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🎯 3 Teaching Pearls from the “Compact Disc” Method for ERCP Cannulation 1️⃣ Visualize the invisible. Imagine stacked CDs inside the papilla to conceptualize the 3D bile duct axis—especially in long oral protrusion (LOP). 2️⃣ Advance gently, not forcefully. Cannulation should feel like passing through the center hole of... show more

Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD

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15,630 次观看 • 4 个月前 •via X (Twitter)

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🔴Nice teaching case for the advanced therapeutic fellow ERCP Teaching Pearl 🧠 | Hock-Pull Technique in Supine Position 🛌 Supine patient = altered orientation → technique matters 🔹 Papilla orientation: In supine ERCP, the papilla often appears more inferior/posterior and less en face, with a tendency for the catheter to fall into the pancreatic duct due to gravity and scope torque. 🔹 Why Hock-Pull helps: • Hockey bow redirects the tip upward toward the biliary axis despite gravity. • Gentle pull-back everts and opens the papillary orifice, counteracting the “downward fall” seen in supine cases. • Improves coaxial alignment (~11 o’clock) without pushing. 🔹 Manoeuvrability advantage: • Pulling back stabilizes the papilla against respiratory motion. • Small rotations become effective—micro-adjustments instead of force. • Reduces repeated pancreatic duct entry and papillary trauma. 💡 Pearl: > “In supine ERCP, gravity favors the pancreas—hock-pull brings you back to bile.” #ERCP #SupineERCP #Endoscopy #GI #TeachingPearls #PatientSafety

🔴Nice teaching case for the advanced therapeutic fellow ERCP Teaching Pearl 🧠 | Hock-Pull Technique in Supine Position 🛌 Supine patient = altered orientation → technique matters 🔹 Papilla orientation: In supine ERCP, the papilla often appears more inferior/posterior and less en face, with a tendency for the catheter to fall into the pancreatic duct due to gravity and scope torque. 🔹 Why Hock-Pull helps: • Hockey bow redirects the tip upward toward the biliary axis despite gravity. • Gentle pull-back everts and opens the papillary orifice, counteracting the “downward fall” seen in supine cases. • Improves coaxial alignment (~11 o’clock) without pushing. 🔹 Manoeuvrability advantage: • Pulling back stabilizes the papilla against respiratory motion. • Small rotations become effective—micro-adjustments instead of force. • Reduces repeated pancreatic duct entry and papillary trauma. 💡 Pearl: > “In supine ERCP, gravity favors the pancreas—hock-pull brings you back to bile.” #ERCP #SupineERCP #Endoscopy #GI #TeachingPearls #PatientSafety

Turki AlAmri |تُرْكي عبدالله الْعَمريَّ MD

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Netanyahu from Hungary: "The Iranian axis threatens not only Israel, but also its neighbors in the Middle East and all of Europe. That's why we are determined to crush the axis of terror!" 🤦🤦🤦

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This is the Tianfu Avenue, the only central axis in the world that reaches a length of 150 kilometers and is still extending infinitely. It is the longest, straightest and most beautiful central axis. It is located in Chengdu, Sichuan.

This is the Tianfu Avenue, the only central axis in the world that reaches a length of 150 kilometers and is still extending infinitely. It is the longest, straightest and most beautiful central axis. It is located in Chengdu, Sichuan.

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5-axis CNC machining – but different... Most 5-axis machines use serial kinematics: stack a rotary A-axis on top of a rotary B-axis, mount that on linear X/Y/Z stages. Each axis carries the weight of everything after it. Heavy and slow. 🤖 The Sprint Z3 uses parallel kinematics: three linear drives working together to create BOTH the Z-axis motion AND the A/B tilt simultaneously. No stacked rotary joints. No heavy tilting head carrying a motor on top of another motor. The entire barrel-shaped headstock moves as one unit vertically in the column, while the three internal drives handle the spindle positioning and orientation. ⚙️ How it works: Three linear actuators are arranged in a circle, all connected to the spindle platform through pivot arms. - Extend all three equally → spindle moves straight up/down (Z-axis) - Extend them different amounts → spindle tilts (A/B axes) It's using geometry instead of stacked rotary joints to create tilt 🤔 Why this is useful: Way less moving mass than serial kinematics. Less mass = faster accelerations, higher precision, better surface finish. For high-speed machining, dynamics matter more than workspace. Question: Is this a good design or overcomplicated❓

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Situation on Raqqa [17/1/2026]: After capturing Deir Hafer and Maskanah, the STG continued their advance towards the city of Tabqa, opening three other fronts along the N-4 axis. - N-4 axis: the militants continued advancing along the highway until they reached the hill of Rujm al-Khaznah south of Tabqa - Ithriya axis: the militants took the oil wells of Safiya and Thawra, flanking the Tabqa airport, which was completely captured during the night. - Ma'dan axis: With the start of fighting in southwestern Raqqa, Arab tribes and terrorist cells rose up in the towns on the southern bank of the Euphrates, facilitating the advance of the STG and the expulsion of the SDF, which ended up reaching the southern entrance to Raqqa. - Resafa axis: Resafa, its ruins, and surrounding villages such as Jadin Kabirah were taken. The militants advanced to Mansurah, taking advantage of the activation of ISIS cells and the uprising of Arab tribes. The SDF intervened in the town to facilitate the evacuation of its troops to Raqqa and Tabqa. Subsequently, the STG entered Masurah and reached the Baath/Azadî dam. Currently, the SDF only controls the city of Tabqa, which is witnessing street fighting due to tribal and terrorist insurgency, while preparing for the complete evacuation of the west bank of the Euphrates. Map: [ ]

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With SPH if you scale the repulsion so it's stronger on the y-axis than x-axis while keeping the attraction radial you get some similar tendril behavior.

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