Gauze Pads Research Articles

A Novel Technique of Urine Drainage from Bilateral Kidneys with a Single Catheter

A 69-year-old woman who underwent posterior pelvic exenteration and sacral resection for rectal cancer presented with urine leakage from a vesicocutaneous fistula at the sacral resection site (Figs 1, 2). She had bladder dysfunction after surgery. To stop urine leakage, bilateral nephrostomy catheters and a urinary catheter were placed, and embolization of the fistula with coils, glue, Amplatzer vascular plugs (Abbott, St. Paul, Minnesota), and a modified covered stent was performed. Urine leakage decreased but persisted. Her activity was severely restricted by 3 catheters and a gauze pad that was always needed at the fistula site. Therefore, we attempted to use a single catheter to drain the bilateral renal pelvis and reduce the number of catheters, while maintaining bilateral renal function. A guide wire inserted via the right renal pelvis was grasped in the bladder by a snare inserted via the left renal pelvis (Fig 3), and through-and-through access was obtained. An 80-cm-long 7-F catheter (Percuflex Urinary Diversion Stent; Boston Scientific, Marlborough, Massachusetts) with handmade proximal side holes was coaxially inserted through the left nephrostomy route into the right renal pelvis to drain the bilateral renal pelvis (Fig 4). Consequently, urine from the bilateral renal pelvis was drained by the single catheter, and urine leakage from the vesicocutaneous fistula stopped. The patient has been doing well for 15 months with the single catheter, which is exchanged regularly. This technique may be useful to improve activity levels of patients by reducing the number of nephrostomy catheters without compromising bilateral renal function. Figure 2Lateral x-ray of pelvis during cystography demonstrating leakage of contrast medium from urinary bladder (arrowheads) through the skin defect (star) via the vesicocutaneous fistula (arrow). View Large Image Figure Viewer Download Hi-res image Figure 3Oblique x-ray of pelvis during establishment of through-and-through access. The snare (arrowheads) was inserted through the left renal pelvis and advanced into urinary bladder to grasp the guide wire (arrow), which was inserted through the contralateral side. View Large Image Figure Viewer Download Hi-res image Figure 4Abdominal x-ray demonstrating long catheter (arrow) draining bilateral renal pelvis. A modified covered stent and several coils (arrowhead) were placed within the vesicocutaneous fistula. The stent lumen was sealed off by tying a string around its center; additional coils were placed around it to further occlude the fistula. View Large Image Figure Viewer Download Hi-res image

Synthesis of TiO2 doped selenium nanoparticles using herbal turmeric powders coating on cotton fabric for antibacterial

Nano materials based on the titanium dioxide doping selenium oxide and turmeric coated fibers of gauze pad cotton. The titania hydrosol was successfully prepared at low temperature by a microwave facilitated sol-gel method. The study also explored the efficiency of this sample to inhibit the growth of Escherichia coli and Staphylococcus aureus with various samples of titanium dioxide, titanium dioxide doped selenium oxide and titanium dioxide doped selenium oxide with turmeric powder. The morphology and composition of the surface pure and titanium dioxide coated gauze pad cotton fibers were investigated by the Scanning electron microscopy. The physical properties result showed the smaller size of selenium oxide dope compound crystal (11.06 nm.) than undoped crystal (15.80 nm.) by X-ray spectroscopy. The antibacterial activity against Escherichia coli and Staphylococcus aureus under ambient temperature showed that cotton coated with titanium dioxide, titanium dioxide doped selenium oxide and titanium dioxide doped selenium oxide with Turmeric nanoparticles enhance bacterial inactivation efficiency completed 100% within AATCC test method 2004-100 standard.

Abstract 192: Pressure Methods for Primary Hemorrhage Control

Introduction: Hemorrhage is the primary cause of death in 35% of traumatic mortalities. However, guidelines give little guidance regarding the best method of applying direct pressure including the mechanics of applying the pressure. Hypothesis: The purpose of this study is to compare the force generated using different techniques of force application. Additionally, we aimed to measure the pressure generated by a pressure wrap using two commonly used types of bandages in comparison to manual pressure. Methods: In this IRB approved study, subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) with a flat force sensitive resistor was used in this study to measure force. Subjects were randomized to application order of each of the following techniques: the finger pads of 3 digits of the right hand, 3 fingers of the right hand with the opposing hand applying counter pressure, or 3 digits of each of two hands on top of the other. The subjects were asked to hold pressure at each application for 10 seconds and all completed each method sequentially. Subjects then applied a compression wrap using either an elastic wrap or self-adhesive wrap. Researchers were not blinded during data collection, but data analysts were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age was 34.2 years (range 26-63). Two hand pressure application generated the most amount of force averaging a constant of 3.75 (SD 1.54) lbs. This was statistically different from one hand application which generated an average of 3.00 (SD 1.29) lbs of force (p <0.001). Comparison of opposing hands to single hand and two hands to opposing hands did not reach statistical significance. Neither pressure wrap technique generated a comparable amount of force to that of manual pressure [0.70 (SD 0.49) lbs vs 1 hand with 10 4x4” gauze pads (p <0.001)]. Conclusions: In this model of bleeding, medical personnel generated the most force when two hands were used to apply pressure over the wound. This study also demonstrated direct manual pressure generated much higher pressures than a pressure dressing.

Abstract 237: Less is More When Using Gauze to Stop Bleeding

Introduction: In first aid gauze is often used over the wound to absorb blood while applying pressure. Several sources recommend that if the gauze becomes saturated with blood, add more gauze and apply more pressure but offer no supporting data. However, adding more gauze will theoretically dissipate the force applied to the wound, thereby decreasing the pressure on the required area. Hypothesis: The purpose of this study is to evaluate the pressure generated when adding increasing layers of gauze to a simulated wound. Methods: In this IRB approved study subjects were recruited as a convenience sample of medical providers during a weekly medical conference. A standardized bleeding simulator (Z-Medica) and a flat (<0.5 mm) force sensitive resistor were used to measure force. Subjects were randomized to order of gauze application and were instructed to apply pressure to the simulated wound with three different layers of gauze (10, 20 & 30 4x4 inch cotton gauze, respectively) with the finger pads of 3 digits of the dominant hand as they would to stop bleeding. Subjects were asked to hold pressure for ten seconds and then release. All subjects completed application with each of the three stacks. Researchers were not blinded during data collection, but researchers analyzing data were blinded to the groups. Results: Thirty-three subjects were enrolled and all had data available for analysis. Twenty-two were residents, 11 attending physicians, 22 were male, and the average age of the subjects was 34.2 years (range 26-63). A steady decline in pressure with increasing amounts of gauze occurred. A stack of 10 4x4 inch gauze pads generated a constant of 3.20 (SD 1.11) lbs of force, 20 gauze pads 2.25 (SD 0.77) lbs of force, 30 gauze pads generated an average constant of only 1.5 (SD 0.54) lbs of force (p <0.001). Conclusions: In this simulated model of bleeding, medical personnel generated the most force on a wound when a stack of 10 4x4 inch gauze was used to apply pressure over the wound. From this study, it is apparent that increasing the amount of gauze will decrease the amount of pressure generated on the wound. As pressure on the bleeding vessel is important in stopping bleeding, this is likely detrimental to hemorrhage control.

Effect of CS preexposure on the conditioned ejaculatory preference of the male rat: behavioral analyses and neural correlates.

Early experiences with sexual reward play a pivotal role in the formation of sexual behavior and partner preference. Associations of salient partner cues, or even neutral cues on a partner, with sexual reward states are a product of Pavlovian learning. However, the extent to which first experiences that associate a neutral stimulus with no immediate consequence, and how that association may affect subsequent associability after being paired with a sexual reward state after copulation to ejaculation, remains unclear. To address this question, sexually naïve males were preexposed over one or five trials to almond scented gauze pads prior to training during which half of the males were trained 10 times with scented receptive females, and the other half with unscented receptive females. A final test of partner preference was conducted in a large open field containing two sexually receptive females, one scented and the other unscented. Males developed a conditioned ejaculatory preference for the type of female they were trained with, except when they were preexposed five times to the odor and then trained with females bearing the same odor, indicating a significant CS preexposure effect. One CS preexposure was not sufficient to inhibit subsequent conditioning. Exposure to the scent before perfusion for inmunohistochemistry, revealed different patterns of brain activation in brain areas previously associated with the development of partner preference, like the medial preoptic area, ventral tegmental area, nucleus accumbens, basolateral amygdala, among others, depending on group membership. Thus, CS preexposure results in a subsequent impairment of the association that links the odor cue to sexual reward and preference. This highlights the impact of the first sexual experiences in future partner preference.

Local Cooling as a Step of Treatment for Tissue Ischemia Caused by Hyaluronic Acid Injection-induced Embolism-A Report of 9 Cases.

Summary:Hyaluronic acid injection is 1 of the most popular procedures in facial rejuvenation and augmentation. It is widely popular in the cosmetic surgery due to several advantages, which include rapid effect, minimal injury, and a short postoperative recovery period. With continuous increase in hyaluronic acid injections, many cases of hyaluronic acid injection-induced embolism have been reported. At present, methods for early treatment of hyaluronic acid injection–induced embolism include local injection of hyaluronidase, topical application of nitroglycerin ointment, massage, hot compression, and intravenous injections of antibiotics and hormones. Although early warm massage may facilitate hyaluronic acid degradation by hyaluronidase, local application of heat will also increase metabolic rate in the tissue, thereby reducing the ischemic tolerance of the tissue. Therefore, in this study, warm massage was limited to the first 30 minutes after hyaluronidase injection and was followed by local cooling using a gauze pad soaked with antibiotic saline solution. Excellent therapeutic effects were achieved with this approach. The methods of treatment for tissue ischemia caused by hyaluronic acid injection–induced embolism and clinical cases are introduced in the article.

Saliva Production and Enjoyment of Real-Food Flavors in People with and Without Dysphagia and/or Xerostomia.

Non-food gustatory stimulation has multiple potential therapeutic benefits for people with dysphagia and xerostomia. This study examined palatability and saliva flow associated with dissolvable flavored films. Taste strips with real-food flavors dissolved on the tongues of 21 persons with dysphagia and/or xerostomia and 21 healthy age- and sex-matched adults while sublingual gauze pads absorbed saliva over randomized 3-min trials. Participants rated taste enjoyment for each trial on a hedonic general labeled magnitude scale. Flavored strips elicited more saliva than baseline for both groups, and production was higher for controls than patients (M = 2.386 and 1.091g, respectively; p = 0.036). Main effects of flavor were observed for saliva production (p = 0.002) and hedonics (p < 0.001). Hedonic ratings and saliva production were weakly correlated (r = 0.293, p < 0.001). Results support dissolvable taste strips as a tool for providing low-risk taste stimulation in dysphagia and for eliciting an increase in saliva flow that may provide temporary relief from dry mouth symptoms. The preferred flavors were, on average, also the ones that elicited greater saliva production. Taste strips have the potential to be beneficial for swallowing-related neural activity, timing, and safety in dysphagia. Further, they may ameliorate complications of xerostomia.

The Use of Closed Incision Negative-Pressure Wound Therapy in Orthopaedic Surgery.

Wound complications and surgical site infections after orthopaedic procedures result in substantial morbidity and costs. Traditional postoperative wound care consists of applying sterile, dry gauze and abdominal pads to the surgical site, with more frequent dressing changes performed in cases in which wound drainage is excessive. Persistent incisional drainage is of particular concern because it increases the risk of deep infection. The use of closed incision negative-pressure wound therapy (ciNPWT) to manage delayed wound healing was first reported a decade ago, and the benefits of this treatment modality include wound contraction with diminished tensile forces, stabilization of the wound environment, decreased edema and improved removal of exudate, and increased blood and lymphatic flow. Numerous trauma, plastic surgery, and general surgery studies have demonstrated that ciNPWT improves wound healing. In orthopaedic surgery, ciNPWT has been shown to be clinically effective for incisions at high risk for perioperative complications. However, specific indications for ciNPWT continue to be defined.

Evaluation of airborne asbestos exposure from routine handling of asbestos-containing wire gauze pads in the research laboratory

Three independently conducted asbestos exposure evaluations were conducted using wire gauze pads similar to standard practice in the laboratory setting. All testing occurred in a controlled atmosphere inside an enclosed chamber simulating a laboratory setting. Separate teams consisting of a laboratory technician, or technician and assistant simulated common tasks involving wire gauze pads, including heating and direct wire gauze manipulation. Area and personal air samples were collected and evaluated for asbestos consistent with the National Institute of Occupational Safety Health method 7400 and 7402, and the Asbestos Hazard Emergency Response Act (AHERA) method. Bulk gauze pad samples were analyzed by Polarized Light Microscopy and Transmission Electron Microscopy to determine asbestos content. Among air samples, chrysotile asbestos was the only fiber found in the first and third experiments, and tremolite asbestos for the second experiment. None of the air samples contained asbestos in concentrations above the current permissible regulatory levels promulgated by OSHA. These findings indicate that the level of asbestos exposure when working with wire gauze pads in the laboratory setting is much lower than levels associated with asbestosis or asbestos-related lung cancer and mesothelioma.

Assessment of dermal exposure to halogenated flame retardants: Comparison using direct measurements from hand wipes with an indirect estimation from settled dust concentrations

There are few studies estimating dermal exposure to halogenated flame retardants in adults. To fill this gap, sixty-one hand wipe samples were collected from a Norwegian adult cohort using gauze pads immersed in isopropanol. BDE-47, BDE-209, bis(2‑ethyl‑hexyl)‑3,4,5,6‑tetrabromophthalate (BEH-TEBP) and decabromodiphenylethane (DBDPE) were the most frequently detected chemicals. The highest median mass in hand wipes was that of sumEHFR (570 ng), followed by sumHBCDD (180 ng) and sumPBDE (2.9 ng). The high EHFR level was mainly driven by tetrabromobisphenol A (TBBPA) which accounted for 77% of the total mass. Positive and significant correlations were observed between FR levels in hand wipes and settled dust (0.26 < r < 0.56, p < 0.05), as well as between FR levels in hand wipes and the number of electronic consumer products at home (0.27 < r < 0.40, p < 0.05). Significant bivariate associations with number of laptops/tablets and phones/mobiles were further confirmed by multivariate linear regression analyses. Dermal exposure was estimated using the levels measured in handwipes. The estimated median dermal exposure was 2600, 840 and 6.2 pg/kg bw/d for sumEHFR, sumHBCDD and sumPBDE, respectively. Further, we compared these results with the dermal exposure as estimated indirectly by utilizing previously reported FR levels in settled dust collected from the residences of the same studied cohort. With the indirect approach, higher dermal exposures to sumPBDE but lower exposures to sumEHFR and sumHBCDD were observed compared to the direct dermal exposure estimated via hand wipes. Comparable exposure estimates between hand wipes and the indirect method were obtained for α‑, β‑tetrabromoethylcyclohexane (DBE-DBCH), DBDPE, BDE-28, -35, -49, -99, -153, 154, and -183. For other individual HFRs, the exposure estimates obtained from the two approaches were significantly different (Mann-Whitney U test, p < 0.05). Both methods gave similar dermal exposure estimates for many individual FRs. However, it is important to be aware of the value and limitations of each method when using them to estimate human exposure.

First Aid for Skin Tears by Mini Patch Grafting from the Flap Edge

BackgroundTraumatic skin tears often occur in patients with dystrophic skin. Closing them with adhesive skin closures is useful for patients with a healthy flap, but occasionally fails to cover the entire defect. We describe a simple technique to perform mini patch grafting on the remaining raw surface without damaging healthy skin. DiscussionThe skin flap is spread out and fixed with adhesive skin strips to minimize defects first. Small pieces of skin are obtained by trimming the edges of the skin flap with curved tip scissors. They are placed on the defect with free spaces of 3 to 5 mm between each of the grafts. Then the whole wound is covered with a dressing and gauze pads. Healing of the ulcer could be markedly promoted with little enlargement of the skin defect. ConclusionsSmall pieces of skin trimmed out from the edge of skin flap can be used as a mini patch graft that remarkably enhances healing of remaining open surface.

Effectiveness of binahong leaves extract, soursop leaves extract and combination of binahong leaves and soursop leaves extract on hemostasis in cuts of mice

Objective: Tooth extraction is a process of removing a tooth from the alveolar process which will always cause bleeding. Bleeding is usually occurs as a result of higher pressure in the blood vessels than outside the blood vessel. In Indonesia, many plants used as herbal medicine. Binahong (anredera cordifolia (tenore) steenis) contains flavonoids, terpenoids, essential oils, tannins. Soursop (annona muricata l.) leaf contains flavonoids, triterpenoids, saponins, polyphenols, tannins. The purpose of this study is to determine the effectiveness of binahong leaves extract, soursop leaves and combination of binahong and soursop leaves extract on hemostasis process in cuts of mice.Material and Methods: This research was conducted at the Phytochemicals Laboratory Faculty of Pharmacy and Entomology Laboratory Medical Hasanuddin University. This research is laboratory experimental with post test only with control group design. First stage by making binahong and soursoup leaves extract using maceration techniques. Male mice were adapted for seven days. Treatment on day eight by cutting the tail as much as 1 cm from the tip of the tail. Bleeding time is calculated after dipping tip of tail into the extract for 5 seconds until no blood dripping on gauze pads. Data were analyzed using kruskal wallis test followed by mann-whitney test.Results: Binahong leaves extract, soursop leaves extract and combination of binahong and soursop leaves extracts affected hemostasis on cuts of male mice (mus musculus).Conclusion: Combination binahong and soursop leaves extracts have the best effectiveness.

Recurrent Buried Bumper Syndrome: A Rare but Preventable Complication of Percutaneous Endoscopic Gastrostomy (PEG) Tube in an Obese Patient

PEG was initially developed in early 1980s and is now the preferred modality for long term enteral access for nutrition. Buried bumper syndrome was first described in 1988 and is a less frequent but a major complication of PEG tube placement. Incidence of buried bumper syndrome is around 0.3-2.4%. We report a 54-year-old female patient with a BMI of 40.37 who needed a long term nutritional access after undergoing tracheostomy. A 20 French PEG tube was placed without any complications. On a follow-up CT scan of the chest in one month, the G-tube internal diaphragm had migrated from the stomach into the abdominal wall musculature consistent with buried bumper syndrome. She was asymptomatic and afebrile. Physical exam was unremarkable without any evidence of erythema or purulence around the PEG tube site. Successful replacement with a 20 French PEG tube was performed endoscopically under direct visualization. A month later, the patient complained of abdominal pain around the tube site along with intermittent oozing of blood through the PEG tube. On examination, tenderness and discharge of secretions was noted around the PEG tube site. As the tract was mature and oral intake was adequate, it was decided to remove the tube. Repeat EGD was performed and PEG tube bumper was not visualized in the gastric cavity. The bumper was noted to have migrated within the tract. Using a guidewire, the PEG tube was safely removed. The defect in the gastric wall at the tract site was closed with placement of endoclips. Complete occlusion was ascertained by successful insufflation of the stomach. Buried bumper syndrome usually occurs due to excessive tightening of the external bumper of the gastrostomy tube against the abdominal wall which creats tension within the gastrostomy tube tract. The internal bumper will eventually erode and migrate through the gastric wall into the abdominal musculature resulting in buried bumper. Obesity is considered to one of the risk factors for buried bumper. In obese patients, alterations in the abdominal pannus during positional changes can create undue tension/friction in the gastrostomy tract thus resulting in migration of internal bumper leading to buried bumper syndrome. This can potentially be prevented by frequent inspection of the PEG tube, adjustment of the external bumper so that the tube is freely rotating, ensure 1 to 1.5 cm space between the bumper and the skin wall and avoid gauze pads between external bumper and the abdominal wall.FigureFigureFigure

A novel TRPM8 agonist relieves dry eye discomfort

BackgroundPhysical cooling of the eye surface relieves ocular discomfort, but translating this event to drug treatment of dry eye discomfort not been studied. Here, we synthesized a water-soluble TRPM8 receptor agonist called cryosim-3 (C3, 1-diisopropylphosphorylnonane) which selectively activates TRPM8 (linked to cooling) but not TRPV1 or TRPA1 (linked to nociception) and tested C3 in subjects with mild forms of dry eye disease.MethodsA set of 1-dialkylphosphoryalkanes were tested for activation of TRPM8, TRPV1 and TRPA1 receptors in transfected cells. The bioactivity profiles were compared by perioral, topical, and intravenous delivery to anesthetized rats. The selected lead candidate C3 or vehicle (water) was applied with a cotton gauze pad to upper eyelids of patients with dry eye disease (n = 30). Cooling sensation, tear film break-up time (TBUT), basal tear secretion, and corneal staining were evaluated. C3 was then applied four times daily for 2 weeks to patients using a pre-loaded single unit applicator containing 2 mg/mL of C3 in water (n = 20) or water only. TBUT, basal tear secretion, and corneal staining, and three questionnaires surveys of ocular discomfort (VAS scale, OSDI, and CVS symptoms) were analyzed before and at 1 and 2 weeks thereafter.ResultsC3 was a selective and potent TRPM8 agonist without TRPV1 or TRPA1 activity. In test animals, the absence of shaking behavior after C3 perioral administration made it the first choice for further study. C3 increased tear secretion in an animal model of dry eye disease and did not irritate when wiped on eyes of volunteers. C3 singly applied (2 mg/ml) produced significant cooling in <5 min, an effecting lasting 46 min with an increase in tear secretion for 60 min. C3 applied for 2 weeks also significantly increased basal tear secretion with questionnaire surveys of ocular discomfort indices clearly showing improvement of symptoms at 1 and 2 weeks. No complaints of irritation or pain were reported by any subject.ConclusionsC3 is a promising candidate for study of TRPM8 function on the eye surface and for relief of dry eye discomfort.Trial registrationISRCTN24802609 and ISRCTN13359367. Registered 23 March 2015 and 2 September 2015.

The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial.

Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available. To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs). Prospective, randomized, controlled, clinical study. Three nursing and care centers. Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24). All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 μs; 100 pps; 0.25 A; 250 μC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU. Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6. Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results. The time of treatment proved insufficient for PrUs to close. Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.

A Randomized Controlled Trial of Procedural Techniques for Large Volume Paracentesis

Introduction. The aim of this study is to investigate large volume therapeutic paracentesis using either a z-tract or axial (coxial) technique in a randomized controlled trial.Materials and methods. In this randomized, single blind study, patients with cirrhosis undergoing outpatient therapeutic paracentesis were randomized to the z-tract or the modified angular (coaxial) needle insertion technique. Subject and procedure characteristics were compared between the groups with ascites leakage as quantified by need for dressing changes with standardized sized gauze pads as a primary endpoint and subject procedural discomfort, operator preference, and procedure complications as secondary endpoints.Results. 72 paracenteses were performed during the study period: 34 to the z-tract and 38 to the coaxial insertion technique. Following exclusions, a total of 61 paracenteses were analyzed: 30 using the z-tract technique and 31 using the coaxial technique. There were equal rates of post-procedural leakage of ascites between groups (13% in both groups, p = 1.00). Using the visual analog scale (0 - 100), there was a statistically significant increase in the subject reported pain score with the z-tract compared with the coaxial method [26.4 (95% CI 18.7 - 34.1) vs. 17.2 (95% CI 10.6 - 23.8), p = 0.04]. Mean physician rated procedure difficulty (1 - 5) was significantly higher for the z-tract vs. the coaxial technique [2.1 (95% CI 1.6 - 2.6) vs. 1.5 (95% CI 1.2 - 1.8), p = 0.04].Conclusion. When compared to the z-tract technique, the coaxial insertion technique is superior during large volume paracentesis in cirrhosis patients.

Occurrence of organophosphorus flame retardants on skin wipes: Insight into human exposure from dermal absorption

This study surveyed occurrences and influencing factors of organophosphorus flame retardants (PFRs) on skin surface. Skin wipe samples from palms, back-of-hands and forearms of 30 adults were collected by using gauze pads soaked in isopropyl alcohol in Beijing, China. Tris(chloropropyl) phosphate isomers (∑TCPP), tris(2-chloroethyl) phosphate (TCEP) and triphenyl phosphate (TPHP) were the most abundant compounds with detection frequencies higher than 97%. ∑TCPP showed the highest mean level (4.6μg/m2), followed by TPHP (2.4μg/m2) and TCEP (1.6μg/m2). Levels on palms were slightly higher than on back-of-hands, and both were substantially higher than those on forearms. TCEP and ∑TCPP levels were strong reliable in three repeated measurements from 4 participants over a three month period (intraclass correlation of coefficient of 0.91 and 0.95, respectively), while TPHP levels were not. Washing with soap and water removed a large fraction of PFRs on hands with median reduction of 76, 72 and 67% for TCEP, ∑TCPP and TPHP, respectively. Paired dust samples, table surface wipe and hand wipe samples were collected from 17 offices (13 surface wipes and 22 hand wipes) in Beijing. Hand wipe TCEP, ∑TCPP and TPHP were neither correlated with dust samples nor with table surface wipe samples. Two methods were used for dermal exposure assessments. The estimated lower median total exposure from palms, back-of-hands and forearms by the relative absorption method were 0.6, 1.0, 0.3ng/kg BW-d for TCEP, ∑TCPP and TPHP, respectively. These estimates were in the same range as those via dust ingestion for adults in Beijing, suggesting dermal absorption is likely a significant pathway of human PFR exposure.

Estimation of human exposure to halogenated flame retardants through dermal adsorption by skin wipe

This study was undertaken to determine levels of halogenated flame retardants (HFRs) on skin surface to provide preliminary exposure estimates from dermal absorption. Skin wipes of palms, back-of-hands, and forearms were collected from 30 participants by using gauze pads soaked in isopropyl alcohol. Eight polybrominated diphenyl ethers (PBDEs), two novel brominated FRs, and two Dechlorane Plus (DPs) isomers were determined. BDE209, Decabromodiphenylethane (DBDPE), and 1, 2-Bis (2, 4, 6-tribromophenoxy) ethane (BTBPE) were most frequently detected. BDE209 showed the highest median level (1760 ng m−2), followed by DBDPE (277 ng m−2) and anti-DP (64 ng m−2). The comparison of levels on palms and back-of-hands revealed no statistical differences, but both were significantly higher than the levels on forearms. Detections of HFRs on arms suggested that skin areas covered by clothing were exposed to these chemicals likewise. BDE209 and DPs levels from three repeated samples showed moderate to strong reliability over 3 months, while the levels of other compounds were not statistically reliable. Males had significant higher levels than females for most HFRs, while participants' age, time from last hand washing to sampling, and other behaviors contributed limitedly to the variations in levels. Daily uptakes of HFRs through dermal absorption were estimated. The estimated median total exposure from palms, back-of-hands, and forearms were 25.9, 1.6, and 7.2 ng d−1 for ∑PBDEs, ∑DPs, and ∑NBFRs, respectively, which were in the same ranges as those from diet and dust ingestion for adults in China, suggesting that dermal absorption would be an important exposure route for HFRs.

Method of intraoperative tissue sampling for culture has an effect on contamination risk.

This prospective study was designed to determine whether exposure of intraoperative tissue samples to the operating room environment affects subsequent culture results. A prospective study conducted on 125 patients undergoing primary total knee arthroplasty was conducted from August 2013 to December 2015. During surgery, three samples from the infrapatellar fat pad were obtained. The first sample was obtained using clean instruments and placed directly into a specimen cup (direct). The second sample was obtained using clean instruments, placed in the palm of an assistant, then placed in the hands of the scrub nurse, and finally transferred into a specimen cup (glove). The third sample was obtained with clean instruments, placed on a gauze pad on the back table, and transferred to a specimen cup at the time of skin closure (table). There were two (1.6%) positive cultures in the direct transfer group, none (0.0%) in the glove contact group, and eight (6.4%) in the exposed (table) group; there was a statistically significant difference between the glove contact and table samples (p=0.01). The organisms isolated were coagulase-negative Staphylococcus in five samples, Proprionibacterium acnes in two samples, Staphylococcus epidermidis in one sample, Pediococcus pentosaceus in one sample, and Corynebacterium in one sample. Contamination of tissue samples obtained for culture can occur if samples are exposed to the operating room environment. To prevent potential contamination, samples obtained for culture should be retrieved using clean instruments, transferred to a culture bottle directly, and transported to the microbiology laboratory as soon as possible. II.

Antinociceptive effects of topical mepivacaine in a rat model of HIV-associated peripheral neuropathic pain.

BackgroundA consequence of HIV infection is sensory neuropathy, a debilitating condition that degrades the quality of life of HIV patients. Furthermore, life-extending antiretroviral treatment may exacerbate HIV sensory neuropathy. Analgesics that relieve other neuropathic pains show little or no efficacy in ameliorating HIV sensory neuropathy. Thus, there is a need for analgesics for people with this particular pain. While lidocaine is used in the management of painful peripheral neuropathies, another local anesthetic mepivacaine, with a potentially improved bioavailability, could be utilized for the management of HIV neuropathic pain.MethodsThe efficacy of topical anesthetics was evaluated in a preclinical rodent model of painful peripheral neuropathy induced by epineural administration of the HIV envelope protein gp120 delivered using saturated oxidized cellulose implanted around the sciatic nerve. Beginning at 2 weeks following gp120 administration, the effects of local anesthetics topically applied via gauze pads were tested on heat and mechanical hyperalgesia in the hind paw. Rats were tested using several concentrations of mepivacaine or lidocaine during the following 2 weeks.ResultsBy 2 weeks following epineural gp120 implantation, the ipsilateral hind paw developed significant hypersensitivity to noxious pressure and heat hyperalgesia. A short-lasting, concentration-dependent amelioration of pressure and heat hyperalgesia was observed following topical application of mepivacaine to the ipsilateral plantar hind paw. By contrast, topical lidocaine ameliorated heat hyperalgesia in a concentration-dependent manner but not pressure hyperalgesia. Equipotent concentrations of mepivacaine and lidocaine applied topically to the tail of mice significantly increased tail withdrawal latencies in the tail flick test, demonstrating that both local anesthetics attenuate responding to a brief noxious stimulus.ConclusionThese findings showed that mepivacaine, rather than lidocaine, consistently attenuated two distinct symptoms of neuropathic pain and suggest that topical formulations of this local anesthetic could have utility in the alleviation of clinical HIV neuropathic pain.