultaneous puncture and valve placement was achieved in 34 consecutive patients. There was 1 major complication; blood loss was negligible; and the procedure could be accomplished in all cases. There were no cases of prosthesis failure as a result of the insertion technique. Conclusion: Concurrent tracheoesophageal puncture and voice prosthesis placement is a simple and efficient method of voice restoration in the laryngectomized patient and can be more easily accomplished with a hybrid device assembled from the components of 2 commercially available puncture kits. It can be performed under local as well as general anesthesia. The procedure is adaptable to a variety of clinical situations.

A novel hybrid device is described herein for performing simultaneous Positron Emission Tomography (PET) and Ultrafast Ultrasound Imaging (UUI) in vivo. This study aims in qualifying this device for in-vivo studies. Two major issues are addressed: the co-registration of the images originating from each modality and the effect of placing a US probe inside a PET system on the PET images. Experiments on UUI/CT and PET phantoms were performed for the co-registration calibration of this prototype and for quantifying the effect of the US probe on the PET signal.

The application of SPECT/CT hybrid imaging devices, which consist of SPECT (single photon emission computed tomography) and CT (X-ray computed tomography) promises advances in clinical practice. The hybrid device offers improved evaluation of functional and anatomical information by e. g. exact registration as well as increased patient comfort and improved logistics. - However the complexity of the single modalities is further increased by the combination of both. Therefore, for making use of the full potential of SPECT/CT, background knowledge about physical and technical aspects of both modalities is mandatory. SPECT is based on the gamma camera principle and by the use of collimators gains views of the activity distribution of the patient under different angles. Out of the views a 3-dimensional estimate of the activity distribution is formed by using reconstruction techniques. Image degrading effects like photon scatter and photon attenuation can be partially corrected by applying several methods. - In CT, transmission images for X-ray radiation of the examined object are formed. By analogy with SPECT, it is necessary to choose a compromise between image quality and radiation dose of the patient. For this, knowledge and understanding of the key parameters of CT are imperative. - Furthermore the requirements for constancy testing of the hybrid SPECT/CT for ensuring the stability of the imaging capabilities should not be neglected in clinical practice.

The aim of this study was to investigate the performance of different orthodontic devices for mandibular symphyseal distraction osteogenesis (MSDO). Two performance parameters were analysed, the first of which concerned the stability guaranteed by a distractor in the fracture gap under mastication loads and the second the level of reliability with which a distractor transfers a given expansion to the mandibular bone, inasmuch as the more reliable the device the smaller the difference between the degree of expansion provided to the device and the displacement achieved on the mandibular arch. Hence, a non-linear finite element (FE) model of a human mandible with different devices (tooth-borne, bone-borne, and hybrid) was constructed and then utilized to assess the structural behaviour of the mandibular bone under distraction and mastication loads. An ad hoc algorithm was developed to simulate progressive expansion of the devices; a distraction protocol comprising a 10 day latency period and a 6 day distraction period was hypothesized. The first hypothetical expansion given to the device was 2 mm, and the five subsequent expansions were 1 mm. The results showed that the hybrid device was the most stable appliance under mastication loads, followed by the tooth- and bone-borne devices. However, parasitic rotations of the mandibular arms caused by mastication might counteract the benefits of distraction. The tooth-borne device was found to have the highest reliability in transferring expansion to the mandibular bone. For this device, mandibular expansion was less than the nominal aperture of the distractor by no more than 15 per cent. Lower values of reliability were achieved with the bone-borne device. As the values of the aperture of the appliances increased, the stability guaranteed in the fracture gap increased while the reliability in transferring expansion to the mandibular arch decreased.

Synchronous peri-anastomotic pseudo-aneurysms were discovered in a 65-year-old man 26 years after an aorto-bi-iliac bypass and 11 years after an ileo-femoral bypass. He was a poor surgical candidate owing to his obesity, hostile abdomen, and multiple medical comorbidities. Therefore, a novel hybrid device was designed that was part stent graft with the addition of two 6-mm Dacron limbs for anastomosis onto the superficial femoral and profunda femoris arteries. An unexpected type 2 endoleak developed through the internal iliac artery, which was thought to be occluded. This was successfully treated with a direct injection of bovine thrombin. This was an excellent outcome, and the patient made an uneventful recovery.

The aim of this study is to present the treatment of a juxtarenal inflammatory aneurysm using a Nellix device (Endologix, Inc., Irvine, CA) to seal the entire aneurysmatic aorta combined with bilateral iliac–renal bypass using the Gore hybrid vascular graft (W. L. Gore & Associates, Inc., Flagstaff, AZ). A 63-year-old man was diagnosed with a 6-cm juxtarenal inflammatory aneurysm. It was initially decided to treat him with an aorto-aortic bypass and to revascularize the 2 renal arteries with “graft to renal artery bypass” using Gore hybrid vascular grafts. Due to the high intraoperative bleeding preparing the proximal neck and the tight adhesion of the aorta to the adjacent structures, we decided to change our plans and to treat the patient using the Nellix system combined with bilateral iliac–renal bypass using the Gore hybrid vascular grafts. Contrast computed tomography control at 1 month showed complete sealing of the aneurysm sac and patent iliac renal bypasses. The reported case demonstrated that the Nellix Endovascular Aneurysm Sealing system combined with Gore hybrid vascular grafts for bilateral iliac–renal bypass showed that it can be an effective modality for the treatment of juxtarenal, inflammatory aortic aneurysm and revascularization of the renal arteries from the distal iliac arteries.

Endovascular repair of an abdominal aortic aneurysm (AAA) offers hope of improved outcomes in patients presenting with acute rupture. However, a high proportion of such patients have unfavorable proximal neck anatomy and are not suitable for treatment with conventional endografts. Fenestrated endografts overcome the problem of a short proximal neck, but at present their deployment is time consuming and therefore not easily applicable to a ruptured AAA. In this case report, the authors describe a hybrid device (a composite thoracic and infrarenal stent graft) that was able to overcome the problem of a short wide proximal neck in a patient with a ruptured AAA.

With increased use of stereotactic body radiotherapy (SBRT) for early-stage lung cancer, quantification of intrafraction variation (IFV) is required to develop adequate target margins.A total of 409 patients with 427 tumors underwent 1593 fractions of lung SBRT between 2005 and 2010. Translational target position correction of the mean target position (MTP) was performed via onboard cone-beam computed tomography (CBCT). IFV was measured as the difference in MTP between the post-correction CBCT and the post-treatment CBCT and was calculated on 1337 fractions.Mean IFV-MTP was 0.0 ± 1.7 mm, 0.6 ± 2.2 mm, and -1.0 ± 2.0 mm in the mediolateral (ML), anteroposterior (AP), and craniocaudal (CC) dimensions, and the vector was 3.1 ± 2.0 mm; 67.8% of fractions had an IFV vector greater than 2 mm, and 14.3% greater than 5 mm. Weight, excursion, forced expiratory volume in the first second of expiration, diffusing capacity of the lung for carbon monoxide, and treatment time were found to be significant predictors of IFV-MTP greater than 2 mm and 5 mm. Significant differences in IFV-MTP were seen between immobilization devices with a mean IFV of 2.3 ± 1.4 mm, 2.7 ± 1.6 mm, 3.0 ± 1.7 mm, 3.0 ± 2.5 mm, 3.3 ± 1.7 mm, and 3.3 ± 2.2 mm for the body frame, hybrid device, alpha cradle, body fix, wing board, and no immobilization, respectively (P.001). Estimated required target margins for the entire cohort were 4.3, 6.1, and 6.0 mm in the ML, AP, and CC dimensions, with differences in margins based on immobilization.IFV is dependent on several factors: immobilization device, treatment time, pulmonary function, and bodyweight. These factors are responsible for a significant portion of target margins with a mean IFV vector of 3 mm. Target margins of 6 mm or greater are required to encompass IFV in all dimensions when using four-dimensional CT with CBCT without respiratory gating or compression.

Both automated and auscultatory blood pressure (BP) devices have their strengths and accuracy limitations. Hybrid devices, such as the Nissei DM-3000, are mercury free and provide both automated and auscultatory measurement modes. The aim of this study was to validate all measurement modes of the Nissei DM-3000 device according to the European Society of Hypertension (ESH) protocol, as well as to develop and validate a 'blinded' auscultatory measurement mode. Different measurement modes were developed and evaluated in separate studies. Nine sequential same-arm BP measurements were taken alternating between simultaneous mercury sphygmomanometer readings and the device. The latter seven measurements were analysed according to the requirements of the ESH protocol. All measurement modes of the device passed the ESH protocol. The blinded mode achieved the best results with a mean difference+/-s.d. of -0.1+/-2.6 and 0.04+/-2.4 mm Hg for systolic BP (SBP) and diastolic BP (DBP), respectively. The most accurate auscultatory measurement results were obtained with a deflation rate of 2.5 mm Hg s(-1) achieving a mean difference+/-s.d. of -0.6+/-4.4 (for SBP) and -1.4+/-2.8 mm Hg (for DBP). The automated mode achieved a mean difference+/-s.d. of -0.8+/-6.0 (SBP) and 0.8+/-4.8 mm Hg (DBP). The Nissei DM-3000 device is a suitable replacement for the mercury sphygmomanometer.

Our aim was to evaluate the role of SPECT/CT for the diagnosis of diabetic foot infection by labeled leukocytes. Methods: Seventeen patients with 19 clinically suspected sites of infection were included. After leukocyte labeling and administration, planar scans were acquired at 30 min, 4 h, and 24 h for 18 consecutive patients. SPECT/CT was obtained at 6 h. The final diagnosis was established by clinical follow-up (24 mo) in all cases and by bone biopsy for 14 sites. Results: Leukocyte scanning was positive in 16 of 19 lesions and negative in 3. SPECT/CT changed the interpretation of the planar and SPECT images for 10 of 19 suspected sites (52.6%): it excluded osteomyelitis in 6 cases, revealed bone infection in 1 case, and revealed both bone and soft-tissue infection in 3 cases. The hybrid device did not significantly contribute to the evaluation of patients with negative scan results. Conclusion: SPECT/CT can be useful for a more accurate diagnosis of diabetic foot infection by labeled leukocyte imaging.

Mandibular symphyseal distraction osteogenesis (DO) is an alternative to the orthodontic treatment to resolve mandibular anterior width deficiencies or dental crowding. Different types of devices (tooth-borne, bone-borne, and hybrid device) have been used until now. The aim of this clinical study was to report our results with bone-borne device and compare them with previous studies' data to improve our symphyseal distraction protocol and future results.Fourteen patients were treated with symphyseal DO during a 10-year period. Two types of bone-borne distractors have been used. We evaluated morbidity and stability in the short- and long-term (from 12 to 24 months) follow-up, with clinical and radiological examinations.Appropriate symmetrical distraction of both basal and alveolar bone was obtained for all the patients, but correction of the discrepancy failed in 1 case. Mucosa irritation was the main problem. None of the patients presented with local infection. One temporomandibular joint dysfunction occurred during the distraction period, and 1 patient with preoperative temporomandibular joint dysfunction had his symptoms resolved in the long-term follow-up. In 1 case, a root exposure occurred during osteotomy, resulting in an osteogenesis delay.Considering the previous data of the literature and our clinical experience, mandibular symphyseal distraction is a safe alternative to orthodontic and previous surgical treatments, with low morbidity and stable long-term results. Bone-borne device is expected to assert stable results in the long term but with higher morbidity, compared with tooth-borne device. Both surgical techniques and devices have to improve, to assess the superiority of mandibular symphyseal DO to incisor-crowding treatment.

The purpose of this study is to define the relationship between SPECT and CTA measured parameters of left ventricular (LV) function and volumes obtained in a single session using SPECT/64-slice CT hybrid imaging device, and in addition, to assess the reproducibility of LV parameters measured using 64-slice CTA. Materials and methods Seventy-six patients with suspected or known coronary artery disease underwent cardiac CTA and GSPECT in one session using a hybrid SPECT/CT device. LV end-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were measured on each component of the hybrid device. For the CTA component, these parameters were re-measured by the same investigator and by a second investigator with an interval of 3–54 weeks. Corresponding GSPECT and CTA measured parameters were compared. For CTA, intra-observer and inter-observer variability of LV function and volume measurements were calculated. Results A very good correlation was found between the GSPECT and CTA measured LVEF ( r = 0.81), ESV ( r = 0.90) and EDV ( r = 0.82). There was a small positive difference by CTA measured LVEF (3.9 ± 14.2%), and more prominent positive differences by CTA measured ESV and EDV (9.8 ± 14.8 and 44.9 ± 23.1 cm 3 , respectively). There was excellent reproducibility in the measurements of all parameters with very low intra- and inter-observer variability ( r = 0.93 for EF and 0.98 for EDV and ESV). Conclusions Although a good correlation was found between the EF measurements obtained from CTA and SPECT, interchangeable use of EF measurements between the two modalities should be done cautiously and interchangeable use of LV EDV and ESV should be avoided.

The hybrid artificial pancreas for treatment of diabetes consists of insulin-secreting pancreatic tissue which is surrounded by a membrane that protects the tissue from rejection by the immune system following implantation. In this paper, we review the alternative therapeutic approaches for diabetes under study and then discuss the technical requirements that must be met by a hybrid device useful to humans. Previous work on intravascular and extravascular immunoisolation devices is reviewed from the standpoint of these requirements, and three critical unresolved issues are discussed: biocompatibility, oxygen supply limitations, and prevention of immune rejection.

Assessment of the accuracy of the AD UM-101 mercury-free professional device for auscultatory blood pressure (BP) measurement according to the European Society of Hypertension International Protocol. Further to auscultation, the device has a button to mark readings during deflation.Fifteen adults were included in phase 1 and another 18 in phase 2. Simultaneous BP measurements were taken by two observers (connected mercury sphygmomanometers) four times, sequentially with three measurements using the tested device (two connected tested devices, one used with and the other without the mark button).In phase 1, the device produced 44/45/45 measurements within 5/10/15 mmHg, respectively, for systolic BP (SBP) and 39/43/45 for diastolic (DBP). In phase 2.1, 87/97/99 measurements within 5/10/15 mmHg, respectively, for SBP, and 91/97/99 for DBP (using the mark button 65/93/98 for SBP and 76/96/99 for DBP). In phase 2.2, 29 participants had at least two of their SBP differences within 5 mmHg and none had any differences within 5 mmHg, whereas 32 and none, respectively, for DBP (with mark 24/4 participants for SBP; 29/1 for DBP). Mean SBP differences were -1.5+/-3.5 mmHg and DBP -1.3+/-3.0 (with mark -3.6+/-4.2 and -2.8+/-3.7). The difference in SBP measured by the tested device with versus without using the mark button was 3.0+/-3.3 mmHg (P0.001) and DBP 1.9+/-2.5 mmHg (P0.001).The device comfortably passed the validation protocol requirements. Using the mark button, the device, however, failed to meet the validation criteria. Therefore, it is recommended for clinical use without using the mark button.

The topic of this review is the strategy of preserving residual acoustic hearing in the implanted ear to provide combined electrical stimulation and acoustic hearing as a rehabilitative strategy for sensorineural hearing loss. This chapter will concentrate on research done with the Iowa/Nucleus 10 mm Hybrid device, but we will also attempt to summarize strategies and results from other groups around the world who use slightly different approaches. A number of studies have shown that preserving residual acoustic hearing in the implanted ear is a realistic goal for many patients with severe high-frequency hearing loss. The addition of the electric stimulation to their existing acoustic hearing can provide increased speech recognition for these patients. In addition, the preserved acoustic hearing can offer considerable advantages, as compared to a traditional cochlear implant, for tasks such as speech recognition in backgrounds or appreciation of music and other situations where the poor frequency resolution of electric stimulation has been a disadvantage.

Non-invasive assessment of coronary artery anatomy and physiology may soon become a reality, says a new paper published online ahead of print publication in the Journal of the American College of Cardiology (www.sciencedirect.com, doi: 10.1016/j.jacc.2006.10.069). A research team at the Israeli Rambam Medical Centre, Haifa, has shown that a prototype hybrid device that combines computed tomography coronary angiography (CTCA) with single photon emission computed tomography (SPECT) is an accurate way of evaluating coronary …

The aims of this study were to assess the clinical usefulness of [Tc-99m] tetrofosmin (TF) single photon emission computed tomography (SPECT) and X-ray transmission computed tomography (CT), performed simultaneously with a hybrid imaging device for the functional anatomical mapping of brain tumors and to evaluate the additional information of SPECT/CT when compared to SPECT alone. Thirty (30) patients were studied: 20 were evaluated before undergoing surgery and 10 after surgery and before radiotherapy planning. The acquisition of both functional (SPECT) and morphologic (CT) images were obtained in a single session. SPECT images were firstly evaluated alone and then reinterpreted by adding the anatomical (CT) planes. Fusion imaging was successfully obtained in all patients with precise correspondence between SPECT and CT slices. SPECT/CT had a significant clinical impact in 13 (43.3%) of 30 cases; in particular, SPECT/CT accurately characterized eight lesions near sites of physiological uptake (i.e., four near ventricles/choroids plexus, three near venous sinuses, one near the skull) and localized viable tumor tissue in 5 patients evaluated after surgery. SPECT/CT with TF using this hybrid device represents a useful clinical tool in brain tumor imaging, both correctly categorizing focal areas near sites of physiological uptake and localizing viable tumor tissue after surgery.

A material–cell hybrid device that mimics the anatomic shape of the intervertebral disc has been made and successfully implanted into mice to show that tissue engineering may, in the future, benefit sufferers from back pain.

The presented hybrid system allows precise temperature measurements in various sites of the circulation, from the acquisition and preprocessing of dilution curves. From haemodynamic data and left ventricular heat production, an in situ estimate of left heart efficiency is made available. A simplifying hypothesis allows the determination of total left ventricular heat production from three data inputs: (1) the coronary sinus blood flowrate, (2) the thermal coronary veno-arterial difference, (3) the ratio of thermodilution curves areas recorded in the aortic root and the coronary sinus, following a rapid injection in the left ventricular cavity of cold isotonic glucose. Experiments were performed on anaesthetized, artificially ventilated, closed-chest dogs, into which five catheters and probes had been inserted.

A simple FHR pattern diagnostic program has been developed with the use of the IBM graphic terminal and an IBM 360 computer. The program is designed to provide the background for the development of a simple specialized analogue or hybrid device to interface with a fetal monitor. Of 171 fetal heart rate/uterine contraction patterns selected, the accuracy of the computer diagnosis was 84.0 per cent, which was quite adequate for clinical application.