Central venous catheterization(CVC) is an invasive procedure for administering fluids,nutrients,and drugs;monitoring central venous pressure;performing pulmonary artery catheterization;and placing transvenous pacemake...Central venous catheterization(CVC) is an invasive procedure for administering fluids,nutrients,and drugs;monitoring central venous pressure;performing pulmonary artery catheterization;and placing transvenous pacemakers in intensive care units and all specialties,from anesthesia to emergency medicine,for the treatment of trauma and hemodynamically unstable pediatric and adult patients.[1,2]Complications have been observed in more than 15% of patients who underwent CVC.Mechanical,infectious,and thrombotic complications have been reported in 5%–19%,5%–26%,and 2%–26% of patients,respectively.[3] Malposition,on the other hand,is common in subclavian catheter insertion and is usually associated with an initially misplaced guidewire.[4]展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neona...BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neonates.The available evidence about PICC-related thrombosis was manifold,but the cardiac tamponade,an emergency and life-threatening complication,has been rarely reported.Early recognized cardiac tamponade by ultrasound may reduce mortality.CASE SUMMARY A neonate weighting 2.8 kg was born at 40 wk of gestation.He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon.A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition.Three days later,the patient was still on total parenteral nutrition.Cardiac tamponade caused by PICC was found on ultrasound.The patient recovered spontaneously after an emergency pericardiocentesis.CONCLUSION Proficiency in the use of point-of-care ultrasound may save the life of patients,since it enables clinicians to treat patients faster,more accurately,and in a noninvasive way at the point of care.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombo...BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression between the thrombosis group and the non-thrombosis group.Other aspects had no statistically significant differences(P>0.05).Multivariate regression analysis showed that age≥60 years,KPS score≤50 points,parenteral nutrition,stage III to IV,distant metastasis,bone marrow suppression,and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer(P<0.05).Catheter duration of 1-6 months and catheter duration>6 months were protective factors for PICC-related thrombosis(P<0.05).The predictive model for PICC-related thrombosis was obtained as follows:P predictive probability=[exp(Logit P)]/[1+exp(Logit P)],where Logit P=age×1.907+KPS score×2.045+parenteral nutrition×9.467+catheter duration×0.506+tumor-node-metastasis(TNM)staging×2.844+distant metastasis×2.065+bone marrow suppression×2.082+activities of daily living impairment×13.926.ROC curve analysis showed an area under the curve(AUC)of 0.827(95%CI:0.724-0.929,P<0.001),with a corresponding optimal cut-off value of 0.612,sensitivity of 0.755,and specificity of 0.857.Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence(P>0.05).ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets,respectively.CONCLUSION Age,KPS score,parenteral nutrition,TNM staging,distant metastasis,bone marrow suppression,and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer,while catheter duration is a protective factor for the disease.The predictive model has an AUC of 0.827,indicating high predictive accuracy and clinical value.展开更多
BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients...BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.展开更多
The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricu...The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.展开更多
Let G be a graph, the square graph G 2 of G is a graph satisfying V(G 2)=V(G) and E(G 2)=E(G)∪{uv: dist G(u, v)=2} . In this paper, we use the technique of vertex insertion on l -connected ( l=k or k...Let G be a graph, the square graph G 2 of G is a graph satisfying V(G 2)=V(G) and E(G 2)=E(G)∪{uv: dist G(u, v)=2} . In this paper, we use the technique of vertex insertion on l -connected ( l=k or k+1, k≥2 ) claw-free graphs to provide a unified proof for G to be Hamiltonian, 1 -Hamiltonian or Hamiltonian-connected. The sufficient conditions are expressed by the inequality concerning ∑ k i=0N(Y i) and n(Y) in G for each independent set Y={y 0, y 1, …, y k} of the square graph of G , where b ( 0<b<k+1 ) is an integer, Y i={y i, y i-1, …, y i-(b-1)}Y for i∈{0, 1, …, k} , where subscriptions of y j s will be taken modulo k+1 , and n(Y)={v∈ V(G): dist (v, Y)≤ 2} .展开更多
Currently, the modeling of cutting process mainly focuses on two aspects: one is the setup of the universal cutting force model that can be adapted to a broader cutting condition; the other is the setup of the exact c...Currently, the modeling of cutting process mainly focuses on two aspects: one is the setup of the universal cutting force model that can be adapted to a broader cutting condition; the other is the setup of the exact cutting force model that can accurately reflect a true cutting process. However, there is little research on the prediction of chatter stablity in milling. Based on the generalized mathematical model of inserted cutters introduced by ENGIN, an improved geometrical, mechanical and dynamic model for the vast variety of inserted cutters widely used in engineering applications is presented, in which the average directional cutting force coefficients are obtained by means of a numerical approach, thus leading to an analytical determination of stability lobes diagram (SLD) on the axial depth of cut. A new kind of SLD on the radial depth of cut is also created to satisfy the special requirement of inserted cutter milling. The corresponding algorithms used for predicting cutting forces, vibrations, dimensional surface finish and stability lobes in inserted cutter milling under different cutting conditions are put forward. Thereafter, a dynamic simulation module of inserted cutter milling is implemented by using hybrid program of Matlab with Visual Basic. Verification tests are conducted on a vertical machine center for Aluminum alloy LC4 by using two different types of inserted cutters, and the effectiveness of the model and the algorithm is verified by the good agreement of simulation result with that of cutting tests under different cutting conditions. The proposed model can predict the cutting process accurately under a variety of cutting conditions, and a high efficient and chatter-free milling operation can be achieved by a cutting condition optimization in industry applications.展开更多
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.展开更多
Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages a...Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages as the female is under anesthesia so no extra manipulation needed, decrease pain, and also the female at the period of delivery had high motive for family planning. Post placental IUD insertion also had many disengages like bleeding and displacement. Material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to May 31 2019. Two groups of patients were selected;each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion during cesarean section and group II was subjected to interval IUD insertion (3 months after cesarean delivery). The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 12 months was 13.72% in study group compared to 16.66% in the control group. The satisfaction rates in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 1.96% in study group and 4.17% in control group with p value = 0.949. Conclusion: Post-placental IUD insertion is found to be safe, easily applied during cesarean section with slight prolongation of cesarean section duration. Post-placental IUD insertion is also effective, with few complications compared to interval IUD insertion. This modality of insertion was accepted by the great majority of patients being painless and at the same time of surgery with no added cost or maneuver and utilizing the enthusiasm of patients for immediate contraception. The continuation rates are good in the study follow up duration.展开更多
The microstructure and mechanical properties of cast inserted dies for automobile covering components were studied. The results show that the as-cast microstructures of cast inserted dies are composed of pearlite, mar...The microstructure and mechanical properties of cast inserted dies for automobile covering components were studied. The results show that the as-cast microstructures of cast inserted dies are composed of pearlite, martensite, bainite, and austenite; and that the annealed microstructure is granular pearlite. The mechanical properties of cast inserted dies approach that of forged inserted dies. The tensile strength is 855 MPa, the elongation is 16%, the impact toughness is 177 J/cm2, and the hardness after annealing and quenching are HRC 19 and HRC 60-62. In addition, the cast inserted dies have good hardenability. The depth of the hardening zone and the hardness after flame quenching satisfy the operating requirements. The cast inserted dies could completely replace the forged inserted dies for making the dies of automobile covering components.展开更多
Implant insertion is an alternative to classical treatment with bridges after tooth extraction or traumatic tooth loss in the anterior and premolar region of the upper and lower jaw. Nevertheless both types of prosthe...Implant insertion is an alternative to classical treatment with bridges after tooth extraction or traumatic tooth loss in the anterior and premolar region of the upper and lower jaw. Nevertheless both types of prosthetic treatment inhere major gingival aesthetic pitfalls by physiological vertical and horizontal resorption. Aim of the study was to investigate if the immediate insertion of root analogue single-stage implants and prosthetic treatment could prevent gingival recessions and bone resorption thus keeping the natural gingival aesthetics untouched. Between 2003 and 2006, 348 root analogue Q1-Implants (TRINON Karlsruhe GmbH/Germany) were inserted in 342 patients’s premolar and molar regions immediately after tooth extraction or traumatic tooth loss and treated with provisional resin crowns. The observation period with recurring 6-month clinical and radiographic check-ups was a minimum of 5 years. Of 348 inserted implants 4 (1.15%) were lost resulting in an overall success rate of 98.85%. In the first 12 weeks after surgery a mean recession of the buccal gingival margin of 0.2 mm (SD 0.34) could be detected, after final prosthetic treatment an overall mean recession of 0.2 mm (SD 0.13) within the survey period. Immediate implant insertion of root analogue single stage implants and immediate prosthetic treatment with provisional resin crowns after minimal invasive tooth extraction seems to be appropriate to prevent bone resorptions of the buccal alveolar crest and the recessions of the gingiva and papillae and thus suggests to be the preferable treatment to keep the natural gingival and papillary aesthetics untouched preventing further traumatic surgical gingival reconstructions.展开更多
The impacts of HfOx inserting layer thickness on the electrical properties of the ZnO-based transparent resistance random access memory (TRRAM) device were investigated in this paper. The bipolar resistive switching...The impacts of HfOx inserting layer thickness on the electrical properties of the ZnO-based transparent resistance random access memory (TRRAM) device were investigated in this paper. The bipolar resistive switching behavior of a single ZnO film and bilayer HfOx/ZnO films as active layers for TRRAM devices was demonstrated. It was revealed that the bilayer TRRAM device with a 10-nm HfOx inserted layer had a more stable resistive switching behavior than other devices including the single layer device, as well as being forming free, and the transmittance was more than 80% in the visible region. For the HfOx/ZnO devices, the current conduction behavior was dominated by the space-charge-limited current mechanism in the low resistive state (LRS) and Schottky emission in the high resistive state (HRS), while the mechanism for single layer devices was controlled by ohmic conduction in the LRS and Poole-Frenkel emission in the HRS.展开更多
BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often ac...BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often accompanied by arteries;thus,it is easy to mistakenly enter the artery.CASE SUMMARY The case of an extremely premature infant(born at gestational age 28+3)in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported.On the 19th day of hospitalization,the index finger,middle finger and ring finger of the left hand were rosy,the left radial artery and brachial artery pulse were palpable,the recovery was 95%,and the improvement was obvious.At discharge 42 d after admission,there was no abnormality in fingertip activity during the follow-up period.CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2%nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb.Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.展开更多
We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of ch...We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of chemotherapeutic agents administered. In this case report, we review the literatures for the underlying pathophysiology of this uncommon phenomenon. IV nurses should consider the possibility of the infusion dysfunction deriving from the PICC line fractured. Accurate tip catheter placement and specific care may reduce morbidity.展开更多
Dear Editor,Clustered Regularly Interspaced Short Palindromic Repeats(CRISPR)is a powerful and versatile gene editing system that has been extensively utilized in various animals and plants,which holds enormous potent...Dear Editor,Clustered Regularly Interspaced Short Palindromic Repeats(CRISPR)is a powerful and versatile gene editing system that has been extensively utilized in various animals and plants,which holds enormous potential and value for scientific research and breeding.However,single-targeted CRISPR can only induce a few base deletions,insertions,or substitution.Ideally,thesemutations result in premature termination of the protein encoded by the target gene,leading to a loss of function[1].展开更多
Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemot...Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy.Methods:The data of the incidence,diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August,2009 to September,2011 were analyzed retrospectively.Results:216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days,(median catheterization duration,88.9 days,range 1-212 days).Among those,3(1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29,73 and 108 catheter-days(median 70 d),with a rate of 0.16 per 1000 catheter-days.Conclusion:Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible.Careful observation of relevant symptoms and signs,early diagnosis and treatment,not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.展开更多
Catheter fracture is a rare but serious complication of a peripherally inserted central catheter (PICC). An adolescent patient was sent to Tianjin Medical University General Hospital (Tianjin, China) because the P...Catheter fracture is a rare but serious complication of a peripherally inserted central catheter (PICC). An adolescent patient was sent to Tianjin Medical University General Hospital (Tianjin, China) because the PICC was fractured when removed by a nurse. Chest X-ray showed that the PICC fragment slid into the right pulmonary artery. Through emergency surgery, the remainder of the PICC was successfully retrieved by an interventional operation percutaneously via the right femoral vein. PICC fracture is less common and always without significant discomfort if not found timely, and it may lead to serious complications, such as pulmonary embolism, and even death. Thus, nurses, patients and their family members should pay enough attention to the daily maintenance of PICC and have a deep understanding of the reasons associated with PICC fracture as well as how to prevent it. Interventional operation is minimally invasive, which is a good choice for the removal of intravascular foreign bodies, leading to fewer complications and a good prognosis.展开更多
Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, ...Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. We have seen a successful reduction in Central line associated bloodstream infection related the past decade. In spite of this, Intensive care unit-Catheter related bloodstream infections remain high. The emergence of new pathogens further complicates treatment and threatens patient outcomes in this context. In addition, the SARS-CoV-2 (COVID-19) pandemic served as a reminder that an emerging pathogen poses a challenge for adjusting prevention measures regarding both the risk of exposure to caregivers and maintaining a high level of care. ICU nurses play an important role in the prevention and management of CLABSI as they are involved in basic hygienic care, quality improvement initiatives, microbiological sampling, and aspects of antimicrobial stewardship. Microbiological techniques that are more sensitive and our increased knowledge of the interactions between critically ill patients and their microbiota are forcing us to rethink how we define CLABSIs and how we can diagnose, treat, and prevent them in the ICU. The objective of this multidisciplinary expert review, focused on the ICU setting, is to summarize the recently observed occurrence of CLABSI in ICU, to consider the role of modern microbiological techniques in their diagnosis, to examine clinical and epidemiological definitions, and to redefine several controversial preventive measures including antimicrobial-impregnated catheters, chlorhexidine-gluconate impregnated sponge, and catheter dressings.展开更多
BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdo...BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis(PD)insertion.CASE SUMMARY A 37-year-old woman was surgically placed a Tenckhoff catheter because of endstage renal disease.On the third postoperative day,the color of the abdominal drainage fluid was pink,and deepened gradually.It turned pale after initiating conservative treatment.On the tenth postoperative day,the color of the abdominal drainage fluid suddenly turned dark red,and the color progressively deepened.The patient’s hemoglobin dropped from 88 g/L to 57 g/L.Abdominal computed tomography(CT)indicated abdominal effusion and a high-density shadow in the abdominal cavity.The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed.The gynecologist repaired the ovary and performed a bilateral oophoroplasty.After the operation,the patient stopped bleeding and hemodialysis was temporarily stopped.PD was resumed after half a month.The patient’s condition improved,and she was discharged 14 d after the laparotomy.CONCLUSION If abdominal hemorrhage occurs in women of childbearing age after PDC insertion,luteal rupture should be considered as the cause.展开更多
文摘Central venous catheterization(CVC) is an invasive procedure for administering fluids,nutrients,and drugs;monitoring central venous pressure;performing pulmonary artery catheterization;and placing transvenous pacemakers in intensive care units and all specialties,from anesthesia to emergency medicine,for the treatment of trauma and hemodynamically unstable pediatric and adult patients.[1,2]Complications have been observed in more than 15% of patients who underwent CVC.Mechanical,infectious,and thrombotic complications have been reported in 5%–19%,5%–26%,and 2%–26% of patients,respectively.[3] Malposition,on the other hand,is common in subclavian catheter insertion and is usually associated with an initially misplaced guidewire.[4]
文摘BACKGROUND Peripherally inserted central catheters(PICCs)have been increasingly applied worldwide owing to many advantages.Even with these advantages,the related complications should not be ignored,especially in neonates.The available evidence about PICC-related thrombosis was manifold,but the cardiac tamponade,an emergency and life-threatening complication,has been rarely reported.Early recognized cardiac tamponade by ultrasound may reduce mortality.CASE SUMMARY A neonate weighting 2.8 kg was born at 40 wk of gestation.He was admitted to the Surgery Intensive Care Unit due to suspected congenital megacolon.A PICC line was inserted via the left antecubital fossa for the administration of total parenteral nutrition.Three days later,the patient was still on total parenteral nutrition.Cardiac tamponade caused by PICC was found on ultrasound.The patient recovered spontaneously after an emergency pericardiocentesis.CONCLUSION Proficiency in the use of point-of-care ultrasound may save the life of patients,since it enables clinicians to treat patients faster,more accurately,and in a noninvasive way at the point of care.
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are commonly used in hospitalized patients with liver cancer for the administration of chemotherapy,nutrition,and other medications.However,PICC-related thrombosis is a serious complication that can lead to morbidity and mortality in this patient population.Several risk factors have been identified for the development of PICC-related thrombosis,including cancer type,stage,comorbidities,and catheter characteristics.Understanding these risk factors and developing a predictive model can help healthcare providers identify high-risk patients and implement preventive measures to reduce the incidence of thrombosis.AIM To analyze the influencing factors of PICC-related thrombosis in hospitalized patients with liver cancer,construct a predictive model,and validate it.METHODS Clinical data of hospitalized patients with liver cancer admitted from January 2020 to December 2023 were collected.Thirty-five cases of PICC-related thrombosis in hospitalized patients with liver cancer were collected,and 220 patients who underwent PICC placement during the same period but did not develop PICC-related thrombosis were randomly selected as controls.A total of 255 samples were collected and used as the training set,and 77 cases were collected as the validation set in a 7:3 ratio.General patient information,case data,catheterization data,coagulation indicators,and Autar Thrombosis Risk Assessment Scale scores were analyzed.Univariate and multivariate unconditional logistic regression analyses were performed on relevant factors,and the value of combined indicators in predicting PICC-related thrombosis in hospitalized patients with liver cancer was evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Univariate analysis showed statistically significant differences(P<0.05)in age,sex,Karnofsky performance status score(KPS),bedridden time,activities of daily living impairment,parenteral nutrition,catheter duration,distant metastasis,and bone marrow suppression between the thrombosis group and the non-thrombosis group.Other aspects had no statistically significant differences(P>0.05).Multivariate regression analysis showed that age≥60 years,KPS score≤50 points,parenteral nutrition,stage III to IV,distant metastasis,bone marrow suppression,and activities of daily living impairment were independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer(P<0.05).Catheter duration of 1-6 months and catheter duration>6 months were protective factors for PICC-related thrombosis(P<0.05).The predictive model for PICC-related thrombosis was obtained as follows:P predictive probability=[exp(Logit P)]/[1+exp(Logit P)],where Logit P=age×1.907+KPS score×2.045+parenteral nutrition×9.467+catheter duration×0.506+tumor-node-metastasis(TNM)staging×2.844+distant metastasis×2.065+bone marrow suppression×2.082+activities of daily living impairment×13.926.ROC curve analysis showed an area under the curve(AUC)of 0.827(95%CI:0.724-0.929,P<0.001),with a corresponding optimal cut-off value of 0.612,sensitivity of 0.755,and specificity of 0.857.Calibration curve analysis showed good consistency between the predicted occurrence of PICC-related thrombosis and actual occurrence(P>0.05).ROC analysis showed AUCs of 0.888 and 0.729 for the training and validation sets,respectively.CONCLUSION Age,KPS score,parenteral nutrition,TNM staging,distant metastasis,bone marrow suppression,and activities of daily living impairment are independent risk factors for PICC-related thrombosis in hospitalized patients with liver cancer,while catheter duration is a protective factor for the disease.The predictive model has an AUC of 0.827,indicating high predictive accuracy and clinical value.
基金the Chongqing Medical Scientific Research Project(a joint project of the Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX046。
文摘BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.
文摘The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.
文摘Let G be a graph, the square graph G 2 of G is a graph satisfying V(G 2)=V(G) and E(G 2)=E(G)∪{uv: dist G(u, v)=2} . In this paper, we use the technique of vertex insertion on l -connected ( l=k or k+1, k≥2 ) claw-free graphs to provide a unified proof for G to be Hamiltonian, 1 -Hamiltonian or Hamiltonian-connected. The sufficient conditions are expressed by the inequality concerning ∑ k i=0N(Y i) and n(Y) in G for each independent set Y={y 0, y 1, …, y k} of the square graph of G , where b ( 0<b<k+1 ) is an integer, Y i={y i, y i-1, …, y i-(b-1)}Y for i∈{0, 1, …, k} , where subscriptions of y j s will be taken modulo k+1 , and n(Y)={v∈ V(G): dist (v, Y)≤ 2} .
基金supported by Hunan Provincial Natural Science Foundation of China (Grant Nos. 10JJ2040, 11JJ3055)National Major Science and Technology Special Projects of China (Grant No.2012ZX04011-011)+1 种基金Postdoctoral Science Funded Project of China (GrantNo. 20110490261)Hunan Provincial 12th Five-year Plan Key Disciplines of China (Grant No. 2012-42)
文摘Currently, the modeling of cutting process mainly focuses on two aspects: one is the setup of the universal cutting force model that can be adapted to a broader cutting condition; the other is the setup of the exact cutting force model that can accurately reflect a true cutting process. However, there is little research on the prediction of chatter stablity in milling. Based on the generalized mathematical model of inserted cutters introduced by ENGIN, an improved geometrical, mechanical and dynamic model for the vast variety of inserted cutters widely used in engineering applications is presented, in which the average directional cutting force coefficients are obtained by means of a numerical approach, thus leading to an analytical determination of stability lobes diagram (SLD) on the axial depth of cut. A new kind of SLD on the radial depth of cut is also created to satisfy the special requirement of inserted cutter milling. The corresponding algorithms used for predicting cutting forces, vibrations, dimensional surface finish and stability lobes in inserted cutter milling under different cutting conditions are put forward. Thereafter, a dynamic simulation module of inserted cutter milling is implemented by using hybrid program of Matlab with Visual Basic. Verification tests are conducted on a vertical machine center for Aluminum alloy LC4 by using two different types of inserted cutters, and the effectiveness of the model and the algorithm is verified by the good agreement of simulation result with that of cutting tests under different cutting conditions. The proposed model can predict the cutting process accurately under a variety of cutting conditions, and a high efficient and chatter-free milling operation can be achieved by a cutting condition optimization in industry applications.
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
文摘Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section. Background: IUD could be applied to the female after delivery of placenta during cesarean section, it had many advantages as the female is under anesthesia so no extra manipulation needed, decrease pain, and also the female at the period of delivery had high motive for family planning. Post placental IUD insertion also had many disengages like bleeding and displacement. Material and methods: A randomized controlled study was conducted at tertiary care hospital (Tanta University Hospital) in the period from Jan, 1, 2017 to May 31 2019. Two groups of patients were selected;each group included 60 patients with desire of birth control. The group I was subjected to post-placental intrauterine device (IUD) insertion during cesarean section and group II was subjected to interval IUD insertion (3 months after cesarean delivery). The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: The demographic data were comparable in both groups. The duration of cesarean surgery was slightly prolonged in the study group. The infection, puerperal bleeding, and displacement of IUDs were not significantly different in both groups. The discontinuation rate after 12 months was 13.72% in study group compared to 16.66% in the control group. The satisfaction rates in both groups were 90.20%, 91.67% in study and control groups respectively. The expulsion rates were 3.92% and 0.00% in the study and control groups respectively. Pregnancy on top of IUD was 1.96% in study group and 4.17% in control group with p value = 0.949. Conclusion: Post-placental IUD insertion is found to be safe, easily applied during cesarean section with slight prolongation of cesarean section duration. Post-placental IUD insertion is also effective, with few complications compared to interval IUD insertion. This modality of insertion was accepted by the great majority of patients being painless and at the same time of surgery with no added cost or maneuver and utilizing the enthusiasm of patients for immediate contraception. The continuation rates are good in the study follow up duration.
文摘The microstructure and mechanical properties of cast inserted dies for automobile covering components were studied. The results show that the as-cast microstructures of cast inserted dies are composed of pearlite, martensite, bainite, and austenite; and that the annealed microstructure is granular pearlite. The mechanical properties of cast inserted dies approach that of forged inserted dies. The tensile strength is 855 MPa, the elongation is 16%, the impact toughness is 177 J/cm2, and the hardness after annealing and quenching are HRC 19 and HRC 60-62. In addition, the cast inserted dies have good hardenability. The depth of the hardening zone and the hardness after flame quenching satisfy the operating requirements. The cast inserted dies could completely replace the forged inserted dies for making the dies of automobile covering components.
文摘Implant insertion is an alternative to classical treatment with bridges after tooth extraction or traumatic tooth loss in the anterior and premolar region of the upper and lower jaw. Nevertheless both types of prosthetic treatment inhere major gingival aesthetic pitfalls by physiological vertical and horizontal resorption. Aim of the study was to investigate if the immediate insertion of root analogue single-stage implants and prosthetic treatment could prevent gingival recessions and bone resorption thus keeping the natural gingival aesthetics untouched. Between 2003 and 2006, 348 root analogue Q1-Implants (TRINON Karlsruhe GmbH/Germany) were inserted in 342 patients’s premolar and molar regions immediately after tooth extraction or traumatic tooth loss and treated with provisional resin crowns. The observation period with recurring 6-month clinical and radiographic check-ups was a minimum of 5 years. Of 348 inserted implants 4 (1.15%) were lost resulting in an overall success rate of 98.85%. In the first 12 weeks after surgery a mean recession of the buccal gingival margin of 0.2 mm (SD 0.34) could be detected, after final prosthetic treatment an overall mean recession of 0.2 mm (SD 0.13) within the survey period. Immediate implant insertion of root analogue single stage implants and immediate prosthetic treatment with provisional resin crowns after minimal invasive tooth extraction seems to be appropriate to prevent bone resorptions of the buccal alveolar crest and the recessions of the gingiva and papillae and thus suggests to be the preferable treatment to keep the natural gingival and papillary aesthetics untouched preventing further traumatic surgical gingival reconstructions.
基金Project supported by the National Key Research and Development Program of China(Grant No.2017yfb0405600)the National Natural Science Foundation of China(Grant Nos.61404091,61274113,61505144,51502203,and 51502204)the Natural Science Foundation of Tianjin City(Grant Nos.17JCYBJC16100 and 17JCZDJC31700)
文摘The impacts of HfOx inserting layer thickness on the electrical properties of the ZnO-based transparent resistance random access memory (TRRAM) device were investigated in this paper. The bipolar resistive switching behavior of a single ZnO film and bilayer HfOx/ZnO films as active layers for TRRAM devices was demonstrated. It was revealed that the bilayer TRRAM device with a 10-nm HfOx inserted layer had a more stable resistive switching behavior than other devices including the single layer device, as well as being forming free, and the transmittance was more than 80% in the visible region. For the HfOx/ZnO devices, the current conduction behavior was dominated by the space-charge-limited current mechanism in the low resistive state (LRS) and Schottky emission in the high resistive state (HRS), while the mechanism for single layer devices was controlled by ohmic conduction in the LRS and Poole-Frenkel emission in the HRS.
文摘BACKGROUND Extremely premature infants have poor vascular conditions.Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters,and these vessels are often accompanied by arteries;thus,it is easy to mistakenly enter the artery.CASE SUMMARY The case of an extremely premature infant(born at gestational age 28+3)in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported.On the 19th day of hospitalization,the index finger,middle finger and ring finger of the left hand were rosy,the left radial artery and brachial artery pulse were palpable,the recovery was 95%,and the improvement was obvious.At discharge 42 d after admission,there was no abnormality in fingertip activity during the follow-up period.CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2%nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb.Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.
文摘We report a case of a 7-year-old child who received a peripherally inserted central catheter (PICC) for chemotherapy. He suffered from an unusual PICC fracture in vivo with pulmonary embolism after eight circles of chemotherapeutic agents administered. In this case report, we review the literatures for the underlying pathophysiology of this uncommon phenomenon. IV nurses should consider the possibility of the infusion dysfunction deriving from the PICC line fractured. Accurate tip catheter placement and specific care may reduce morbidity.
基金We thank Professor Pengcheng Wei of Anhui Agricultural University for his guidance on the experimental methods.This work was supported by the National Key Research and Development Program of China(Grant No.2022YFD2100101)the Joint NSFC-ISF Research Program(Grant No.32061143022)+1 种基金the 2115 Talent Development Program of China Agricultural University(Grant No.1061-00109017)to HZthe National Natural Science Foundation of China(Grant No.3217180159).
文摘Dear Editor,Clustered Regularly Interspaced Short Palindromic Repeats(CRISPR)is a powerful and versatile gene editing system that has been extensively utilized in various animals and plants,which holds enormous potential and value for scientific research and breeding.However,single-targeted CRISPR can only induce a few base deletions,insertions,or substitution.Ideally,thesemutations result in premature termination of the protein encoded by the target gene,leading to a loss of function[1].
文摘Objective:The aim of our research was to study the incidence,clinical diagnosis and treatment of peripherally inserted central catheters(PICC)-related sepsis in breast cancer patients carrying PICC catheter for chemotherapy.Methods:The data of the incidence,diagnosis and treatment of PICC-related sepsis in 215 cases of breast cancer patients carrying PICC catheter for chemotherapy in our hospital from August,2009 to September,2011 were analyzed retrospectively.Results:216 PICCs had been successfully applied in 215 cases of breast cancer patients and followed for a total of 19,109 catheter days,(median catheterization duration,88.9 days,range 1-212 days).Among those,3(1.39%) PICCs were removed respectively as a result of PICC-related sepsis in 29,73 and 108 catheter-days(median 70 d),with a rate of 0.16 per 1000 catheter-days.Conclusion:Chemotherapeutic treatment via PICC for breast cancer patients is one of the most secure and effective measures but there exists small number of cases in which PICC catheter related sepsis is possible.Careful observation of relevant symptoms and signs,early diagnosis and treatment,not relying completely on blood culture tests and timely removal of PICC catheter can be very effective in treating PICC-related sepsis in these patients.
文摘Catheter fracture is a rare but serious complication of a peripherally inserted central catheter (PICC). An adolescent patient was sent to Tianjin Medical University General Hospital (Tianjin, China) because the PICC was fractured when removed by a nurse. Chest X-ray showed that the PICC fragment slid into the right pulmonary artery. Through emergency surgery, the remainder of the PICC was successfully retrieved by an interventional operation percutaneously via the right femoral vein. PICC fracture is less common and always without significant discomfort if not found timely, and it may lead to serious complications, such as pulmonary embolism, and even death. Thus, nurses, patients and their family members should pay enough attention to the daily maintenance of PICC and have a deep understanding of the reasons associated with PICC fracture as well as how to prevent it. Interventional operation is minimally invasive, which is a good choice for the removal of intravascular foreign bodies, leading to fewer complications and a good prognosis.
文摘Background: Intensive care units (ICUs) have an increased risk of Central line associated bloodstream infection (CLABSI) due to the prevalence of invasive procedures, devices, immunosuppression, comorbidity, frailty, and elderly patients. We have seen a successful reduction in Central line associated bloodstream infection related the past decade. In spite of this, Intensive care unit-Catheter related bloodstream infections remain high. The emergence of new pathogens further complicates treatment and threatens patient outcomes in this context. In addition, the SARS-CoV-2 (COVID-19) pandemic served as a reminder that an emerging pathogen poses a challenge for adjusting prevention measures regarding both the risk of exposure to caregivers and maintaining a high level of care. ICU nurses play an important role in the prevention and management of CLABSI as they are involved in basic hygienic care, quality improvement initiatives, microbiological sampling, and aspects of antimicrobial stewardship. Microbiological techniques that are more sensitive and our increased knowledge of the interactions between critically ill patients and their microbiota are forcing us to rethink how we define CLABSIs and how we can diagnose, treat, and prevent them in the ICU. The objective of this multidisciplinary expert review, focused on the ICU setting, is to summarize the recently observed occurrence of CLABSI in ICU, to consider the role of modern microbiological techniques in their diagnosis, to examine clinical and epidemiological definitions, and to redefine several controversial preventive measures including antimicrobial-impregnated catheters, chlorhexidine-gluconate impregnated sponge, and catheter dressings.
文摘BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis(PD)insertion.CASE SUMMARY A 37-year-old woman was surgically placed a Tenckhoff catheter because of endstage renal disease.On the third postoperative day,the color of the abdominal drainage fluid was pink,and deepened gradually.It turned pale after initiating conservative treatment.On the tenth postoperative day,the color of the abdominal drainage fluid suddenly turned dark red,and the color progressively deepened.The patient’s hemoglobin dropped from 88 g/L to 57 g/L.Abdominal computed tomography(CT)indicated abdominal effusion and a high-density shadow in the abdominal cavity.The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed.The gynecologist repaired the ovary and performed a bilateral oophoroplasty.After the operation,the patient stopped bleeding and hemodialysis was temporarily stopped.PD was resumed after half a month.The patient’s condition improved,and she was discharged 14 d after the laparotomy.CONCLUSION If abdominal hemorrhage occurs in women of childbearing age after PDC insertion,luteal rupture should be considered as the cause.