Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.

Evaluation of hand infections in the emergency department using point-of-care ultrasound

BACKGROUND:We aimed to evaluate the utility of point-of-care ultrasound(POCUS)in the assessment of hand infections that present to the emergency department(ED)and its impact on medical decision making and patient management.METHODS:We conducted a retrospective review of patients who presented to two urban academic EDs with clinical presentations concerning for skin and soft tissue infections(SSTI)of the hand between December 2015 and December 2021.Two trained POCUS fellowship physicians reviewed an ED POCUS database for POCUS examinations of the hand.We then reviewed patients’electronic health records(EHR)for demographic characteristics,history,physical examination findings,ED course,additional imaging studies,consultations,impact of POCUS on patient care and final disposition.RESULTS:We included a total of 50 cases(28 male,22 female)in the final analysis.The most common presenting symptoms and exam findings were pain(100%),swelling(90%),and erythema(74%).The most common sonographic findings were edema(76%),soft tissue swelling(78%),and fluid surrounding the tendon(57%).POCUS was used in medical decision making 68%of the time(n=34),with the use of POCUS leading to changes in management 38%of the time(n=19).POCUS use led to early antibiotic use(11/19),early consultation(10/19),and led to the performance of a required procedure(8/19).The POCUS diagnosis was consistent with the discharge diagnosis of flexor tenosynovitis 8/12 times,abscess 12/16 times,and cellulitis 14/20 times.CONCLUSION:POCUS is beneficial for evaluating of hand infections that present to the ED and can be used as an important part of medical decision making to expedite patient care.

Electrochemical biosensors for point-of-care testing

Point-of-care testing(POCT)is the practice of diagnosing and monitoring diseases where the patient is located,as opposed to traditional treatment conducted solely in a medical laboratory or other clinical setting.POCT has been less common in the recent past due to a lack of portable medical devices capable of facilitating effective medical testing.However,recent growth has occurred in this field due to advances in diagnostic technologies,device miniaturization,and progress in wearable electronics.Among these developments,electrochemical sensors have attracted interest in the POCT field due to their high sensitivity,compact size,and affordability.They are used in various applications,from disease diagnosis to health status monitoring.In this paper we explore recent advancements in electrochemical sensors,the methods of fabricating them,and the various types of sensing mechanisms that can be used.Furthermore,we delve into methods for immobilizing specific biorecognition elements,including enzymes,antibodies,and aptamers,onto electrode surfaces and how these sensors are used in real-world POCT settings.

Point-of-care ultrasonography in cirrhosis-related acute kidney injury:How I do it

Discerning the etiology of acute kidney injury(AKI)in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes.The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload.In the recent past,point-of-care ultrasonography(POCUS)has emerged as a valuable adjunct to clinical assessment,offering advantages in terms of diagnostic accuracy,rapidity,cost-effectiveness,and patient satisfaction.This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI.The review distinguishes basic and advanced POCUS,emphasizing a 5-point basic POCUS protocol for efficient assessment.This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy,lung ultrasound for detecting extravascular lung water,inferior vena cava(IVC)ultrasound for estimating right atrial pressure,internal jugular vein ultrasound as an alternative to IVC assessment,and focused cardiac ultrasound for assessing left ventricular(LV)systolic function and identifying potential causes of a plethoric IVC.Advanced POCUS delves into additional Doppler parameters,including stroke volume and cardiac output,LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload.POCUS,when employed judiciously,enhances the diagnostic precision in evaluating AKI in cirrhotic patients,guiding appropriate therapeutic interventions,and minimizing the risk of fluid-related complications.

Point-of-care ultrasonography spotlight:Could venous excess ultrasound serve as a shared language for internists and intensivists?

Point-of-care ultrasonography(POCUS),particularly venous excess ultrasound(VExUS)is emerging as a valuable bedside tool to gain real-time hemodynamic insights.This modality,derived from hepatic vein,portal vein,and intrarenal vessel Doppler patterns,offers a scoring system for dynamic venous congestion assessment.Such an assessment can be crucial in effective management of patients with heart failure exacerbation.It facilitates diagnosis,quantification of congestion,prognostication,and monitoring the efficacy of decongestive therapy.As such,it can effectively help to manage cardiorenal syndromes in various clinical settings.Extended or eVExUS explores additional veins,potentially broadening its applications.While VExUS demonstrates promising outcomes,challenges persist,particularly in cases involving renal and liver parenchymal disease,arrhythmias,and situations of pressure and volume overload overlap.Proficiency in utilizing spectral Doppler is pivotal for clinicians to effectively employ this tool.Hence,the integration of POCUS,especially advanced applications like VExUS,into routine clinical practice necessitates enhanced training across medical specialties.

Sound waves and solutions:Point-of-care ultrasonography for acute kidney injury in cirrhosis

This article delves into the intricate challenges of acute kidney injury(AKI)in cirrhosis,a condition fraught with high morbidity and mortality.The complexities arise from distinguishing between various causes of AKI,particularly hemodynamic AKI,in cirrhotic patients,who experience hemodynamic changes due to portal hypertension.The term"hepatocardiorenal syndrome"is introduced to encapsulate the intricate interplay among the liver,heart,and kidneys.The narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis,unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic function.The conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed,highlighting potential risks and variable patient responses.We advocate for a nuanced algorithm for AKI evaluation in cirrhosis,prominently featuring point-of-care ultrasonography(POCUS).POCUS applications encompass assessing fluid tolerance,detecting venous congestion,and evaluating cardiac function.

Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics.As a part of cardiorenal syndrome,the diagnosis is usually made based on history and physical examination,with findings such as jugular venous distension,a third heart sound,and vital signs as supporting findings.More recently,however,these once though objective measures have come under scrutiny for their accuracy.At the same time,bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion.In this mini-review,we will discuss some of the traditional methods used to measure venous congestion,describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation,and offer a description of venous excess ultrasound score,a relatively novel scoring technique used to objectively quantify congestion.While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements,more study is underway to solidify the role of this objective measure in daily clinical practice.

Transcending boundaries:Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury

Acute kidney injury(AKI)is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both.In spite of thorough history-taking,physical examination,and laboratory analysis,there are limitations in the diagnostic process and clinical monitoring of AKI.Point-of-care ultrasonography(POCUS),a limited ultrasound study performed by clinicians at the bedside,has emerged as a valuable tool in different clinical settings.In this discussion,we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients.POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics,enabling formulation of individualized treatment plans.Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI,as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.

Bow-and-arrow sign on point-of-care ultrasound for diagnosis of pacemaker lead-induced heart perforation:A case report and literature review

BACKGROUND Pacemaker lead-induced heart perforation is a rare but life-threatening complication of pacemaker implantation,and timely diagnosis remains a challenge for clinicians.Here,we report a case of pacemaker lead-induced cardiac perforation rapidly diagnosed by a“bow-and-arrow”sign on point-of-care ultrasound(POCUS).CASE SUMMARY A 74-year-old Chinese woman who had undergone permanent pacemaker implantation 26 d before suddenly developed severe dyspnea,chest pain,and hypotension.The patient had received emergency laparotomy for an incarcerated groin hernia and was transferred to the intensive care unit 6 d before.Computed tomography was not available due to unstable hemodynamic status,so POCUS was performed at the bedside and revealed severe pericardial effusion and cardiac tamponade.Subsequent pericardiocentesis yielded a large volume of bloody pericardial fluid.Further POCUS by an ultrasonographist revealed a unique“bow-and-arrow”sign indicating right ventricular(RV)apex perforation by the pacemaker lead,which facilitated the rapid diagnosis of lead perforation.Given the persistent drainage of pericardial bleeding,urgent off-pump open chest surgery was performed to repair the perforation.However,the patient died of shock and multiple organ dysfunction syndrome within 24 h post-surgery.In addition,we also performed a literature review on the sonographic features of RV apex perforation by lead.CONCLUSION POCUS enables the early diagnosis of pacemaker lead perforation at the bedside.A step-wise ultrasonographic approach and the“bow-and-arrow”sign on POCUS are helpful for rapid diagnosis of lead perforation.

基于先验信息约束的Curvelet域地震数据POCS插值方法

由于野外采集环境的限制,常常无法采集得到完整规则的野外地震数据,为后续地震处理、解释工作的顺利进行,需要进行地震数据重构。凸集投影(POCS)方法利用地震波形在Curvelet域的稀疏特性,可以重构出高信噪比地震数据,该迭代算法稳定,其收敛速度较快。但在地震数据恢复的时候,由于直达波和炮集上部空白区域的影响,随着迭代的进行,重构数据中噪声干扰越来越严重,导致最终恢复的地震数据信噪比较低。本文在实现POCS迭代阈值算法基础上,引入先验信息约束的思想对算法进行优化。通过先进行坐标映射的方法进行炮集插值,然后将其作为先验信息约束进行插值,可以有效地压制迭代噪音对重构地震波形数据的影响。通过合成地震炮记录与实际炮集进行测试,结果表明本文提出的改进方法可以明显改善重构地震数据的信噪比,并提高地震波场同相轴的连续性。

POC型煤气柜柜壁凸鼓问题的原因分析及解决措施

唐钢新区30万m~3POC型煤气柜运行中出现气柜柜壁凸鼓,内壁板焊缝开裂漏油,密封装置在柜容量13.5万m^(3)、18万m^(3)、22万m^(3)左右时,出现6个油泵站双泵全启,活塞油沟油位下降快速等隐患问题。经过全面检查和原因分析,通过检修解决了相关问题。为业内同行提供借鉴与参考。

基于point-of-care理念的手卫生设施设置现状调查

目的基于point-of-care(POC)理念调查某三级甲等综合性教学医院手卫生设施的设置现状。方法采用横断面方法调查该院各诊疗区域主要供医务人员使用的手卫生设施种类、数量、位置、设施完备程度,以及速干手消毒剂的消耗量。结果调查102个区域,1165间诊疗用房,手卫生设施配置率为96.48%,洗手池完备率为91.37%%,不同区域完备率比较,差异有统计学意义(P<0.01)。80.53%的速干手消毒剂设置符合POC理念,59.51%的普通病区病室速干手消毒剂设置符合POC理念,速干手消毒剂设置符合POC理念比例高的科室手消毒剂消耗量相对较高。结论手卫生设施的设置和改进应强化POC理念,以提高手卫生依从性和预防医院感染的发生。

基于卫星遥感的南海海域POC浓度时空变化特征研究

海水中颗粒有机碳(POC)是海洋碳循环的基本变量,在海洋碳循环研究中起着关键作用。根据2003—2020年南海区域遥感数据反演的POC数据集,分析了南海海域POC浓度时空变化规律。研究结果表明:在整个研究区POC的年平均浓度变化范围为76.98~83.91 mg/m^(3);POC浓度分布呈现出近岸高、远海低,主要原因为南海近岸浅水海域POC浓度主要受陆源输入和沿岸流影响,远海区域内POC浓度主要受南海环流和水团控制。在季度上,第1—4季度POC浓度平均值为89.62,72.90,79.22,84.86 mg/m^(3);总体上POC浓度呈现出夏季低、冬季高的趋势,主要原因为南海受到冬季的东北季风和夏季的西南季风影响,影响到南海海水混合层的结构变化,浮游植物在冬季比夏季更为繁盛。在月尺度上,1月POC浓度平均值达到最高值;2—4月POC浓度平均值快速下降,5月POC浓度平均值达到最低值;6—12月POC浓度平均值开始缓慢上升。以上研究结论可为南海碳循环、政府碳达峰、碳中和及应对气候变化等提供决策依据。

基于PoC共识的区块链可靠存储系统

针对互联网环境下,各行业大量重要数据、文档、视频等电子文件安全存储的问题,提出了基于PoC共识的区块链可靠存储方案。该方案利用区块链去中心化、不可篡改等特点,结合IPFS技术共同实现在公有链上的电子文件可靠存储。对于部分主流共识机制存在的资源浪费、中心化风险的情况,方案引入了容量证明(PoC)共识机制,通过采用PoC的方式,不但具有更低的计算成本和去中心化的特性,还能减少共识带来的能源消耗,实现区块链的有效共识。安全性分析和性能测试表明,本方案能够保证数据的安全、可靠存储及查询,具有较高的运行效率。

Perihepatic nodes detected by point-of-care ultrasound in acute hepatitis and acute-on-chronic liver disease

AIM: To study the manifestations of perihepatic lymph nodes during the episode of acute hepatitis flare by point-of-care ultrasonography.METHODS: One hundred and seventy-six patients with an episode of acute hepatitis flare(ALT value > 5 × upper normal limit) were enrolled retrospectively. Diagnosis of etiology of the acute hepatitis flare was based on chart records and serological and virological assays. The patients were categorized into two groups(viral origin and non-viral origin) and further defined into ten subgroups according to the etiologies. An ultrasonograpy was performed within 2 h to 72 h(median, 8 h). The maximum size of each noticeable lymph node was measured. Correlation between clinical parameters and nodal manifestations was analyzed RESULTS: Enlarged lymph nodes(width ≥ 5mm)were noticeable in 110(62.5%) patients, mostly in acute on chronic hepatitis B(54.5%). The viral group had a higher prevalence rate(89/110 = 80.9%) and larger nodal size(median, 7 mm) than those of the non-viral group(21/66 = 31.8%; median, 0 mm)(P < 0.001 for both). Meanwhile, there were significant differences in the nodal size between acute and chronic viral groups(P < 0.01), and between acute hepatitis A and non-hepatitis A viral groups(P < 0.001). In logistical regression analysis, the nodal width still showed strong significance in multivariate analysis(P < 0.0001) to stratify the two groups. The area under the curve of ROC was 0.805, with a sensitivity of 80.9%, a specificity of 68.2%, positive predictive value of 80.92%, negative predictive value of 68.18%, and an accuracy of 76.14%. CONCLUSION: Point-of-care ultrasonography to detect perihepatic nodal change is valuable for clarifying the etiologies in an episode of acute hepatitis flare.

What is the ideal approach for emergent pericardiocentesis using point-of-care ultrasound guidance?

BACKGROUND:Traditionally performed using a subxiphoid approach,the increasing use of point-of-care ultrasound in the emergency department has made other approaches(parasternal and apical)for pericardiocentesis viable.The aim of this study is to identify the ideal approach for emergency-physician-performed ultrasound-guided pericardiocentesis as determined by ultrasound image quality,distance from surface to pericardial fl uid,and likely obstructions or complications.METHODS:A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial eff usions.The images were reviewed for technical quality,distance of eff usion from skin surface,and predicted complications.RESULTS:A total of 166 pericardial effusions were identified during the study period.The mean skin-to-pericardial fl uid distance was 5.6 cm(95%confi dence interval[95%CI]5.2-6.0 cm)for the subxiphoid views,which was signifi cantly greater than that for the parasternal(2.7 cm[95%CI 2.5-2.8 cm],P<0.001)and apical(2.5 cm[95%CI 2.3-2.7 cm],P<0.001)views.The subxiphoid view had the highest predicted complication rate at 79.7%(95%CI 71.5%-86.4%),which was signifi cantly greater than the apical(31.9%;95%CI 21.4%-44.0%,P<0.001)and parasternal(20.2%;95%CI 12.8%-29.5%,P<0.001)views.CONCLUSIONS:Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach.The distance from skin to fl uid collection is the least in both of these views.

Smartphone-based cytometric biosensors for point-of-care cellular diagnostics

Analysis on a single-cell basis is both fundamental and meaningful in biomedical research and clinical practice.Flow cytometry is one of the most popular approaches in this field with broad applications in cell sorting,counting,and identification of rare cells.However,the complicated design and bulky size of conventional flow cytometry have restricted their applications mainly in centralized laboratories.With the recent development of smartphone devices,smartphone-based cytometry has been explored and tested for single-cell analysis.Compared with traditional cytometers,smartphone-based cytometric biosensors are more suitable for point-of-care(POC)uses,such as on-site disease diagnosis and personal health monitoring.In this review article,the history of traditional flowcytometry is introduced,and advances of smartphone-enabled cytometry are summarized in detail based on different working principles.Representative POC applications of smartphone cytometers are also discussed.The achievements demonstrated so far illustrate the potential of smartphone-based cytometric devices to transform single-cell measurement in general,with a significant impact in POC diagnostics,preventive medicine,and cell biology.

Wave-shaped microfluidic chip assisted point-of-care testing for accurate and rapid diagnosis of infections

Background:Early diagnosis and classification of infections increase the cure rate while decreasing complications,which is significant for severe infections,especially for war surgery.However,traditional methods rely on laborious operations and bulky devices.On the other hand,point-of-care(POC)methods suffer from limited robustness and accuracy.Therefore,it is of urgent demand to develop POC devices for rapid and accurate diagnosis of infections to fulfill on-site militarized requirements.Methods:We developed a wave-shaped microfluidic chip(WMC)assisted multiplexed detection platform(WMC-MDP).WMC-MDP reduces detection time and improves repeatability through premixing of the samples and reaction of the reagents.We further combined the detection platform with the streptavidin–biotin(SA-B)amplified system to enhance the sensitivity while using chemiluminescence(CL)intensity as signal readout.We realized simultaneous detection of C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)on the detection platform and evaluated the sensitivity,linear range,selectivity,and repeatability.Finally,we finished detecting 15 samples from volunteers and compared the results with commercial ELISA kits.Results:Detection of CRP,PCT,and IL-6 exhibited good linear relationships between CL intensities and concentrations in the range of 1.25–40μg/ml,0.4–12.8 ng/ml,and 50–1600 pg/ml,respectively.The limit of detection of CRP,PCT,and IL-6 were 0.54μg/ml,0.11 ng/ml,and 16.25 pg/ml,respectively.WMC-MDP is capable of good adequate selectivity and repeatability.The whole detection procedure takes only 22 min that meets the requirements of a POC device.Results of 15 samples from volunteers were consistent with the results detected by commercial ELISA kits.Conclusions:WMC-MDP allows simultaneous,rapid,and sensitive detection of CRP,PCT,and IL-6 with satisfactory selectivity and repeatability,requiring minimal manipulation.However,WMC-MDP takes advantage of being a microfluidic device showing the coefficients of variation less than 10%enabling WMC-MDP to be a type of point-of-care testing(POCT).Therefore,WMC-MDP provides a promising alternative to POCT of multiple biomarkers.We believe the practical application of WMC-MDP in militarized fields will revolutionize infection diagnosis for soldiers.

Effect of Point-of-care Hemoglobin/Hematocrit Devices and Autologous Blood Salvage on Reduction of Perioperative Allogeneic Blood Transfusion

Objective To evaluate the effect of point-of-care hemoglobin/hematocrit(POC HGB/HCT) devices and intraoperative blood salvage on the amount of perioperative allogeneic blood transfusion and blood conservation in clinical practice. Methods A total of 46 378 medical records of 22 selected hospitals were reviewed. The volume of allogeneic red blood cell and plasma, number of patients transfused, number of intraoperative autologous blood salvage, total volume of autologous blood transfusion, and amount of surgery in the year of 2011 and 2013 were tracked. Paired t-test was used in intra-group comparison, while t-test of two isolated samples carried out in inter-group comparison. P<0.05 was defined as statistically significant difference. Results In the hospitals where POC HGB/HCT device was used(n=9), the average allogeneic blood transfusion volume per 100 surgical cases in 2013 was significantly lower than that in 2011(39.86±20.20 vs. 30.49±17.50 Units, t=3.522, P=0.008). In the hospitals without POC HGB/HCT meter, the index was not significantly different between 2013 and 2011. The average allogeneic blood transfusion volume was significantly reduced in 2013 than in 2011 in the hospitals where intraoperative autologous blood salvage ratio [autologous transfusion volume/(autologous transfusion volume+allogeneic transfusion volume)] was increased(n=12, t=2.290, P=0.042). No significant difference of the above index was found in the hospitals whose autologous transfusion ratio did not grow. Conclusion Intraoperative usage of POC HGB/HCT devices and increasing autologous transfusion ratio could reduce perioperative allogeneic blood transfusion.

Delayed cardiac tamponade diagnosed by point-of-care ultrasound in a neonate after peripherally inserted central catheter placement: A case report

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.