Antecubital Fossa Research Articles

Highly Stretchable, Weavable, and Washable Piezoresistive Microfiber Sensors.

A key challenge in electronic textiles is to develop an intrinsically conductive thread of sufficient robustness and sensitivity. Here, we demonstrate an elastomeric functionalized microfiber sensor suitable for smart textile and wearable electronics. Unlike conventional conductive threads, our microfiber is highly flexible and stretchable up to 120% strain and possesses excellent piezoresistive characteristics. The microfiber is functionalized by enclosing a conductive liquid metallic alloy within the elastomeric microtube. This embodiment allows shape reconfigurability and robustness, while maintaining an excellent electrical conductivity of 3.27 ± 0.08 MS/m. By producing microfibers the size of cotton threads (160 μm in diameter), a plurality of stretchable tubular elastic piezoresistive microfibers may be woven seamlessly into a fabric to determine the force location and directionality. As a proof of concept, the conductive microfibers woven into a fabric glove were used to obtain physiological measurements from the wrist, elbow pit, and less accessible body parts, such as the neck and foot instep. Importantly, the elastomeric layer protects the sensing element from degradation. Experiments showed that our microfibers suffered minimal electrical drift even after repeated stretching and machine washing. These advantages highlight the unique propositions of our wearable electronics for flexible display, electronic textile, soft robotics, and consumer healthcare applications.

Anatomical Variation of the Radial Artery Associated With Clinically Significant Ischemia.

The purpose of this retrospective review was to investigate the incidence of radial artery anatomical variations in patients with clinically significant distal upper extremity (UE) ischemia. Available anatomical studies report that high takeoff of the radial artery occurs in up to 15% of the population. We hypothesized that there is a higher incidence of high origin of the radial artery in patients with clinically significant ischemia compared with the reported frequency in the general population. We performed a retrospective review of all patients who underwent UE angiography for clinically significant hand and digital ischemia in our institution from 2012 to 2016. Data collected included patient age, sex, comorbidities, and modality of treatment. Twenty-six angiograms were performed for UE ischemia meeting inclusion criteria. Eight patients had Raynaud disease or scleroderma. Ten patients (38%) had high radial artery takeoff with radial artery origin proximal to the antecubital fossa. The need for surgical intervention was similar in patients with normal anatomy and those with high takeoff of the radial artery. Incidence of high radial artery takeoff was found more frequently in patients with distal UE ischemia requiring angiogram than in reported population data. Diagnostic IV.

Bacteraemia Following Different Orthodontic Treatment Procedures

The purpose of this research was to estimate the percentage and nature of bacteraemia following four orthodontic treatment procedures which were: an upper alginate impression, separator placement, band fitting or placement, and arch wire adjustment on a fixed appliance. The study group consisted of 40 patients (25 females and 15 males) ranging from 17-25 years of age attending Orthodontic Department in the College of Dentistry/Baghdad University, and out patients department from private clinic. The 40 patients were divided into four groups (10 patients each). A cannula was inserted into either the left or right antecubital fossa using an aseptic technique. A 5ml of blood was taken immediately before orthodontic treatment procedure and a second 5ml sample was taken 1-2 minutes after the procedure.The blood samples showed a percentage of bacteraemia of 50%, 40%, 30%, and 20% in cases of post-band placement, post-separator placement, post-arch wire adjustment, and post-alginate impression procedures respectively.This investigation demonstrated that the placement of separator and fitting of band procedures could cause a significant bacteraemia, thus these procedures for patients at–risk of bacterial endocarditis should be placed in consideration, and the orthodontist should be advised to consult the patient's medical specialist for controlling and prescribing the necessarily antibiotic coverage.

How to undertake venepuncture to obtain venous blood samples

Venepuncture and obtaining accurate blood samples is an important procedure in healthcare, and can assist in the diagnosis, care and treatment of patients. This article outlines the procedure for undertaking venepuncture and obtaining venous blood samples. It emphasises the importance of undertaking a visual assessment of the patient's skin and palpating the veins to identify a suitable site for venepuncture. REFLECTIVE ACTIVITY: 'How to' articles can help update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Lymphatic vessel mapping in the upper extremities of a healthy Korean population.

BackgroundIntraoperative indocyanine green (ICG) lymphography can effectively detect functioning lymph vessels in edematous limbs. However, it is sometimes difficult to clearly identify their course in later-stage edematous limbs. For this reason, many surgeons rely on experience when they decide where to make the skin incision to locate the lymphatic vessels. The purpose of this study was to elucidate lymphatic vessel flow patterns in healthy upper extremities in a Korean population and to use these findings as a reference for lymphedema treatment.MethodsICG fluorescence lymphography was performed by injecting 1 mL of ICG into the second web space of the hand. After 4 hours, fluorescence images of lymphatic vessels were obtained with a near-infrared camera, and the lymphatic vessels were marked. Three landmarks were designated: the radial styloid process, the mid-portion of the cubital fossa, and the lower border of the deltopectoral groove. A straight line connecting the points was drawn, and the distance between the connected lines and the marked lymphatic vessels was measured at 8 points.ResultsThere were 30 healthy upper extremities (15 right and 15 left). The average course of the main lymph vessels passed 26.0±11.6 mm dorsal to the styloid process, 5.7±40.7 mm medial to the mid-cubital fossa, and 31.3±26.1 mm medial to the three-quarters point of the upper landmark line.ConclusionsThe main functioning lymphatic vessel follows the course of the cephalic vein at the forearm level, crosses the mid-cubital point, and travels medially toward the mid-axilla.

Analysis of the skin mycobiome in adult patients with atopic dermatitis.

With the recent availability of culture-independent sequencing methods, studies have been conducted to analyse skin micro-organisms present in patients with atopic dermatitis (AD). However, the database on the skin fungal communities, "mycobiome," has been relatively restrictive compared with the bacterial world. We aimed to comparatively analyse the overall skin mycobiome between patients with AD and healthy individuals in the Korean population. We analysed skin swab samples obtained from the antecubital fossae of 8 patients with AD and 8 healthy controls. Using sequencing method followed by direct DNA extraction and molecular PCR, taxonomic compositions of fungi at stepwise level ranks were analysed. The phylogenic marker used was internal transcribed spacer 2 regions of DNA. We observed the tendency of higher intra- and interpersonal taxonomic diversity at genus and species levels in AD samples. Non-Malassezia fungal diversity was also noticeable in the patient group compared with healthy controls. Malassezia globosa and Malassezia restricta were prevalent in all samples across both study groups, and some Malassezia species, including Malassezia sloofiae and Malassezia dermatis, characterized AD. Our data might provide a new insight into the mycobiome of adult AD, which contributes to building a systemic mycobiome database in AD.

Elevated sympathetic vasomotor outflow in response to increased inspiratory muscle activity during exercise is less in young women compared with men.

What is the central question of this study? Premenopausal women have an attenuated inspiratory muscle metaboreflex-induced increase in arterial blood pressure compared with men. It is unclear whether sympathetic vasomotor outflow during dynamic exercise with increased inspiratory muscle activation is less in young women than in men. What is the main finding and its importance? The magnitude of increased sympathetic vasomotor outflow during leg cycling with inspiratory resistance was smaller in women than in men. Less sympathetic vasomotor outflow with inspiratory muscle metaboreflex activation could be one of the mechanisms for the attenuated inspiratory muscle-induced metaboreflex during exercise in young women. We compared changes in muscle sympathetic nerve activity (MSNA) and cardiovascular variables during leg cycle exercise with increased inspiratory muscle resistance in men and women. We hypothesized that sympathetic vasomotor outflow during exercise with increased inspiratory resistance would be attenuated in young women compared with age-matched men. Eight women and seven men completed the study. The subjects performed two 10min exercise bouts at 40% peak oxygen uptake using a cycle ergometer in a semirecumbent position [spontaneous breathing for 5min and voluntary hyperventilation with or without inspiratory resistive breathing for 5min (breathing frequency 50breathsmin-1 with a 50% duty cycle; inspiratory resistance 30% of maximal inspiratory pressure)]. Mean arterial blood pressure (MAP) was acquired using finger photoplethysmography. The MSNA was recorded via microneurography of the right median nerve at the cubital fossa. During leg cycle exercise with inspiratory resistive breathing, MSNA burst frequency was increased, accompanied by an increase in MAP in both men and women. Women, compared with men, had less of an increase in MAP (women +22.8±12.3mmHg versus men +32.2±5.4mmHg; P<0.05) and MSNA burst frequency (women +9.6±2.9burstsmin-1 versus men +14.6±6.4burstsmin-1 ; P<0.05). These results suggest that the attenuated inspiratory muscle-induced metaboreflex during exercise in young women is attributable, in part, to a lesser sympathetic vasomotor outflow compared with men.

Areas under peripheral pulse waves: a potential marker of atherosclerotic changes

Objective: In this study, we propose a method for finding atherosclerotic changes based on the ratios of areas under peripheral arterial pulse wave (PW) contours and analyze its performance. Approach: The PW signals were recorded with force sensors and photoplethysmographic sensors from ankle, wrist, cubital fossa, index finger and second toe from 30 atherosclerotic patients and 52 control subjects. In addition, the day-to-day repeatability of the method was studied with 10 test subjects examined on three different days. The ratios of areas under the PWs were computed and the results were evaluated by means of receiver operating characteristic (ROC) analysis, intra-class correlation (ICC) coefficient and multiple linear regression analysis. Main results: Areas under ROC curves of 0.802–0.906 were found for different area ratios having statistically significant differences between the atheroslerotic group and control groups. ICCs over 0.80 were found widely for the beat-by-beat analyzed data and over 0.95 for the data based on the averages over different numbers of PWs. Multiple linear regression analysis showed linear dependence between the area ratios and age and the diagnosis of atherosclerosis. Significance: Our findings may facilitate development of novel diagnostic approaches and preventive strategies against cardiovascular disorders. However, further studies are needed to confirm the results. The presented study demonstrates the potential of arterial PW analysis in finding vascular abnormalities.

The Vascular Arrangement and Main Branches of Arteria Axillaris in Wing of Sparrowhawk (Accipiter nisus)

This study was aimed to determine the vascular arrangement of the wing arteries in the sparrowhawk. For this purpose, wing arteries of eight sparrowhawks were assessed by latex injection method and angiography. Latex injection method was applying to the five materials and barium sulphate solution was injected for angiography in other three materials. It was observed that the arterial blood was mainly provided to the wing by arteria axillaris. The arteria axillaris gave off arteria subscapularis. After branching the arteria subscapularis, it emitted the arteria profunda brachii and arteria supracoracoidea. After ramifying these vessel, the arteria axillaris continued down arteria brachialis. This vessel was giving off the arteria circumflexa humeri from its cranial aspect. In the nearby the cubital fossa the arteria brachialis bifurcated arteria ulnaris and arteria radialis. The arteria ulnaris gave off common stem of arteria recurrens ulnaris et arteria ulnaris profunda. After branching the common stem, the arteria ulnaris proceeded as arteria ulnaris superficialis. The arteria radialis was the deep terminate branch of the arteria brachialis. This vessel bifurcated the arteria radialis profunda and arteria radialis superficialis.

Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017).

Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017).

Unilateral higher division of brachial artery

Arterial variations are common in upper extremity. The present article describes a case of higher division of brachial artery. Higher division of brachial artery occurred above the level of insertion of coracobrachialis muscle. Further, the brachial artery proper continues lateral to median nerve in the cubital fossa and divides into radial and ulnar artery at the level of neck of radius. Higher division of brachial artery continues downward and medially, medial to the median nerve in cubital fossa, forming the superficial palmar arch in the palm. Knowledge of such variation is extremely important, especially for the limb surgeons (for carrying out surgeries in arm, creating arteriovenous fistulas for dialysis), routine blood pressure measurements, radiographic imaging, and interventionists. The relevant topics of embryology, anatomy, and its clinical importance have been discussed in the literature review. The purpose of this article is to highlight the need for the awareness of the potential existence of such anatomical variation and how it can be preoperatively detected by color Doppler imaging, which would help the surgeons and clinicians to plan out surgery and therapeutic interventions.

Superficial brachial artery traversing a median nerve loop in the arm associated with other vascular and muscular anomalies: case report and clinical implications

Knowledge of the various morphological patterns of the brachial artery and median nerve in the upper limb area is of considerable clinical and surgical importance to physicians intervening with these areas. In the current study, in the right upper limb of a male cadaver a rare variation of a superficial brachial artery associated with a median nerve loop in the upper arm is presented. The artery gave off a deep brachial artery in the arm and normally bifurcated in the cubital fossa. Additionally, a muscular bundle from the brachialis muscle was also present, overlapping the median nerve along with the deep brachial artery above the elbow. To the best of our knowledge such a combination of arterial, neural and muscular anatomical variations is extremely rare. Since brachial plexus and brachial artery variations are more prone to injury, their surgical, diagnostic and interventional importance are valuable to radiologists in interpreting images and to vascular surgeons, neurosurgeons and orthopedic surgeons involved in compressive peripheral neuropathy treatment. The relevant clinical and surgical implications are discussed as well.

Improved Coronary Sinus Blood Sampling for Cardiac Research

Background: Coronary sinus (CS) blood sampling is important for measuring metabolites and biomarkers in cardiovascular research, but can be technically challenging. Here we demonstrate the use of the antecubital fossa for CS blood sampling as an alternative to femoral access, and a simple technique of paired venous and CS blood gas analysis for confirmation of valid CS sampling. We also demonstrate improvement in sampling accuracy by using a coronary guide wire to stabilize the sampling catheter in the CS. Methods: Paired blood samples from CS and peripheral vein were collected from patients at the time of primary PCI for acute myocardial infarction. Venous access for CS sampling was via the antecubital vein. Blood gas analysis was used to confirm a true CS sample (pO2[CS]<pO2[v]). CS sampling was carried out with a catheter in the CS (standard technique) or with the addition of a coronary guide wire for stability (modified technique). Results: 108 patients underwent CS and peripheral venous blood sampling. The standard technique for CS sampling was used in 62 patients and the modified technique in 46 patients. Blood gas analysis confirmed a true CS sample in 77% of patients using the standard technique and 100% using the modified technique. Conclusions: CS blood sampling via the antecubital fossa is feasible and safe. Blood gas analysis of paired venous and CS samples can be used to confirm a valid CS sample. A coronary guide wire can be used to stabilise the sampling catheter in the CS, and this increases CS sampling accuracy.

A rare complication after blood donation: Brachial artery pseudoaneurysm

Pseudoaneurysm of brachial artery following whole blood donation is a very rare complication due to inadvertent arterial puncture. There are only a few cases reported in literature. Here, we describe this rare event in a young male whole blood donor presenting 2 months after blood donation with pulsatile swelling in the right antecubital fossa and paresthesia of hand. He was successfully managed with surgical intervention.

Endovascular procedures in pancreatic surgery

To evaluate an effectiveness of endovascular techniques in pancreatic surgery. For the period 1995-2017 at Vishnevsky Institute of Surgery endovascular treatment (EVT) was applied in 51 patients with chronic pancreatitis complicated by false aneurysms (FA) and postoperative hemorrhage after pancreatectomy. Various methods of embolization and stenting were used in 24 and 11 cases respectively in order to exclude FA of celiac trunk and superior mesenteric artery from blood flow. Endovascular hemostasis for postoperative hemorrhage was carried out with embolization of damaged vessel in 11 patients. Stent-grafts were deployed in 5 patients with marginal defect of the wall of hepatic/superior mesenteric arteries. In all 35 patients with chronic pancreatitis complicated by false aneurysms EVT ensured thrombosis of the aneurysm's cavity. EVT was final in 14 patients with FA and absent communication with pancreatic duct. Radical surgical treatment was required after 7-10 days for FA communicated with pancreatic duct due to lysis of thrombotic masses by pancreatic enzymes. Spleen infarction was diagnosed in 3 patients. Two of them did not require treatment while 1 patient underwent splenectomy in view of splenic abscess. 1 patient died from liver cirrhosis followed by severe hepatic failure, death was not associated with bleeding. In 16 patients with post-pancreatectomy bleeding hemostasis was achieved in all cases with EVT. However, recurrent bleeding occurred in 2 patients who underwent successful redo endovascular intervention. Complications after EVT were observed in 2 patients: duodenal wall necrosis followed by fistula which was closed spontaneously (n=1); advanced intestinal infarction (n=1) followed by fatal outcome; pulsating hematoma within cubital fossa that required brachial artery ligation and autovenous bypass. EVT provides thrombosis of FAs of celiac trunk and superior mesenteric artery branches in patients with chronic pancreatitis, as well as hemostasis for postoperative bleeding after pancreatectomy.

Hyper-IgE syndrome

Hyper-IgE syndrome (HIES) is a rare primary immunodeficiency condition. It is characterized by the triad of recurrent skin and lung infections, chronic dermatitis, and elevated serum Ig E level. An 8-year-old girl presented with recurrent papulovesicular lesions on the neck, axillae, cubital, and popliteal fossae since 3 years of age. The lesions healed with scarring. There was a history of recurrent diarrhea. Cutaneous examination revealed flexural dermatitis consisting of crusted lesions on the ears, neck, axillae, groins, and genitalia. The ears were deformed, and there was atrophic scarring on the face and eyelids. Routine blood investigations revealed hypereosinophilia. Serum IgE level was >2000 KIU/L. A diagnosis of HIES was made and treated with a short course of oral antibiotics, topical steroid-antibiotic combination. Children affected with HIES can develop life-threatening pulmonary infections. Hence, early diagnosis and proper management are necessary.

Co-Innervation of Triceps Brachii Muscle with Variant Branch of Ulnar Nerve.

To evaluate the existence of nerve innervation of the triceps brachii muscle via the ulnar nerve and its clinical importance in terms of nerve transfer or susceptibility to iatrogenic injuries during surgical procedures. Thirty-five skeletally mature upper extremities of adult cadavers were included in the present study. The ulnar nerve was revealed from the medial cord to the distal part of the cubital fossa. The existence of the branches of the ulnar nerve and communicant branch of the radial nerve was examined in the brachium. The diameter and length of the variant nerve branches were measured. A nerve branch from the ulnar nerve to the triceps brachii muscle was found in five of the dissected extremities (14.7%). The mean length and diameter of the variant nerve branch were 20.2 mm and 1.46 mm, respectively. The mean distance of the muscle entry point of the variant nerve branch from the bi-condylar line was 8.18 cm. A variant nerve branch via the ulnar nerve can innervate the medial head of the triceps brachii at the distal third of the brachium. This variant nerve branch will be under risk of iatrogenic injury during elbow surgery and it seems to be an option for nerve grafts.

Variation in patterns of superficial vein of cubital fossa

Aim: To determine anatomical variations of superficial veins of cubital fossa. Background: The cubital fossa Veins lie superficially in the subcutaneous tissue and not paired with any artery, they are easy to view and access. The superficial veins include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries. The knowledge of superficial venous distribution of the cubital fossa is important, not only from an anatomical-clinical and surgical point of view, but also anthropologically and biologically. Materials and Methods: The study done on120 males and 30 females were randomly selected from among the rural area of central India which also include the students and staff members of J.N.M. College Sawangi Wardha (M.S.) 150 cases of right upper limbs and 150 cases of left upper limbs. After taking the subject's consent, the superficial veins of the cubital fossa were made prominent by using tourniquet. The patterns of cubital veins were marked on skin and photograph are taken. Results: the patterns of arrangement of superficial cubital vein observed are as follow. Type I –MCoV joining with the CV and BV in 51%., type II CV bifurcating intoMBV and MCV which join BV and ACV respectively, Type III-MVF bifurcating in MBV and MCV 9.66%., Type IV- 7.66%subjects of present study the CV terminates in to BV and ACV runs separately, In Type V- 3% of subjects the CV communicating directly with BV and ACV was absent and Type VI –A large single CV ascending upwards without any communication with other veins. 3 of 300 subjects i.e. 1%. Conclusion: Numerous studies in different races and ethnic groups have shown similarities and differences in the deposition of the superficial veins of the cubital fossa. Various procedure should be perform with caution bearing in mind the anatomical variation present in these region.

Five-year prospective study on cardiovascular events, in patients with erectile dysfunction and hypotestosterone.

Testosterone levels play a role in cardiac and vascular pathology. In the present study we investigated the prognostic significance of this hormone for cardiovascular outcome, in a 5-year follow-up. Our cohort included 802 adult subjects, from 40 to 80 years. Patients were excluded if they had a past history of peripheral or coronary artery disease, and revascularization. A blood sample was drawn to valuate testosterone level, and we considered normal testosterone levels 300 ng/dl. FMD (flow mediated dilatation) of the brachial artery was assessed by measuring the increase of the brachial artery diameter during reactive hyperemia after transient forearm ischemia. B-mode longitudinal images of the brachial artery were obtained at the level of the antecubital fossa. The FMD was defined as the percentage change in the brachial artery diameter 60 s after releasing the ischemic cuff. Erectile dysfunction (ERD) was assessed by the International Index of Erectile Function-5 (IIEF-5) score questionnaire. We considered composite end points including the following major adverse cardiovascular events (MACEs) Results: Subjects with lower serum testosterone levels (n = 332) had higher prevalence of traditional cardiovascular risk factors, such as hypertension (p = 0.009), diabetes (p = 0.03), dyslipidemia (p < 0.0001), obesity (p = 0.002), and endothelial function score (p < 0.0001). AMI, death after AMI, major stroke and all clinical events were more frequent (p < 0.001) in patients with testosterone levels < 300 ng/dl. Further, by multiple logistic regression analysis we found that only dyslipidemia (p = 0,001), obesity (p = 0,007), testosterone < 300 ng/dl (p < 0,0001) and ED (p < 0,0001) were independent predictors of future events. A therapeutic intervention on testosterone may not only have a positive effect on the cardiovascular system but also an important role in preventing new cardiovascular events.

Topographical diversity of common skin microflora and its association with skin environment type: An observational study in Chinese women

This study evaluated cutaneous microbial distribution, and microbial co-occurrence at different body sites and skin environments in Chinese women (39.6 ± 11.9 years, N = 100) during the winter season. Microbial distribution (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Lactobacillus, Pseudomonadaceae, and Malassezia furfur), association with biomarkers (antimicrobial peptides: LL-37, β-defensins [HBD-2, HBD-3]), and claudin-1) and skin biophysical parameters (transepidermal water loss, pH, skin scaliness and roughness, sebum and hydration levels) were also determined. Skin sites (glabella [GL], hand-back [HB], interdigital web-space [IS], antecubital fossa [AF], volar forearm [VF], back [BA]) were classified as normal, oily or dry based on two-step cluster analysis and exposed or unexposed (uncovered or covered by clothes, respectively) based on seasonal apparel. Pseudomonadaceae and Staphylococcus aureus had the highest and lowest detection rate respectively at all sites. Cluster analysis identified skin sites as ‘normal’ (HB, BA, AF, VF), ‘dry’ (IS) and ‘oily’ (GL). Bacterial alpha diversity was higher in exposed (HB, IS, and GL) compared with unexposed sites (BA, AF and VF). Co-occurrence of Staphylococcus aureus with any of the other five microorganisms was lower in dry and oily skin versus normal skin. Skin exposure, biophysical/barrier profile and biomarkers were found to be associated with bacterial distribution and co-occurrence.