10-mL Syringe Research Articles

Combined thrombus aspiration and recanalization in treating Budd-Chiari syndrome with inferior vena cava thrombosis.

To investigate the feasibility, safety, and effectiveness of combined thrombus aspiration and inferior vena cava (IVC) recanalization for Budd-Chiari syndrome (BCS) patients with IVC thrombosis. From March 2011 to October 2014, 17 consecutive BCS patients with IVC thrombosis [male 13, female 4 (mean age 52.6±8.4years, range 43-72years)] treated by combined thrombus aspiration and IVC recanalization were enrolled in this retrospective study. An 8F guiding catheter was used as the aspiration catheter. During the treatment, the aspiration catheter was placed from the right femoral vein to the IVC thrombi, and a 20-ml syringe was connected with the aspiration catheter for thrombus aspiration. IVC recanalization was performed after thrombus aspiration. Data on technical success, clinical success, and follow-up were analyzed. Technical success was achieved in all patients. After thrombus aspiration, 12 patients had no visible thrombi on IVC venography, while 5 patients were shown to have the IVC mural thrombi. Afterwards, 13 patients were treated by IVC balloon dilation, and 4 patients were treated by IVC stent insertion. No patient experienced dyspnea after treatment. The average IVC pressure decreased from 29.8±3.4 cmH2O to 8.6±2.1 cmH2O (P<0.001). Clinical success was achieved in all patients. The average follow-up period was 15.3±11.6months (range 2-44months). Long-term IVC patency was achieved in 15 of 17 patients. Combined thrombus aspiration and IVC recanalization can be a safe and effective method for BCS patients with IVC thrombosis.

Using a modified syringe technique to adjust the intracuff pressure of a laryngeal mask airway

Limiting the intracuff pressure of a laryngeal mask airway (LMA) to <60 cmH2O is recommended in clinical practice. This report aimed to assess the efficacy of a modified syringe technique to adjust the intracuff pressure of an LMA. In a preclinical study, commercially available 20-mL syringes were attached to the pilot balloon of LMAs with different preset intracuff pressures (40 cmH2O, 50 cmH2O, 60 cmH2O, 70 cmH2O, 80 cmH2O, 100 cmH2O, and 120 cmH2O). After attachment, the syringe plunger was allowed to passively rebound. If no rebound of the plunger was observed after attachment, 1 mL of air was withdrawn and the plunger was allowed to passively rebound again. This technique allowed the plunger to overcome static friction and avoid excessive deflation of the LMA cuffs. The intracuff pressure was measured using a manometer after the plunger ceased moving. In the preclinical study, the intracuff pressure was always less than or close to 60 cmH2O after adjustment using this modified syringe technique. After evaluating the performance and characteristics of the syringe in the preclinical study, we concluded that the modified syringe technique may be useful for adjusting LMA intracuff pressure effectively.

Contrast-enhanced voiding urosonography: in vitro evaluation of a second-generation ultrasound contrast agent for in vivo optimization.

Pediatric contrast-enhanced ultrasound (CEUS) is primarily performed outside the United States where a track record for safety in intravenous and intravesical applications has been established. Contrast-enhanced voiding urosonography (ceVUS) has also been shown to have a much higher rate of vesicoureteral reflux detection compared to voiding cystourethrography. US contrast agents available in the United States differ from those abroad. Optison® (GE Healthcare, Princeton, NJ) is such an US contrast agent. While Optison® has similar characteristics to other second-generation agents, it has never been used for ceVUS. In vitro optimization of dose and imaging parameters as well as assessment of contrast visualization when delivered in conditions similar to ceVUS are necessary starting points prior to in vivo applications. To optimize the intravesical use of Optison® in vitro for ceVUS before its use in pediatric studies. The experimental design simulated intravesical use. Using 9- and 12-MHz linear transducers, we scanned 20-mL syringes varying mechanical index, US contrast agent concentration (0.25%, 0.5%, 1.0%), solvent (saline, urine, radiographic contrast agent) and time out of refrigeration. We evaluated mechanical index settings and contrast duration, optimized the contrast dose, measured the effect of urine and radiographic contrast agent, and the impact of length of time of contrast outside of the refrigerator on US contrast appearance. We scanned 50-ml saline bags to assess the appearance and duration of US contrast with different delivery systems (injection vs. infusion). Consistent contrast visualization was achieved at a mechanical index of 0.06-0.17 and 0.11-0.48 for the L9 and L12 MHz transducers (P < 0.01), respectively. Thus, it was necessary to increase the mechanical index for better contrast visualization of the microbubbles with a higher transducer frequency. The lowest mechanical index for earliest visible microbubble destruction was 0.21 for the 9MHz and 0.39 for the 12MHz (P < 0.01) transducers. The 0.5% US contrast agent volume to bladder filling was the most optimal. At this concentration, the mean time to visualize homogenous contrast was 2min and destruction of approximately half of the microbubbles in the field of view occurred in 7.8min using the 9-MHz transducer. During contrast infusion, the contrast dose needed to be reduced to 0.12% for maintenance of optimal visualization of microbubbles. There was no deleterious effect on the visualization of contrast in the presence of urine or radiographic contrast agent. Infusion of the US contrast agent speeded visualization of homogeneous enhancement compared with injection. Time outside refrigeration did not affect contrast performance. Transducer mechanical index settings need to be optimized. A very low dose of the US contrast agent Optison® will suffice for intravesical application, i.e. 0.12% to 0.50% of the bladder filling volume. The presence of urine or radiographic contrast agent did not compromise contrast visualization. The best mode of administration is the infusion method due to fast homogenous distribution at the lowest dose of 0.12%. Leaving the US contrast agent outside the refrigerator for an hour does not affect the microbubbles.

Validation of a Combinatorial Approach Toward the Discovery of Electrolyte Formulations for Lithium-Ion Batteries

Combinatorial methods have opened exciting new prospects for screening materials for application in a growing number of technological areas ranging from drug discovery to semiconductors for photovoltaics1,2. These efforts have been paralleled more recently by the use of computers to explore the properties of yet to be synthesized materials incorporating just about every stable element in the periodic table. However, application of these combinatorial techniques to electrolytes for lithium ion batteries have been rather scarce3where optimization of solvent formulations has apparently been performed by coarse trial and error. This contribution describes a unique instrument capable of producing large numbers of electrolyte mixtures involving solvents either currently in use or being considered in the L-ion industry. EXPERIMENTAL All organic solvent formulations were prepared with a programmable non-contact liquid handling instrument (Digilab MicroSYS) using the synQUAD dispensing technique placed inside an Ar (Airgas High Purity) filled high quality glovebox (MBraun UNIlab) to avoid contamination with atmospheric components and reduce safety hazards. During operation, the pressure within the glove box varied between 2.0 and 6.0 mbar. The solvents involved in these studies were all provided by BASF (formerly Novolyte, Independence, OH), and included diethyl carbonate, DEC, dimethyl carbonate, DMC, propylene carbonate, PC ethyl methyl carbonate, EMC and a solution of room temperature solid, ethylene carbonate, EC, in EMC. The composition of all organic solvent mixtures prepared by the combinatorial instrument was assayed using a Hewlett Packard GC/MS (controlled by Xcaliber) equipped with an Rtx-200MS GC column (30 m in length, 0.25 mm I.D. and film thickness equal to 1 μm, RESTEK Corporation). For all the measurements including the standards, 1 μL diluted solvent (1 μL of the solvent mixtures of interest in 1 mL acetonitrile (HPLC purity, Sigma Aldrich) is injected into GC-MS for each run with a 5 μL syringe (Fisher Scientific). Standard curves relating integrated peak area and volume or weight of the solvent of interest in acetonitrile was obtained by running the solvent at four different concentrations. RESULTS AND DISCUSSION Shown in Figure 1 is a typical chromatogram of a solvent mixture, where each of the peaks is associated with an individual solvent as indicated. Figure 2 shows a comparison between the GC/MS analysis and the intended combinatorial ratios for eight different samples. AS evidenced from these data the agreement between the two sets of data .is indeed excellent yielding for a selected specimen average error of only 2.1%. Values for other specimens ranged between 1.2 and 2.1 % providing evidence that the methodology developed displays high degree of accuracy and as such can assist the discovery of new solvent formulations for application in batteries, supercapacitors and redox flow cells. An assessment of the electrochemical performance of mixtures such as those featured in this report is in progress and will be reported in due course. Acknowledgements This work was supported by a grant from BASF (formerly Novolyte, Independence, OH) through a subcontract for the Ohio Third frontier Program. Figure 1

Tu1650 Feasibility and Diagnostic Yield of a New EUS Guided Histology 20-Gauge Needle in the Evaluation of Intraintestinal and Extraintestinal Lesions

Tu1650 Feasibility and Diagnostic Yield of a New EUS Guided Histology 20-Gauge Needle in the Evaluation of Intraintestinal and Extraintestinal Lesions

Percutaneous Needle Puncture Technique to Create a Rabbit Model with Traumatic Degenerative Disk Disease

Several studies have been conducted to identify the pathogenesis of and manage disk degeneration. To further this research, reliable animal models of disk degeneration are required. In the present study, a percutaneous technique is used to create a rabbit model of degenerative disk disease, and the reproducibility and efficacy of this technique is reported. Ten mature male New Zealand white rabbits were included in the present study. The intervertebral disk was injured by a percutaneous technique at the L2-L3, L3-L4, and L4-L5 levels. The center of the disk was identified by C-arm guidance. A 19-gauge spinal needle with a 10-mL syringe was inserted into the center of the disk, and negative pressure was applied. Radiographs including magnetic resonance imaging (MRI) with T2 and lateral x-rays were collected at 1, 4, 9, 15, and 20 weeks. Degeneration was examined using histology at 24 weeks. Narrowed disk height was not observed until 4 weeks after injury, and a significant change was observed at 9 weeks compared with the control L1-L2 level (P < 0.05). MRI revealed disk degeneration beginning at 9 weeks and full degeneration at 15 weeks. Injured intervertebral disks had higher degeneration, seen using MRI, than uninjured control disks. Disk degeneration was confirmed in all injured levels by histologic examination. Cortical osteophyte formation was not found. Our percutaneous technique provides a suitable rabbit model of degenerative disk disease to test the safety and efficacy of treatments for disk degeneration, such as stem cell transplantation.

Air-assisted liquid–liquid microextraction by solidifying the floating organic droplets for the rapid determination of seven fungicide residues in juice samples

A novel air assisted liquid–liquid microextraction using the solidification of a floating organic droplet method (AALLME-SFO) was developed for the rapid and simple determination of seven fungicide residues in juice samples, using the gas chromatography with electron capture detector (GC-ECD). This method combines the advantages of AALLME and dispersive liquid–liquid microextraction based on the solidification of floating organic droplets (DLLME-SFO) for the first time. In this method, a low-density solvent with a melting point near room temperature was used as the extraction solvent, and the emulsion was rapidly formed by pulling in and pushing out the mixture of aqueous sample solution and extraction solvent for ten times repeatedly using a 10-mL glass syringe. After centrifugation, the extractant droplet could be easily collected from the top of the aqueous samples by solidifying it at a temperature lower than the melting point. Under the optimized conditions, good linearities with the correlation coefficients (γ) higher than 0.9959 were obtained and the limits of detection (LOD) varied between 0.02 and 0.25μgL−1. The proposed method was applied to determine the target fungicides in juice samples and acceptable recoveries ranged from 72.6% to 114.0% with the relative standard deviations (RSDs) of 2.3–13.0% were achieved. Compared with the conventional DLLME method, the newly proposed method will neither require a highly toxic chlorinated solvent for extraction nor an organic dispersive solvent in the application process; hence, it is more environmentally friendly.

Bench-top testing of suction forces generated through endoscopic ultrasound-guided aspiration needles.

Adequate needle size and tissue acquisition techniques for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) need further elucidation. Moreover, the actual negative pressure and suction forces of FNA needles remain unknown. We evaluated the suction forces of 19-gauge, 22-gauge, and 25-gauge conventional FNA needles and side hole aspiration needles using conventional negative pressure and the slow pull technique. Using a manometer, we determined the mean (SD) negative pressure and suction force for needle gauge, aspiration volume, and aspiration technique. We also evaluated the time to reach the maximum negative pressure. Suction force was comparatively higher in the 19-gauge needle when 50 ml of negative pressure was applied. Suction force using the slow pull method was very weak at 5% of pressure found with conventional methods. With the use of a 20-ml syringe, the time to reach the maximum negative pressure was 4 s in the 19-gauge needle, 11 s in the 22-gauge needle, and 80 s in the 25-gauge needle. Bench-top testing showed that suction force increases with a larger gauge needle and larger aspiration volume. The slow pull method produces a very weak suction force. The time to reach the maximum negative pressure was longest in the 25-gauge needle.

A comparative study between a small dose of ketamine, lidocaine 1%, and acetominophen infusion to decrease propofol injection pain

Background and objectives Pain during the injection of propofol is one of its drawbacks. The aim of this prospective, randomized and double-blinded study was to compare ketamine (K), lidocaine (L) 1%, and paracetamol (P) infusion as pretreatment before propofol injection regarding pain during injection. Patients and methods A total of 200 patients aged between 20 and 60 years, ASA I or II physical status, were randomly assigned into four equal groups. All patients received pretreatment solutions made up in 20-ml syringes with isotonic saline 0.9%. All the patients were pretreated over a period of 20 s. In group K, patients received ketamine 0.5 mg/kg. In group L, patients received lidocaine 0.5 mg/kg. In group P, patients received paracetamol (perfagan 10 mg/ml) 2 mg/kg. In group C (which served as a control group), patients received isotonic saline. We placed a rubber tourniquet on the forearm for 50 s to occlude the venous blood before giving the study drug. A blinded researcher assessed the patient's pain on propofol injection using a four-point scale, hemodynamics, the incidence of complications, and the dose of propofol used to induce anesthesia. Results There was a significant increase in the pain in group L compared with group K and group P. Also, there was a significant increase in the pain in group C compared with all other groups. After propofol injection, there was a significant decrease in the mean arterial pressure in P, L, and C groups in comparison with the baseline values. There was a significant decrease in the propofol dose for the induction of anesthesia in the ketamine group in comparison with the other groups. Conclusion Pretreatment with paracetamol 2 mg/kg, ketamine 0.5 mg/kg, and lidocaine 0.5 mg/kg were significantly effective in attenuating the pain of propofol. However, pretreatment with lidocaine 0.5 mg/kg was the least effective and pretreatment with paracetamol 2 mg/kg was the most effective in attenuating propofol pain. The incidence of complications was not significant in all groups.

The Effect of Using a Cement Gun With a Narrow Nozzle on Cement Penetration for Total Elbow Arthroplasty: A Cadaveric Study

To compare the cement mantle characteristics associated with use of a narrow nozzle cement gun versus the use of a 60-mL catheter tip syringe. Twelve cadaveric distal humeri were cemented with either a cement gun or a syringe without canal occlusion. The humeri were sectioned and photographed. The corticocancellous junction and the outer margin of the cement mantle were analyzed digitally. The corticocancellous junction defined the available area for cement penetration. The outline of the cement mantle defined the actual area of penetration. The ratio of penetration to the available area was recorded for each slice. The mean ratio for each humerus was multiplied by the number of slices in that sample containing cement to calculate a cement index. The cement penetration ratios observed in cross-sections at the same level and the cement index were significantly greater with the use of the cement gun than with the use of the syringe. There was no difference in the number of slices that contained cement. The use of a cement gun with a narrow nozzle improved cement mantle characteristics compared with the use of a syringe when measured in a cadaveric model in the absence of canal occlusion. Improving cement mantle characteristics may decrease the incidence of aseptic loosening after total elbow arythroplasty.

Simulated fluid resuscitation for toddlers and young children: effect of syringe size and hand fatigue.

In small children, fluid resuscitation requires rapid administration of a relatively large fluid volume. This is often achieved manually. The optimal syringe size is unknown. The purpose of this study was to determine which syringe delivers fluid in the shortest time. The secondary outcome was to determine which syringe was associated with hand fatigue. Participants (n=20) performed a simulated fluid resuscitation using four syringe sizes: 5ml, 10ml, 20ml, and 60ml. The 'pull and push' method was used to transfer 250ml of lactated Ringer's solution from a bag, through IV tubing, into a container. Fluid transfer time (seconds) and hand fatigue were measured. A 'U'-shaped curve was identified between syringe size and transfer time (P<0.0001). The 10-ml and 20-ml syringes did not differ significantly (231±43 vs 228±45s, P>0.2, respectively). The 5-ml and 60-ml syringes did not differ significantly (273±69s vs 295±64, P=0.2, respectively). However, the 5-ml syringe required significantly more time than the 10-ml (by 42s, P=0.002) or the 20-ml (by 45s, P=0.001) syringes. The 60-ml syringe also required significantly more time than the 10-ml (by 64s, P<0.0001) or 20-ml (by 67s, P=0.0001) syringe. Although all participants transferred the 250ml, hand fatigue increased as syringe size increased: 5ml (n=3), 10ml (n=4), 20ml (n=7), and 60ml (n=15). Most participants preferred using the 10-ml syringe (n=11/20), followed by 20-ml (n=6/20), 5-ml (n=3/20), and 60-ml (n=0/20) syringes. Manual fluid resuscitation using the 'pull and push' method is most rapidly accomplished with the 10-ml or 20-ml syringes. The 60-ml syringe is associated with the most hand fatigue. Participants most preferred the 10-ml or 20-ml syringes.

269 EFFECT OF DIFFERENT COLLECTION FREQUENCY INTERVALS ON THE QUALITY OF SEMEN OF FRENCH BULLDOGS

Dogs produce fewer sperm than other species. Furthermore, for French Bulldogs, anatomical peculiarities, low libido, and increased sensitivity to stress could cause further reductions in sperm count. The objective was to compare effects of semen collection at 24- versus 48-h intervals on semen quality of French Bulldogs. Five purebred French Bulldogs, 19 to 48 months old, were subjected to 5 semen collections (24 h apart). After a 30-day rest, collections were repeated, but the interval between collections was 48 h. Semen was collected (all 3 fractions) by digital manipulation without female stimuli. Volume was measured in a 20-mL syringe. Sperm concentration was determined with a Neubauer counting chamber. Motility and vigor were evaluated with a coverslipped drop of semen on a slide (preheated to 37°C). Motility was expressed as a percentage of motile sperm, and vigor was classified on a scale of 1 to 5. Morphology was evaluated by the panoptic method; 100 cells were counted and results expressed as the percentage of normal or defective cells. Effects of collection interval were analysed using PROC MIXED of SAS (animal as subject and collection as a repeated measure), with collections 2 to 5 compared with collection 1 (using the DIFF option). For collection every 24 h, the third, fourth, and fifth sperm collections were lower than the first collection for volume (10.4 ± 1.1, 8.3 ± 1.1, 5.6 ± 1.1, 3.5 ± 1.1, 2.4 ± 1.1 mL), concentration (437 ± 24, 448 ± 24, 370 ± 24, 322 ± 27, 258 ± 31 ×106 sperm mL–1), vigor (4.6 ± 0.2, 4.2 ± 0.2, 3.6 ± 0.2, 3.7 ± 0.2, 3 ± 0.2), and morphologically normal sperm (82 ± 2.2, 83 ± 2.2, 72 ± 2.2, 68 ± 2.5, 66 ± 2.9%). However, when the interval was increased to 48 h, only the fourth and fifth collections were lower (P &lt; 0.05) than the first for volume (11.8 ± 1.1, 10.2 ± 1.1, 8.8 ± 1.1, 6.6 ± 1.1, 2.5 ± 1.1 mL), concentration (447 ± 24, 410 ± 24, 407 ± 24, 322 ± 24, 241 ± 31 ×106 sperm mL–1), vigor (5 ± 0.2, 4.8 ± 0.2, 4.4 ± 0.2, 4.2 ± 0.2, 4 ± 0.2), and sperm with normal morphology (92 ± 2.2, 90 ± 2.2, 87 ± 2.2, 80 ± 2.2, 81 ± 2.9%). Motility decreased (P &lt; 0.05) following the fourth collection at 24-h intervals and decreased (P &lt; 0.05) after the third collection at 48-h intervals. With a 24-h interval, 4 dogs had &lt;60% motility lower at the fifth collection, whereas only 2 dogs had motility &lt;60% on the fifth collection at 48-h intervals. In conclusion, semen collected at 48-h intervals was of better quality than semen collected at 24-h intervals.

Taste and Odour Disturbances in Pediatric Patients Undergoing IV Flush with Normal Saline Administered by Prefilled or Freshly Prepared Syringes: Randomized Single-Blind Study.

Previous studies have reported the occurrence of taste and odour disturbances among patients undergoing IV flush with prefilled syringes of 0.9% sodium chloride (normal saline [NS]). These disturbances have been attributed to the leaching of volatile substances into the NS from the plastic of the syringe. To date, there have been no studies comparing the occurrence of taste and odour disturbances with different NS preparations. To compare the occurrence of taste and odour disturbances in pediatric patients undergoing IV flush with commercially available prefilled NS syringes and NS syringes prepared fresh daily. Patients aged 6 to 18 years who underwent routine flushing of central or peripheral IV tubing were asked to participate in this follow-up randomized single-blind study. Flushing was performed with NS from BD PosiFlush 10-mL sterile prefilled syringes or NS transferred from a polyolefin bag (Baxter AVIVA) to a polypropylene syringe and stored for a maximum of 12 h before use. Fifty pediatric patients (mean age ± standard deviation 13.4 ± 3.8 years) who had undergone flushing of IV tubing with NS were interviewed. Taste or odour disturbances were reported by 18 (72%) of the 25 patients who underwent flushing with NS from a prefilled syringe, whereas only 1 (4%) of the 25 who underwent flushing with NS from a freshly prepared syringe experienced such disturbances (p < 0.001). There were significant differences in taste and odour disturbances experienced by patients who underwent IV flush with commercial prefilled NS syringes and freshly prepared NS syringes.

What is the best method for endoscopic ultrasound-guided fine needle aspiration? Needle types and aspiration techniques

BackgroundMany factors such as the size and type of needle and negative pressure can affect the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, because many biases exist in clinical studies of humans, particularly in terms of individual differences among participants, results are largely dependent on the characteristics of the patients and tumors. The aim of this study was to evaluate the properties of EUS-FNA needles and aspiration techniques using animal and artificial models under stable conditions. MethodsWe performed EUS-FNA on a pig liver under general anesthesia in Protocol 1. We used all types (soft-type, stiff-type, and reverse-beveled needles) and all sizes of needles with negative pressure applied using a 20-mL syringe or the slow-pull technique. All the obtained specimens were fixed in formalin for the cell block method. The specimens were scored according to the our own grading system. In Protocol 2, EUS-FNA was performed using three materials: Japanese sweet bean jelly, tofu, and cow liver. The obtained specimens were placed on the dish one by one. The FNA specimens were evaluated macroscopically and compared with each other. ResultsIn Protocol 1, the mean ± standard deviation score for reverse-beveled needles (4.1 ± 1.41) was significantly higher than that for soft-type needles (3.5 ± 1.79; P < 0.05, Dunn's test). However, there was no significant difference between stiff-type and reverse-beveled needles. The score for each size of needle showed no significant difference, even between 25 gauge (G) and 19 G. Comparing the slow-pull technique with 20-mL negative pressure, the slow-pull technique provided a small specimen but less blood in Protocol 2. Negative pressure was not useful for EUS-FNA of a hard tumor model. ConclusionThe score for the reverse-beveled needle was better than that of the soft-type needle. The slow-pull technique may be useful for a bloody tumor, but it provides less specimen. We should select the EUS-FNA method based on the relevant patient and tumor characteristics.

Medication adsorption into contemporary extracorporeal membrane oxygenator circuits.

This study was conducted to evaluate the amount of medication adsorbed into extracorporeal membrane oxygenation (ECMO) circuits with a polymethylpentane membrane oxygenator and heparin-coated polyvinyl chloride tubing. An ECMO circuit with the aforementioned components was set up ex vivo and primed with expired blood. Midazolam, lorazepam, morphine, and fentanyl were administered to the circuit. Fifteen minutes after medication administration, 60 mL of blood were removed and stored in a 60-mL syringe to serve as a control. Medication levels were drawn from the ECMO circuit (test) and control syringe (control) 15 minutes, 24 hours, and 48 hours after the medications were administered. ECMO circuit medication levels were compared to their corresponding syringe control medication levels. Descriptive statistics were used to determine the percentage of medication remaining in the blood and compare it to the control value. Except for morphine, there was a large decline in medication levels over the 48-hour period. Compared to control values, 17.2% of midazolam, 41.3% of lorazepam, 32.6% of fentanyl, and 102% of morphine remained in the ECMO circuit. Despite the use of newer components in ECMO circuits, a large quantity of medication is adsorbed into the ECMO circuit. Midazolam, lorazepam, and fentanyl all showed reductions in medication levels greater than 50%. Morphine may have advantages for patients on ECMO, as its concentration does not appear to be affected.

Simple, inexpensive, and effective injector for descemet membrane endothelial keratoplasty.

We describe an inexpensive, simple, and effective endothelium-Descemet membrane (EDM) graft injector assembled from regular operating room supplies in Descemet membrane endothelial keratoplasty (DMEK). To assemble the injector, standard intravenous tubing was cut approximately 2 inches from the Luer lock end, leaving a steep bevel. The cut end of the tubing was firmly wedged bevel up and advanced into the back of an Alcon IOL B cartridge. The Luer lock end of the tubing was then attached to a 5- or 10-mL syringe filled with BSS Plus. The EDM graft was then placed into a Petri dish filled with BSS. After the graft was sucked into an injector with bevel-side up under the surgical microscope, the graft was then inserted into the anterior chamber with the injector through the main incision in the superotemporal quadrant. In seven eyes of seven patients with Fuchs endothelial corneal dystrophy treated with DMEK using our injector, clear attached grafts and improved visual acuity were achieved. This simple, inexpensive, and effective injector is a safe and viable device to facilitate this part of DMEK surgery.

Anesthesiologists' ability in calculating weight-based concentrations for pediatric drug infusions: an observational study

Study ObjectivesTo assess the ability of anesthesiologists to calculate weight-specific drug concentrations for continuous drug administration in children, and to evaluate the acceptance of an inhouse-developed, computer-based application for calculating drug infusions for pediatric cardiac surgery. DesignObservational study. SettingAnesthesiology department of a tertiary-care medical center in Israel. Participants45 anesthesiology department staff members (attendings and residents). MeasurementsAnesthesiologists were asked to calculate the weight-based amount of drug and the corresponding amount in mL to be drawn from a standard vial and added to a 50-mL syringe in order to reach an infusion rate, where 1 mL/hr corresponds to 1 μg x kg-1 x min-1. The time it took to reach the result was measured. Staff members were also asked to rate the user-friendliness and usability of the program. Main Results41 of the original 42 participants returned the completed questionnaire. Only 6 (15%) of 41 anesthesiologists provided all the correct answers. The mean calculation time required was 205 (±53) seconds. There was no difference in success rate between attendings and residents. Incorrect calculations ranged from a drug concentration 50 times too low up to 56 times too high. Most staff members believed that the computer-based application to perform these calculations reduced errors (65%) and workload (81%), and improved patient treatment (71%). This application was rated as very user-friendly. ConclusionsAnesthesiologists have difficulty calculating pediatric drug concentrations for continuous drug infusions. The correct calculations are time-consuming. Incorrect calculations may lead to dangerously high or low doses. A computer-based application to calculate drug concentrations was rated as very useful and user-friendly.

In VitroEvaluation of LithAssist: A Novel Combined Holmium Laser and Suction Device

The aim of this in vitro study was to evaluate and compare a novel intracorporeal lithotripter, LithAssist (LA; Cook Medical, Bloomington, IN), with the Swiss LithoClast Ultra (SLU; Boston Scientific, Boston, MA) for the fragmentation and removal of artificial stones made of gypsum-based cement. Ten soft and 20 hard ultracal-30 (U-30) stones were fragmented using two lithotripters. We recorded the stone weight (grams) prior to placing them into a 60-mL syringe for fragmentation. We inserted a 30F percutaneous access sheath into the syringe and positioned the stone within its lumen. Next, we inserted the lithotripter into a right-angled nephroscope. We recorded the times required for first and complete stone disintegration, disintegration to 2 mm, and complete stone removal for each device. In addition, we recorded the stone mass following each minute of stone fragmentation. In total, we subjected 5 soft and 10 hard stones to SLU and LA, respectively. All soft stones were completely disintegrated and removed with both the SLU and LA device. For soft stones, disintegration to 2 mm (2.83±0.41 vs. 4.15±0.70 minutes, p=0.049), complete disintegration (3.18±0.20 vs. 6.40±1.95 minutes, p=0.038), and complete removal (3.30±0.22 vs. 8.82±1.05 minutes, p=0.001) were faster for the SLU compared with the LA. For hard stones, fragmentation was not accomplished with the SLU, whereas with the LA, mean time for first disintegration, disintegration to 2 mm, complete disintegration, and complete removal was 3.60±1.36, 7.25±3.33, 7.54±2.94, and 8.64±2.78 minutes, respectively. In this in vitro study, the SLU was more efficient for softer artificial stones, and the LA was more efficient for harder artificial stones.

A MicroRNA Processing Defect in Smokers' Macrophages Is Linked to SUMOylation of the Endonuclease DICER

Despite the fact that alveolar macrophages play an important role in smoking-related disease, little is known about what regulates their pathophysiologic phenotype. Evaluating smoker macrophages, we found significant down-regulation of multiple microRNAs (miRNAs). This work investigates the hypothesis that cigarette smoke alters mature miRNA expression in lung macrophages by inhibiting processing of primary miRNA transcripts. Studies on smoker alveolar macrophages showed a defect in miRNA maturation. Studies on the miRNA biogenesis machinery led us to focus on the cytosolic RNA endonuclease, DICER. DICER cleaves the stem-loop structure from pre-miRNAs, allowing them to dissociate into their mature 20-22-nucleotide single-stranded form. DICER activity assays confirmed impaired DICER activity following cigarette smoke exposure. Further protein studies demonstrated a decreased expression of the native 217-kDa form of DICER and an accumulation of high molecular weight forms with cigarette smoke exposure. This molecular mass shift was shown to contain SUMO moieties and could be blocked by silencing RNA directed at the primary SUMOylating ligase, Ubc9. In determining the cigarette smoke components responsible for changes in DICER, we found that N-acetylcysteine, an antioxidant and anti-aldehyde, protected DICER protein and activity from cigarette smoke extract. This massive down-regulation of miRNAs (driven in part by alterations in DICER) may be an important regulator of the disease-promoting macrophage phenotype found in the lungs of smokers.

Catridecacog: First drug to treat rare genetic blood clotting disorder

Catridecacog, or coagulation factor XIII A-subunit, recombinant (Tretten—Novo Nordisk), a minimally invasive option for treating rare congenital factor XIII A-subunit deficiency, has received FDA approval. According to Novo Nordisk, catridecacog helps to prevent bleeding in children and adults who have the coagulation factor XIII A-subunit deficiency, an extremely rare genetic disorder. Catridecacog is the first drug to receive FDA approval for this indication. FDA also granted catridecacog orphan drug status because it treats a rare disease. Factor XIII is a terminal enzyme in the blood coagulation cascade that stimulates cross-linking of fibrin and other proteins in the fibrin clot to promote hemostasis. In human plasma, factor XIII circulates as a heterotetramer of two functional subunit proteins—two factor XIII A-subunits and two factor XIII B-subunits. The factor XIII A-subunit acts as the enzyme, while factor XIII B-subunit acts as a carrier for the factor XIII A-subunit. During coagulation, the factor XIII is activated by thrombin and calcium; the factor XIII A-subunit dissociates from the factor XIII B-subunit to become active and help cross-link fibrin to enhance platelet and clot adhesion to injured tissue. Patients with the factor XIII A-subunit deficiency have a significantly lower level of the active subunit, thus resulting in less stable clotting for injured tissue. Catridecacog binds to the free human factor XIII B-subunit, as factor XIII A-subunit, to strengthen fibrin clots, impede fibinolysis, and enhance platelet adhesion to the injury site. Give patients the Médication Guide and review it with them carefully. Verify the diagnosis, since catridecacog should not be used for prophylactic treatment of bleeding in patients with congenital factor XIII B-subunit deficiency. Advise patients that breakthrough bleeding may be a sign and symptom of inhibitor formation, and they may have to see their health care provider to measure antibody concentrations. Tell patients to inform their health care provider of all the medications they may be taking. Patients with the factor XIII A-subunit deficiency have a significantly lower level of the active subunit, thus resulting in less stable clotting for injured tissue. During clinical development, researchers studied the effectiveness of catridecacog in 77 patients with coagulation factor XIII A-subunit deficiency. Catridecacog was effective in preventing bleeding in 90% of the patients when given the recommended dose of 35 IU/ kg. The mean age of study participants was approximately 26 years (63.4% > 18 years), and the male to female ratio was 3:2. The most common related adverse events (occurring in >1% of patients treated with catridecacog) were headache, pain in the extremities, injection site pain, and an increase in nonneutralizing antibodies. Use of catridecacog is contraindicated in patients who have known hypersensitivity to the active substance or to any of the excipients. Because increased levels of rFXIII may increase the risk of thrombosis, health professionals should exercise caution in patients with a predisposition to conditions of thrombosis. Incorrect storage of the product after reconstitution may result in loss of sterility and increased levels of activated rFXIII. Catridecacog, coagulation factor XIII A-subunit, recombinant (Tretten)Manufacturer: Novo NordiskDrug class: Blood coagulation factorsIndication: Treatment of congenital factor XIII A-subunit deficiencyDosage: 35 IU/kg once monthly■To administer, reconstitute with sterile water for injection with a 10-mL syringe.■A dose recommendation cannot be made for older adults, pregnant patients, or children younger than age 6 years due to lack of data.Of note: Treatment should be initiated under the supervision of a physician experienced in the treatment of rare bleeding disorders. Do not use vial if solid matter and discoloration are present in the reconstituted product. Administer at a rate not exceeding 1–2 mL per minute. Do not administer as a drip or with other infusion solutions. Manufacturer: Novo Nordisk Drug class: Blood coagulation factors Indication: Treatment of congenital factor XIII A-subunit deficiency Dosage: 35 IU/kg once monthly■To administer, reconstitute with sterile water for injection with a 10-mL syringe.■A dose recommendation cannot be made for older adults, pregnant patients, or children younger than age 6 years due to lack of data. Of note: Treatment should be initiated under the supervision of a physician experienced in the treatment of rare bleeding disorders. Do not use vial if solid matter and discoloration are present in the reconstituted product. Administer at a rate not exceeding 1–2 mL per minute. Do not administer as a drip or with other infusion solutions.