How to manage the malposition of deep vein catheterization into the artery?

Central venous catheterization establishes temporary,efficient,and rapid use of deep venous access in patients,which provides high flow rate fluid perfusion,enables measurement of central venous pressure,and acts as an important reference for clinical decision-making.However,various complications such as pneumothorax,hemothorax,hematoma,and puncture failure can easily occur during the puncture and catheterization process.

Arthroplasty vs proximal femoral nails for unstable intertrochanteric femoral fractures in elderly patients: a systematic review and metaanalysis

BACKGROUND Proximal femoral nails(PFNs)are the most common method for the treatment of unstable intertrochanteric femoral fractures(IFFs),but postoperative bed rest is required.There is a large amount of blood loss during the operation.Osteoporosis in elderly patients may cause nonunion of fractures and other complications.Arthroplasty can give patients early weight bearing and reduce financial burden,but whether it can replace PFNs remains controversial.AIM To compare the clinical outcomes of arthroplasty and PFNs in the treatment of unstable IFFs in elderly patients.METHODS A search was conducted in the PubMed,Embase,and Cochrane Library databases and included relevant articles comparing arthroplasty and PFN.The search time was limited from January 1,2005 to November 1,2020.Two investigators independently screened studies,extracted data and evaluated the quality according to the inclusion and exclusion criteria.According to the research results,the fixed effect model or random effect model were selected for analysis.The following outcomes were analyzed:Harris Hip score,mortality,complications,operation time,blood loos,hospital stay,weight-bearing time,fracture classification and type of anesthesia.RESULTS We analyzed four randomized controlled trials that met the requirements.A total of 298 patients were included in these studies.According to the AO/OTA classification,there are 20 A1 types,136 A2 types,42 A3 types and 100 unrecorded types.Primary outcome:The Harris Hip Score at the final follow-up of the PFN group was higher[mean difference(MD):9.01,95%confidence interval(CI):16.57 to 1.45),P=0.02].There was no significant difference between the two groups in the rate of overall mortality[risk ratio(RR):1.44,P=0.44]or the number of complications(RR:0.77,P=0.05).Secondary outcomes:blood loss of the arthroplasty group was higher(MD:241.01,95%CI:43.06–438.96,P=0.02);the operation time of the PFN group was shorter(MD:23.12,95%CI:10.46–35.77,P=0.0003);and the length of hospital stay of the arthroplasty group was shorter[MD:0.97,95%CI:1.29 to 0.66),P<0.00001].There was no difference between the two groups in the type of anesthesia(RR:0.99).There were only two studies recording the weight-bearing time,and the time of full weight bearing in the arthroplasty group was significantly earlier.CONCLUSION Compared with PFN,arthroplasty can achieve weight bearing earlier and shorten hospital stay,but it cannot achieve a better clinical outcome.Arthroplasty cannot replace PFNs in the treatment of unstable IFFs in elderly individuals.

Effect of synoviectomy combined with postoperative radiotherapy on pigmented villonodular synovitis in knee:A meta-analysis

Objective:To evaluate the efficacy of synovectomy combined with postoperative radiotherapy in the treatment of pigmented villonodular synovitis compared with only synovectomy in knee. Methods:The related references were searched from SinoMed,CNKI,Wanfang,VIP,PubMed,Embase,Cochrane Library and Web of Science from date of databases establishment to October 2020,and the studies of synovectomy combined with postoperative radiotherapy were screened. According to the type of research,the corresponding evaluation methods were selected for quality evaluation of the literature. RevMan 5.3 software was used for meta-analysis. The primary outcome was recurrence,while the secondary outcomes included complications,excellent and good rate of function of knee,range of motion of knee,Lysholm score,and IKDC score of knee etcetera. Results:A total of 11 articles were included in meta-analysis,with 510 cases,280 in the combined group and 230 in the control group. The results of meta-analysis showed that:(1)The recurrence rate in the combination group was significantly lower than that in the control group,[OR=0.33,95%CI(0.20,0.55),P<0.000 1];(2)The complications in the combined group were higher than that in the control group[OR=2.70,95%CI(1.16,6.31),P=0.02];(3)The excellent and good rate of the combined group was significantly better than that of the control group[OR=2.86,95%CI(1.23,6.64),P=0.01],and it also may be the result of different evaluation criteria of each study;(4)There was no significant difference range of motion[MD=2.96,95%CI(-0.54,6.47),P=0.10],Lysholm score[MD=3.22,95%CI(-0.51,6.96),P=0.09],or IKDC score[MD=2.88,95%CI(-1.07,6.82),P=0.15]in knee between the two groups. Conclusion:The meta-analysis shows that synovectomy combined with radiotherapy can reduce the recurrence rate of pigmented villonodular synovitis in knee,but compared with only operation,there are higher complications. However,the above conclusions need to be verified by long-term follow-up of more high-quality clinical studies.

Melanization induced by Heliothis virescens ascovirus 3h promotes viral replication

Melanization is an important innate immune defense mechanism of insects,which can kill invading pathogens.Most pathogens,for their survival and reproduction,inhibit the melanization of the host.Interestingly,our results suggested that after infection with Heliothis virescens ascovirus 3h(HvAV-3h),the speed of melanization in infected Spodoptera exigiia larval hemolymph was accelerated and that the phenoloxidase(PO)activity of hemolymph in larvae infected with HvAV-3h increased significantly(1.20-fold at 96 hpi,1.52-fold at 120 hpi,1.23-fold at 144 hpi,1.12-fold at 168 hpi).The transcription level of the gene encoding S.exigua prophenoloxidase-1(SePPO-1 gene)was upregulated dramatically in the fat body during the middle stage of infection.In addition,when melanization was inhibited or promoted,the replication of HvAV-3h was inhibited or promoted,respectively.In conclusion,infection with HvAV-3h can markedly induce melanization in the middle stage of infection,and melanization is helpful for HvAV-3h viral replication.

Theoretical study on hydrogen evolution reaction in transition metal borides

Given increasing energy demands and environmental pollution,it is highly desirable to design new hydrogen evolution reaction(HER)catalysts.In this study,we have performed high throughput screening of transition-metal borides(M2B)and Janus counterparts for appealing catalysts.The simulations showcase that the Pd_(2)B,PdPtB,PdIrB and PdAuB possess favorable HER performance with the different chemical nature and unique asymmetry structure.

Identification of four caspase genes from Spodoptera exigua (Lepidoptera: Noctuidae) and their regulations toward different apoptotic stimulations

Apoptosis plays critical roles in multiple biological processes in multicellular organisms.Caspases are known as important participators and regulators of apoptosis.Here,four novel caspase genes of Spodoptera exigua were cloned and characterized which were designated as SeCasp-1,SeCasp-6,ScCasp-7 and SeCasp-S.Analysis of the putative encoded protein sequences of these SeCasps indicated that SeCasp-1 and ScCasp-7 were possible homologs of executor caspases;SeCasp-8 was a possible homolog of initiator caspases;and SeCasp-6 was a unique caspase of S.exigua that shares low similarity with all the identified insect caspases.Based on baculovirus expression system analyses,SeCasp-1 exhibited similar caspase activity to human caspase-1,-3,-4,-6,-8 and-9;SeCasp-6 presented similar caspase activity to human caspase-2,-3,-4,-6,-8 and-9;SeCasp-7 exhibited similar caspase activity to human caspase-2,-3 and-6;and SeCasp-8 presented similar caspase activity only to human caspase-8.Induction with diiTcrent chemicals revealed that SeCasp-1 showed extreme upregulation after 24 h in the treated fat body cell line(IOZCAS-Spex-II)of S.exigua.Developmental expression analysis revealed that SeCasp-1 was highly transcribed in the larval stages,while SeCasp-6,SeCasp-7,SeCasp-H were down-regulated.The in vivo detection of the relative expression levels of SeCasps in S.eixgua larvae inoculated with different pathogens suggested that SeCasp-J was sensitive to Bacillus thuringiensis infection and that SeCasp-6 was sensitive to baculovirus infection.SeCasp-7 and SeCasp-H showed slight changes under either in vitro chemical apoptosis induction or in vivo pathogen infection.

Novel strategies for the biocontrol of noctuid pests(Lepidoptera)based on improving ascovirus infectivity using Bacillus thuringiensis

ldentifying novel biocontrol agents and developing new strategies are urgent goals in insect pest biocontrol.Ascoviruses are potential competent insect viruses that may be developed into bioinsecticides,but this aim is impeded by their poor oral infectivity.To improve the per os infectivity of ascovirus,Bacillus thuringiensis kurstaki(Btk)was employed as a helper to damage the midgut of lepidopteran larvae(Helicoverpa armigera,Mythimna separata,Spodoptera frugiperda,and S.litura)in formulations with Heliothis virescens ascovirus isolates(HvAV-3h and HvAV-3j).Btk and ascovirus mixtures(Btk/HvAV-3h and B1k/HvAV-3j)were fed to insect larvae(3rd instar).With the exception of S.frugiperda larvae,which exhibited low mortality after ingesting Btk,the larvae of the other tested species showed three types of response to feeding on the formulas:type I,the tested larvae(H.armigera)were killed by Btk infection so quickly that insufficient time and resources remained for ascoviral invasion;type II,both Btk and the ascovirus were depleted by their competition,such that neither was successfully released or colonized the tissue;type II,Btk was eliminated by the ascovirus,and the ascovirus achieved systemic infection in the tested larvae.The feeding of Btk/ascovirus formulas led to a great reduction in larval diet consumption and resulted in a significant decrease in the emergence rate of H.armigera,M.separata,and S.litura larvae,which suggested that the formulas exerted marked oral control effects on both the contemporary individuals and the next generation of these tested pest species.