Cephalic Vein Research Articles

Assessment of Blood Gas Pattern amongst Artisanal Refinery Operators in Rivers State, Nigeria

Some identified setbacks of the legitimate and illegitimate explorations/exploitations of crude oil and its derivatives in the Niger Delta are degraded environment, weak economy, and deteriorating health of the populace. Therefore, the current study evaluated the effect of artisanal refinery operation on respiratory blood gases and renal functions of its workers in Rivers State. As a cross-sectional investigation with sparse population, the multistage sampling technique (including purposive and snowball tools) was adopted to recruit 203 (including 120 operators of artisanal refinery―OAR-actively exposed and 83 non-OAR- actively exposed) willing and apparently healthy male and female adult subjects. Following receipt of ethical approval and consent, five milliliter of blood was taken from each subject from their antecubital vein after sterilizing the portion of the cubital fossa. The sample was then put into plain sample bottle and centrifuged to recover serum. Thereafter, the automated blood gas analyzer was used to measure the arterial blood gases of the subjects. The result showed marked (P<0.05) reductions in the partial pressure of oxygen (PO2) and oxygen saturation (SO2) levels in artisanal refinery operators (actively exposed) when compared to that of the passively-exposed subjects. Again, there were marked (P<0.05) elevations in the plasma pH and bicarbonate ions (HCO-3) levels in the actively exposed subjects compared to their passively-exposed counterparts. In conclusion, there could be adverse impact on respiratory blood gases and incidences of metabolic alkalosis over chronic exposures to the OAR activities.

Some Acute Phase Proteins and Biochemistry Parameters of Female Dogs Affected with Pyometra

Some Acute Phase Proteins and Biochemistry Parameters of Female Dogs Affected with Pyometra

Outcomes of AV fistula formation for dialysis patients using interrupted sutures one-year single center study.

To document the Outcomes of AV fistula formation for dialysis patients using interrupted sutures. In this Cross-sectional study conducted at PNS Shifa Karachi, from June 2022 to June 2023, patients above 18 years of age, male or female, with ESRD/CKD were included. After clinical screening and ultrasound doppler, the distal most part of wrist was considered as a site for radio cephalic AVF. Operation was performed under surgical loupe with 4.5x magnification. Standard incision of about 4-5 cm oblique proximal to the wrist crease was given at the volar surface on the radial side of Distal forearm, extending till the lateral side up to the snuffbox. Subcutaneous tissue was incised and dissection was done to identify the cephalic vein and radial artery. Distal most end of the cephalic vein was ligated using vicryl 4-0 suture and cephalic vein dissected free from the underling tissue to mobilize it up to the radial artery. During the study N=35 patients who required AVF creation visited the department. The mean age of the study participants was 59.34±15.48. If thrill at the site of AVF and backflow at cut end of cephalic vein were present the surgeons were satisfied, higher satisfaction among the surgeon was achieved in the AVF created at brachiocephalic artery while the diameter of vessels didn't contribute in surgeon satisfaction. Presence of thrill at the site of AVF and backflow at cut end of cephalic vein have strong association with good prognosis of AVF.

Abstract 7485: Microfluidic detection of dual positive cells in whole blood of metastatic breast cancer patients

Abstract Background. Dual positive cells (DPCs) that express both epithelial markers and leukocytic markers have been observed in peripheral blood of breast cancer patients. DPCs acquire functional behaviors from both cell types which may drive tumor progression. However, the lack of reliable methods to isolate and identify DPCs has hindered the investigation of their origin and clinical implications in breast cancer patients. While microfluidic devices have been widely used for the detection of circulating tumor cells (CTCs) by liquid biopsy, DPC detection is underexplored in these devices. Herein, we demonstrate rapid onchip isolation and detection of DPCs in whole blood samples from metastatic breast cancer (MBC) patients using an integrated microfluidic device. Methods. Our microfluidic device consists of a unique preconditioning component that concentrates targets in whole blood and a downstream cell immobilization component that captures target cells. We included 7 female patients with MBC, of which 29% are white (2), 57% are African American (4), and 14% are Latina (1). The median age is 50y (34y -75y). All patients were undergoing systemic breast cancer therapy at the time of blood collection. A total of 9 samples (4 mL each) were collected from either an antecubital vein (peripheral vein) or the subcutaneous port catheter (central vein) of these patients. All samples were processed within 5 hours of blood drawn in our novel microfluidic biochip. CTCs (EpCAM+/CK+, CD45-, DAPI+) and DPCs (EpCAM+/CK+, CD45+/CD66b+, DAPI+) were identified by immunofluorescence after cells were fixed. Results. Processing of each sample was completed within 40 minutes using our microfluidic device. Both DPCs and CTCs were detected in all the samples (9/9). The average DPC count was 3 DPCs per 4 mL whole blood with a standard deviation of 1.9 cells. The average CTC count was 9 with a standard deviation of 5 per 4 mL whole blood. 89% of the samples (8/9) had > 5 CTCs after the sample volume is scaled to the standard 7.5 mL. No correlation was found between DPC count and CTC count (Pearson correlation coefficient r=0.08). While the blood collection location (central vs peripheral veins) had a significant impact on the CTC count (12.6 vs 4 on average with p<0.01), there was no statistical difference in DPC counts in the samples collected from central and peripheral veins. Conclusions. Both DPCs and CTCs can be rapidly isolated and detected from MBC patient whole blood in our microfluidic device. Our preliminary results indicate no correlation between DPCs and CTCs, suggesting that DPCs might not originate in blood circulation of MBC patients. More work with a larger patient cohort will be needed to further investigate the clinical implications of DPCs on MBC patients. Citation Format: Jian Zhou, Qiyue Luan, Celine Macaraniag, Arielle B. Guzman, Maria Mantice, Oana Danciu, Kent F. Hoskins, Ian Papautsky. Microfluidic detection of dual positive cells in whole blood of metastatic breast cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7485.

Salvage of brachiocephalic aneurysmatic fistulas, using ePTFE graft with a minimally invasive approach.

In this study, we evaluated our surgical approach in requiring surgical treatment of brachiocephalic arteriovenous fistula (AVF) aneurysms for salvage of AVF. Between 2012 and 2022, 20 patients (16 men, 4 women; mean age 54.5 years) who were surgically treated for a brachiocephalic AVF aneurysm in our Cardiovascular Surgery Clinic were evaluated retrospectively. These 20 patients were operated on for aneurysm thrombosis and fistula failure in 16 patients, sudden rupture and severe bleeding in 3 patients, cosmetic reasons, and anxiety in 1 patient. These aneurysms were ligated and divided from distal and proximal cephalic veins. Then, a 6 mm dialysis graft was interposed between the well-developed cephalic vein distal and proximal to the aneurysm with small skin incisions. All patients were taken to dialysis via this dialysis graft 24 h after the procedure without any problem. All patients were discharged after dialysis. After surgery, no catheterization or any other additional procedure was required for hemodialysis. No complications, such as infection, hematoma, neurological damage, or ischemia, were observed after the surgical procedure. The mean postoperative follow-up was 12 months. In brachiocephalic AVF aneurysms requiring surgical treatment, hemodialysis can be continued with a graft placed in the same arm in this technique.

Angiogenic and vasoactive proteins in the maternal-fetal interface in healthy pregnancies and preeclampsia

Preeclampsia is characterized by maternal endothelial activation and placental dysfunction. Imbalance in maternal angiogenic and vasoactive factors has been linked to the pathophysiology. The contribution of the placenta as a source of these factors remains unclear. Furthermore, little is known about fetal angiogenic and vasoactive proteins and the relation between maternal and fetal levels. We describe placental growth factor, soluble Fms-like tyrosine kinase 1, soluble endoglin, and endothelin 1-3 in 5 vessels in healthy pregnancies, early- and late-onset preeclampsia. Specifically, we aimed to (1) compare protein abundance in vessels at the maternal-fetal interface between early- and late-onset preeclampsia, and healthy pregnancies, (2) describe placental uptake and release of proteins, and (3) describe protein abundance in the maternal vs fetal circulations. Samples were collected from the maternal radial artery, uterine vein and antecubital vein, and fetal umbilical vein and artery in 75 healthy and 37 preeclamptic mother-fetus pairs (including 19 early-onset preeclampsia and 18 late-onset preeclampsia), during scheduled cesarean delivery. This method allows estimation of placental release and uptake of proteins by calculation of venoarterial differences on each side of the placenta. The microarray-based SomaScan assay quantified the proteins. The abundance of soluble Fms-like tyrosine kinase 1 and endothelin 1 was higher in the maternal vessels in preeclampsia than in healthy pregnancies, with the highest abundance in early-onset preeclampsia. Placental growth factor was lower in the maternal vessels in early-onset preeclampsia than in both healthy and late-onset preeclampsia. Maternal endothelin 2 was higher in preeclampsia, with late-onset preeclampsia having the highest abundance. Our model confirmed placental release of placental growth factor and soluble Fms-like tyrosine kinase 1 to the maternal circulation in all groups. The placenta released soluble Fms-like tyrosine kinase 1 into the fetal circulation in healthy and late-onset preeclampsia pregnancies. Fetal endothelin 1 and soluble Fms-like tyrosine kinase 1 were higher in early-onset preeclampsia, whereas soluble endoglin and endothelin 3 were lower in both preeclampsia groups than healthy controls. Across groups, abundances of placental growth factor, soluble Fms-like tyrosine kinase 1, and endothelin 3 were higher in the maternal artery than the fetal umbilical vein, whereas endothelin 2 was lower. An increasing abundance of maternal soluble Fms-like tyrosine kinase 1 and endothelin 1 across the groups healthy, late-onset preeclampsia and early-onset combined with a positive correlation may suggest that these proteins are associated with the pathophysiology and severity of the disease. Elevated endothelin 1 in the fetal circulation in early-onset preeclampsia represents a novel finding. The long-term effects of altered protein abundance in preeclampsia on fetal development and health remain unknown. Further investigation of these proteins' involvement in the pathophysiology and as treatment targets is warranted.

Role of Doppler Evaluation in Assessing the Maturation of the Arteriovenous Fistula for Hemodialysis: An Observational Study.

Introduction Arteriovenous fistulas (AVFs) are the preferred type of vascular access for hemodialysis due to their lower risk of complications. This study aimed to determine the role of Doppler evaluation in assessing AVF. Materials and methods We conducted an 18-month prospective observational study of 33 hemodialysis patients who underwent a procedure for the creation of AVF at the Department of Radio-Diagnosis at Sri Devaraj Urs Academy of Higher Education and Research.Patients were evaluated using color Doppler ultrasound. Participants underwent a careful history and clinical examination to diagnose the disease. All relevant parameters were documented in a structured study proforma. AVF maturation was assessed postoperatively at four weeks using Doppler ultrasound color flow evaluation by looking for vascular components (flow volume, vein, and arterial diameter). Data were analyzed using CoGuide V 1.0.3 Statistical Software (CoGuide, Bangalore, India). Results A total of 33 patients, with a mean age of 54.6 ± 7.8 years, were evaluated. Of the 33 participants, 24 (72.7%) were male, and nine (27.3%) were female. The majority (47%, n=16) of participants had diabetes mellitus, eight (24%) had hypertension, and 10 (29%) had both diabetes mellitus and hypertension. A brachiocephalic fistula was created in 45.5% of participants, and 33.33% had radiocephalic anastomoses. Five participants were diagnosed with AVF complications: two had a pseudoaneurysm, and three had a cephalic vein thrombus. Clinical and demographic characteristics (age, vascular components, and complications) were not significantly related to AVF maturation. Conclusions Doppler ultrasound plays an important role in selecting vessels for AVF preoperatively and assessing AVF maturation postoperatively, thus reducing the primary fistula failure rate. The findings suggest that Doppler evaluation can be a reliable tool for assessing AVF maturation and predicting surgical success, which could help healthcare providers make informed decisions about the best course of treatment for their patients. Continued research is warranted in this area to further understand the role of Doppler ultrasound in evaluating AVF surgery.

Computer-assisted image analysis of preexisting histological patterns of the cephalic vein to predict wrist arteriovenous fistula non-maturation

BackgroundWe used computer-assisted image analysis to determine whether preexisting histological features of the cephalic vein influence the risk of non-maturation of wrist fistulas. MethodsThis study focused on patients aged 20–80 years who underwent their first wrist fistula creation. A total of 206 patients participated, and vein samples for Masson's trichrome staining were collected from 134 patients. From these, 94 patients provided a complete girth of the venous specimen for automatic image analysis. Maturation was assessed using ultrasound within 90 days after surgery. ResultsThe collagen to muscle ratio in the target vein, measured by computer-assisted imaging, was a strong predictor of non-maturation in wrist fistulas. Receiver operating characteristic analysis revealed an area under the curve of 0.864 (95% confidence interval of 0.782–0.946, p < 0.001). The optimal cut-off value for the ratio was 1.138, as determined by the Youden index maximum method, with a sensitivity of 89.0% and specificity of 71.4%. For easy application, we used a cutoff value of 1.0; the non-maturation rates for patients with ratios >1 and ≤ 1 were 51.7% (15 out of 29 patients) and 9.2% (6 out of 65 patients), respectively. Chi-square testing revealed significantly different non-maturation rates between the two groups (X2 (1, N = 94) = 20.9, p < 0.01). ConclusionComputer-assisted image interpretation can help to quantify the preexisting histological patterns of the cephalic vein, while the collagen-to-muscle ratio can predict non-maturation of wrist fistula development at an early stage.

Presence of Ehrlichia sp and Hepatozoon sp in dogs infested with ticks or with previous exposure attended at a veterinary centre in Trujillo, Peru

The present study determined the prevalence of Ehrlichia sp morulae and Hepatozoon sp gamonts in dogs treated at a veterinary medical centre in the city of Trujillo. Blood samples were taken from dogs infested with ticks or exposed in the three months prior to the study. Blood samples (3 mL) were collected from the cephalic vein of 95 dogs in EDTA tubes. The samples were centrifuged. A drop of the phlogistic layer of each sample was placed on a slide, which was extended with a coverslip and subjected to Wright staining. The smears were observed under an optical microscope at 40X and 100X. A prevalence of Ehrlichia sp of 31.6 ± 9.4% was found. No presence of Hepatozoon sp gamonts was observed.

Comparison of plasma l-lactate between jugular and cephalic veins in healthy and systemically ill horses using a point-of-care device.

To compare plasma l-lactate (LAC) values between samples collected from jugular and cephalic venipuncture in healthy horses and systemically ill horses. Prospective, experimental study. Large animal university teaching hospital. Thirty healthy adult university-owned horses and 43 client-owned horses presenting to the large animal hospital for elective surgical procedures or for emergent medical evaluation of systemic illness. Blood samples were collected from the jugular vein (JV) and cephalic vein (CV) and placed in EDTA blood tubes prior to any medical therapy. LAC values were obtained with a handheld lactate meter at the time of blood collection. LAC was higher in CV samples than JV samples in healthy horses (P<0.001); however, all values were within the normal reference range. Similarly, LAC was higher in CV samples than JV samples in systemically ill horses (P<0.001), but the median JV value was within normal reference range (1.9mmol/L [17.1mg/dL]), while the median CV value was outside the normal reference range (2.9mmol/L [26.1mg/dL]). The CV is an alternative venipuncture site for assessing plasma LAC if the JV is not accessible or to preserve the JV for subsequent catheterization. However, in ill horses, the CV value may be outside the reference range when the corresponding JV value would have been within the reference range.

Excess dietary Lys reduces feed intake, stimulates jejunal CCK secretion and alters essential and non-essential blood AA profile in pigs

BackgroundCommercial diets are frequently formulated to meet or exceed nutrient levels including those of limiting essential amino acids (AA) covering potential individual variations within the herd. However, the provision of dietary excess of AA, such as Lys, may lead to reduced appetite and growth in pigs. The mechanisms modulating these responses have not been extensively investigated. This study evaluated the effect of Lys dietary excesses on performance and satiety biomarkers in post weaning pigs.MethodsTwenty-four pigs aged 21 d and weighing 6.81 ± 0.12 kg (mean ± SEM) were individually housed and offered 1 of 4 dietary treatments for 3 weeks: a diet containing a standardized ileal digestible Lys reaching 100% (T0), 120% (T1), 150% (T2) or 200% (T3) of the NRC (2012) requirements. At the end of the experiment, blood samples from the cephalic vein of the T0 and T3 groups were obtained for AA analysis. In addition, primary intestinal cultures from T0 pigs were used, following their humane killing, to evaluate the effect of Lys on gut hormone secretion and AA sensors gene expression under ex vivo conditions.ResultsFeed intake was linearly reduced (P < 0.001) and the weight gain to feed ratio reduced (P < 0.10) with increased dietary levels of Lys during the third- and first-week post weaning, respectively. Cholecystokinin concentration (P < 0.05) and the metabotropic glutamate receptor 1 and the solute carrier family 7 member 2 (P < 0.10) gene expression was enhanced in proximal jejunum tissues incubated with Lys at 20 mmol/L when compared to the control (Lys 0 mmol/L). Plasma Lys and Glu (P < 0.05) concentration increased in the T3 compared to T0 pigs. In contrast, plasma levels of His, Val, Thr, Leu (P < 0.05) and Gln (P < 0.10) were lower in T3 than T0 pigs.ConclusionThe present results confirm that excess dietary Lys inhibits hunger in pigs. Moreover, the results provide evidence of pre- and post-absorptive mechanisms modulating these responses. Lys dietary excesses should be narrowed, when possible, to avoid negative effects of the AA on appetite in pigs.

Follow-up evaluation of snuffbox arteriovenous fistula as an alternative site for hemodialysis - a case series in a lower-middle country

Link of Video Abstract: https://youtu.be/MSeO8kuKhGc Introduction: The preferred vascular access for hemodialysis in chronic kidney disease patients is the arteriovenous fistula (AVF). It is recommended to create AVFs as distally as possible. The snuffbox, situated at the far end of the wrist, is infrequently utilized for AVF insertion due to the prevalent smaller vessel calibers. Case: This case series involves seven patients with chronic kidney disease scheduled for first AVF placement in the snuffbox region, with an average age of 56.71 years. All patients showed an average radial artery caliber of 20.3mm, a mean peak systolic velocity of 67.14 cm/s, and a cephalic vein caliber of 22.7mm, according to preoperative vascular ultrasound. The AVF placement involved an end-to-side anastomosis. All patient demonstrated anastomosis clinical maturation, the primary patency rate was 86%. Follow-up Doppler examinations revealed that patients achieving functional patency had an average caliber of 5.22mm and an average flow rate of 810.65 ml/s. Conclusion: SAVF are created less frequently due to predominantly smaller vessel caliber. However, it can be a viable alternative site for fistula implantation. Vascular mapping is required to ensure that both vessels have minimum 2 mm caliber. Maturation in SAVF have comparable results with the other sites.

Comparative studies on haemato-biochemical changes following pre-emptive analgesia with tramadol, pentazocine lactate and meloxicam inpain management of canine ovariohysterectomy

The present study was conducted to evaluate the effects of tramadol, pentazocine lactate and meloxicam as pre- emptive analgesics in dogs premedicated with glycopyrrolate, inducted with propofol and maintained with propofol continuous rate infusion (CRI) for certain haematological and biochemical parameters. The animals were randomly divided into three equal groups,viz. Group-T, Group-P and Group-M comprising six animals in each group and all the animals were premedicated with glycopyrrolate. After 10 min of pre-anaesthetic administration, pre-emptive analgesia was given. Blood was collected from cephalic or saphenous vein at intervals 0 (baseline) min before premedication, thereafter at 10 min, 30 min, 1 h, 2 h and 3 h after pre-emptive analgesic administration and haemato- biochemical parameters were recorded. Hb, PCV and TEC were significantly decreased at 30 min and 1 h interval in all the three groups. TLC and glucose concentration were significantly higher in group-M as compared to group-T and group-P at different time intervals. GGT level increased significantly at 30 min in all the three groups. CRP concentration was significantly higher in group-M as compared to group-T. Total protein was significantly decreased at 1 h interval in group-T and group-P, but in group-M such finding was noticed at 2 h interval. Cortisol was significantly lower in group-T in entire study period. The alterations in physiological and haematological parameters caused by tramadol, pentazocine lactate and meloxicam were found to be minimal and within the physiological limits. Tramadol produced less significant rise in CRP and cortisol concentrations which indicated better pain management. Based on the findings of the present study, it is concluded that tramadol is more effective as compared to pentazocine lactate and meloxicam in the management of post-operative pain due to canine ovariohysterectomy.

Cephalic Vein Cutdown Is Superior to Subclavian Puncture as Venous Access for Patients with Cardiac Implantable Devices after Long-Term Follow-Up.

Cephalic vein cutdown (CVC) and subclavian vein puncture (SVP) are the most commonly used access sites for transvenous lead placement of cardiac implantable electronic devices (CIEDs). Limited knowledge exists about the long-term patency of the vascular lumen housing the leads. Among the 2703 patients who underwent CIED procedures between 2005 and 2013, we evaluated the phlebographies of 162 patients scheduled for an elective CIED replacement (median of 6.4 years after the first operation). The phlebographies were divided into four stenosis types: Type I = 0%, Type II = 1-69%, Type III = 70-99%, and Type IV = occlusion. Due to the fact that no standardized stenosis categorization exists, experienced physicians in consensus with the involved team made the applied distribution. The primary endpoint was the occurrence of stenosis Type III or IV in the CVC group and in the SVP group. In total, 162 patients with venography were enrolled in this study. The prevalence of high-degree stenosis was significantly lower in the CVC group (7/89, 7.8%) than in the SVP group (15/73, 20.5%, p = 0.023). In the CVC group, venographies showed a lower median stenosis (33%) than in the SVP group (median 42%). The present study showed that the long-term patency of the subclavian vein is higher after CVC than after SVP for venous access in patients with CIED.

How to Omit the Potential Pitfalls in Distal Radial Access: Lessons From Cadaveric and CTA Analysis.

To verify the anatomical basis, ideal puncture sites, and potential pitfalls of the distal radial artery (dRA) in the anatomical snuffbox region for distal radial access (dTRA). Overall, 26 formalin-fixed upper limbs and computed tomography angiography (CTA) of the upper limbs of 168 consecutive patients were studied. Cadaveric dissection and dRA 3D reconstruction were used to evaluate the dRA route for dTRA. The puncture sites, dRA diameter, and angle of the dRA and tendons of the extensor pollicis brevis were also measured in the patients and cadavers. The cadaver dissection provided more insights than did the dRA 3D reconstruction. However, preoperative evaluation had better diagnostic accuracy (p=0.024). Puncture sites 1 and 3 had a high success rate (63.2% possible success rate, 191/302). The DISFAVOR theory was put forward, in which 8 types of potential pitfalls that may interrupt puncture procedure or lead to a surgical failure were observed, including occlusion, stenosis, tortuosity, arteriovenous fistula, angioma, different radial artery (RA) ramifications, radial veins, and cephalic veins. The mean diameter of dRA based on cadaver dissection and CTA was 2.53 (SD=0.73) and 2.63 (SD=0.69) mm, respectively. Furthermore, the minimum distance from the outer layer of dRA to the skin was 5.71 (SD=2.0) mm based on CTA. The angle between the dRA and tendons of extensor pollicis brevis (TEPB) based on cadaver dissection and CTA was 58.0° (SD=21.5°) and 51.8° (SD=16.6°), respectively. Puncture sites 1 and 3 were more suitable for the dTRA, and we put forward the DISFAVOR theory to summarize the 8 types of potential pitfalls during the use of dTRA.

A modeling study of position and orientation of hemodialysis needles and the impact on vascular access

Patients with chronic kidney disease (CKD) need renal replacement therapy (RRT) and the favored method is hemodialysis (HD). An arteriovenous fistula is the preferred choice of vascular access, with two metal needles used to transfer the blood with waste to the dialysis machine and return the blood without waste from the dialysis machine to the patient’s body. However, wounds on the veins can cause blood clots which if left untreated could be life threatening. The hemodialysis needles can cause vascular wall abnormalities. The position and orientation of these needles might cause intimal hyperplasia (IH) and finally lead to blood clots. This study aims to analyze the hemodynamic effects on the vascular endothelium in AVF vascular access. A 15G needle was placed inside a vein at angles of 20°, 40°, and 90° with normal insertion and flipped needle in an idealized cephalic vein with the bore of the needle centrally located, conforming to standard cannulation practice. The 3D model created by SolidWorks consists of shaft, back eye, bevel, and vein only; the vein and 15G needle were assembled together. The mathematical model of blood rheology in this paper used Carreau’s law in the fluid domain. It was imported into Ansys CFX for calculation, a finite volume based software, which was implemented to solve the governing equations of the blood flow. The result showed that if the venous needle was not towards the venous return, a vortex appeared at the vein both upstream and downstream due to the venous needle, resulting in wall shear stress at the vein increasing significantly, and the flipped bevel seems to cause higher wall shear stress. For antegrade positioning of the vein vascular access return in the model when normally inserted, it was found that only 1% of the flow out of the back eye and vortex occurred downstream of the vein. Needles placed at a higher angle can increase wall shear stress and pressure on the vein. The flipped bevel is not significant in terms of either pressure or wall shear stress. However, when the needle is placed at a greater angle, wall shear stress and pressure on the vein were also increased. The flipped bevel caused higher wall shear stress and pressure when increasing the needle angle. Jetting from the venous needle causing intimal hyperplasia (IH) leads to blood clots, pain on the vein, and ultimately arm pain. Thus, the best cannulation procedure is for the venous needle to be toward the venous return, at a lower angle, and with the tip of the needle on the middle of the vein. Furthermore, the back eye should not be used for the venous needle but should be used for the arterial needle.

Computed Tomography Evaluation of Frozen or Glycerinated Bradypus variegatus Cadavers: A Comprehensive View with Emphasis on Anatomical Aspects

Bradypus variegatus has unique anatomical characteristics, and many of its vascular and digestive tract aspects have yet to be clearly understood. This lack of information makes clinical diagnoses and surgical procedures difficult. The aim of this study was to evaluate the anatomical aspects of frozen and glycerinated corpses of B. variegatus using computed tomography (CT), emphasizing vascular and digestive contrast studies. Nine corpses that died during routine hospital were examined via CT in the supine position with scanning in the craniocaudal direction. In frozen cadavers, the contrast was injected into a cephalic vein after thawing and, subsequently, was administered orally. In addition to bone structures, CT allowed the identification of organs, soft tissues, and vascular structures in specimens. Visualization of soft tissues was better after contrast been administered intravenously and orally, even without active vascularization. Furthermore, the surfaces of the organs were highlighted by the glycerination method. With this technique, it was possible to describe part of the vascularization of the brachial, cervical, thoracic, and abdominal regions, in addition to highlighting the esophagus and part of the stomach. CT can be another tool for the evaluation of B. variegatus cadavers by anatomists or pathologists, contributing to the identification of anatomical structures.

Ultrasound-Guided Venous Axillary Access Versus Standard Fluoroscopic Technique for Cardiac Lead Implantation: ZEROFLUOROAXI Randomized Trial

BackgroundAxillary vein puncture (AVP) and cephalic vein surgical cutdown are recommended in international guidelines because of their low risk of pneumothorax and chronic lead complications. Directly visualizing and puncturing the axillary vein under ultrasound guidance reduces radiation exposure, provides direct needle visualization, and lowers periprocedural complications. Our hypothesis is that ultrasound-guided axillary access is safer and more feasible than the standard fluoroscopic technique. ObjectivesThe purpose of this study was to assess the efficacy and safety of ultrasound-guided axillary venous access during cardiac lead implantation for pacemakers (PMs) and implantable cardioverter-defibrillator (ICD) implantations. MethodsPatients were randomized in a 1:1 fashion to either axillary venous access under fluoroscopic guidance or ultrasound-guided axillary venous access. The composite outcome, including pneumothorax, hemothorax, inadvertent arterial puncture, pocket hematoma, pocket infection, lead dislodgement, and death, was evaluated 30 days after implantation. ResultsWe randomized 270 patients into 2 groups: the standard group for fluoroguided AVP (n = 134) and the experimental group for ultrasound-guided AVP (n = 136). No disparities in baseline characteristics were observed between the groups. The median age of the patients was 81 years, with women comprising 41% of the population. The majority of patients received single- and dual-chamber PMs (87% vs 88%; P = 1.00), and slightly over 10% in both groups received ICDs (13% vs 12%; P = 0.85). In total, we placed 357 leads in PMs and 48 leads in ICDs. Among these, 295 leads were inserted via axillary vein access and 110 via cephalic vein access. Notably, the subclavian vein was never used as a vascular access. The composite outcome was lower in the ultrasound group according to intention-to-treat analysis (OR: 0.55; 95% CI: 0.31-0.99; P = 0.034). The main difference within the composite outcome was the lower incidence of inadvertent axillary arterial puncture in the experimental group (17% vs 6%; P = 0.004). The ultrasound group also exhibited lower total procedural x-ray exposure (10,344 μGy × cm2 vs 7,119 μGy × cm2; P = 0.002) while achieving the same rate of success at the first attempt (61% vs 69%; P = 0.375). ConclusionsUltrasound-guided AVP is safer than the fluoroscopy-guided approach because it achieves the same rate of acute success while maintaining low total procedural radiation exposure. Ultrasound AVP should be considered the optimal venous access method for cardiac lead implantation. (Ultrasound Guided Axillary Access vs Standard Fluoroscopic Technique for Cardiac Lead Implantation [ZEROFLUOROAXI]; NCT05101720)

Relationships between haptoglobin and inter-alpha trypsin inhibitor heavy chain 4 levels inlocal and peripheral blood and systemic inflammatory response syndrome in bitches withpyometra.

We aimed to assess the usefulness of monitoring inter-alpha trypsin inhibitor heavy chain 4 (ITIH4) and haptoglobin (Hp) in peripheral and local blood in canine pyometra, and evaluation the relationships among acute phase proteins (APPs), systemic inflammatory response syndrome (SIRS) and the presence of bacteria. The material was collected from bitches with pyometra and from healthy ones. Blood was taken from the cephalic and uterine veins. APPs levels were quantified by ELISA. In the peripheral circulation, the Hp was higher in animals with open-cervix pyometra (OCP) than in the closed-cervix pyometra (CCP) and the control group. The Hp concentration was not correlated with age, with the presence of SIRS or with the type of bacteria (Gram-negative, Gram-positive or mixed flora). The ITIH4 concentrations in the peripheral blood did not differ significantly in the cases of pyometra. The Hp concentration in the local circulation increased in the OCP but not in the CCP groups, although the histopathological changes in the endometrium were similar. Peripheral Hp concentrations may be a useful tool in differentiating between the types of pyometra.

Birth Weight and Third-trimester Maternal Vitamins A, C, and E Levels

Background: Deficiencies of micronutrients (especially vitamins C, A, and E) during intra-uterine life have been linked with the possibility of increased risk of some diseases (e.g. cardiovascular disease and type 2 diabetes) in adulthood.&#x0D; Aims: Therefore, it becomes expedient that persistent and vigorous attention be paid to maternal vitamin status during gestation.&#x0D; Methodology: This is a cross-sectional comparative study carried out at maternity centres in Osogbo Local Government. Forty women who were at least 29 weeks of gestation and 40 apparently healthy women, age-matched, non-pregnant constituted the test and control groups respectively. Blood was obtained through an ante-cubital vein, centrifuged and used for vitamin estimations (High-Performance Liquid Chromatography). Birth weight and neonatal mortality ratio were the birth outcomes that were obtained. Data analysis was by Student’s t-test and Pearson’s correlation coefficient. P≤0.05 was considered significant.&#x0D; Results: Serum status of vitamins A (2.68±3.88 µg/dL); C (0.95±0.44 mg/dL); and E (0.67±0.04 mg/dL) were significantly lower at third trimester compared with the corresponding values of 6.98±1.26 µg/dL; 2.99±0.11 mg/dL; and 1.66±0.08 mg/dL among non-pregnant control. There were significant adverse pregnancy outcomes as signified by 10% stillbirths. In addition, low birth weight (1.5-2.4 kg) was observed among approximately 50% of the babies but no correlation was observed except between vitamins C and E.&#x0D; Conclusions: The results of this study revealed that among Nigerian pregnant women, there are risks of abnormal birth outcomes and low levels of vitamin A, C, and E. Aside depletions in vitamin C and E, the results of the study (r= .376; p= .020) suggest possible metabolic interaction between both.