Insertion Rate Research Articles

Higher rates of anatomical insertion of medial hamstring tendon regeneration post-anterior cruciate ligament reconstruction with stump preservation graft harvesting technique: A prospective, randomised, double-blinded clinical trial with magnetic resonance imaging evaluation

Objective(s)The purpose of this study was to compare the regeneration of semitendinosus and gracilis tendons from two different graft harvesting techniques, which are the stump preservation and conventional graft harvesting techniques. We hypothesised that the stump preservation graft harvesting technique, which preserved the distal attachment of tendons at their insertion, would facilitate anatomical regeneration to the pes anserinus. MethodsThis is a prospective, randomised, double-blinded study whereby thirty consecutive patients who underwent single bundle anterior cruciate ligament reconstruction with ipsilateral semitendinosus and gracilis autografts were recruited. The patients were randomly assigned to the stump preservation group (14 patients) or conventional group (16 patients). Magnetic resonance imaging (MRI) evaluation was performed preoperatively and at six months post-operatively. ResultsAt 6-month follow-up, MRI evaluations showed a higher percentage of insertion of regenerated semitendinosus and gracilis at the pes anserinus in the stump preservation group (75.0%) than that in the conventional group (68.8%). There was a significantly higher proximal shift of the musculotendinous junction of semitendinosus (5.70 ​cm versus 3.36 ​cm, p ​= ​0.029) and gracilis (5.28 ​cm versus 3.16 ​cm, p ​= ​0.045) in the conventional group post-operatively. ConclusionThe stump preservation technique yields a higher percentage of anatomical insertion of regenerated tendons and a lesser amount of proximal shift of the musculotendinous junction. Level of EvidenceIII – Prospective study with up to two negative criteria.

Survival, cumulative hospital days and infectious complications in urgent-start PD compared with urgent-start HD.

Urgent-start peritoneal dialysis (PD) carries a similar efficacy and safety profile compared to urgent-start haemodialysis (HD) but is only sparsely applied due to resource issues and concerns of complication risks. Furthermore, few data exist on adverse outcomes associated with central venous catheter (CVC) insertions in urgent-start HD patients. Thus, we sought to compare patient and dialysis-related outcomes in patients undergoing urgent-start PD or HD. All patients initiating urgent-start PD in a tertiary research hospital in 2005-2018 were included in this retrospective, single-centre, comparative study and matched with urgent-start HD patients of similar age and chronic kidney disease aetiology. All urgent-start PDs were initiated within 72 h after catheter insertion, and urgent-start HDs were performed via a CVC. All analyses were performed at 3 months and at 1 year of follow-up, respectively. Thirty-three patients who commenced urgent-start PD and 58 matched urgent-start HD control patients were included. Altogether, 26 patients (29%; PD: 36%, HD 24%) died within the 1-year follow-up, and patient survival was similar at 3 months (hazard ratio (HR): 1.15, 95% confidence interval (CI): 0.35-3.81, p = 0.82) and at 1 year of follow-up (HR: 0.64, 95% CI: 0.30-1.39, p = 0.26) between the study groups. There were no differences in the total kidney replacement therapy (KRT)-related infection rate (p = 0.66) or cumulative first-year hospital care days (p = 0.43) between the treatment groups. Altogether, 139 CVCs were inserted during the 1-year follow-up. The number of CVCs per patient was associated with the emergence of blood culture-positive bacteraemia and increased cumulative first-year hospital care days. Patient survival, cumulative first-year hospital care days and total KRT-related infection rate at 3 months and 1-year follow-up are similar between urgent-start PD and urgent-start HD patients. Furthermore, CVC insertion rate is associated with incident blood culture-positive bacteraemia and increased cumulative first-year hospital care days.

The effect of DNA-binding proteins on insertion sequence element transposition upstream of the bgl operon in Escherichia coli.

The bglGFB operon in Escherichia coli K-12 strain BW25113, encoding the proteins necessary for the uptake and metabolism of β-glucosides, is normally not expressed. Insertion of either IS1 or IS5 upstream of the bgl promoter activates expression of the operon only when the cell is starving in the presence of a β-glucoside, drastically increasing transcription and allowing the cell to survive and grow using this carbon source. Details surrounding the exact mechanism and regulation of the IS insertional event remain unclear. In this work, the role of several DNA-binding proteins in how they affect the rate of insertion upstream of bgl are examined via mutation assays and protocols measuring transcription. Both Crp and IHF exert a positive effect on insertional Bgl+ mutations when present, active, and functional in the cell. Our results characterize IHF's effect in conjunction with other mutations, show that IHF's effect on IS insertion into bgl also affects other operons, and indicate that it may exert its effect by binding to and altering the DNA conformation of IS1 and IS5 in their native locations, rather than by directly influencing transposase gene expression. In contrast, the cAMP-CRP complex acts directly upon the bgl operon by binding upstream of the promoter, presumably altering local DNA into a conformation that enhances IS insertion.

7.5F Mini Flexible Ureteroscope in Retrograde Intrarenal Surgery: Initial Results from a Multicenter Randomized Clinical Trial.

Objective: To report the initial results of an randomized clinical trail comparing the safety and efficacy between 7.5F and 9.2F flexible ureteroscope (FUS) in the management of renal calculi <2 cm. Materials and Methods: Eighty patients were enrolled and received retrograde intrarenal surgery (RIRS) with a different size FUS. The operation results and complications were compared. Results: Two cases in the 7.5F group and four cases in the 9.2F group failed to insert the 12/14F ureteral access sheath (UAS), respectively, and no significant difference (p = 0.396) was noted. However, 10/12F UAS was inserted in the 7.5F group, but not available in the 9.2F group, and thus, the 10/12F UAS inserting rate in the 7.5F group was higher than in the 9.2F group (100% vs 0%, p = 0.014), and the UAS insertion failure rate in 9.2F group was higher than in the 7.5F group (10% vs 0%, p = 0.040). The operation time in 7.5F group was shorter than the 9.2F group (35.60 ± 7.86 vs 41.05 ± 8.14, p = 0.003). Less irrigation was required in 7.5F group (813.93 ± 279.47 mL vs 1504.18 ± 385.31 mL, p = 0.000). The postoperative fever rate in 9.2F group was higher than 7.5F group (20% vs 5%, p = 0.043). There was no significant difference in sepsis (0% vs 2.5%, p = 0.314) between the two groups. No significant difference was noted in hospital stay (0.93 ± 0.49 days vs 1.14 ± 0.64 days, p = 0.099) between the two groups. The final stone-free rate (SFR) in 7.5F group was higher than 9.2F group (95% vs 80%, p = 0.043). Conclusion: The latest 7.5F mini FUS was a reliable instrument in RIRS to keep a good visualization with low requirement of irrigation, low postoperative infection complication, and also a high SFR when compared with the conventional 9.2F FUS. Clinical Trial Registration: NCT05231577.

Therapeutic targeting at genome mutations of liver cancer by the insertion of HSV1 thymidine kinase through Cas9-mediated editing.

Liver cancer is one of the most lethal malignancies for humans. The treatment options for advanced-stage liver cancer remain limited. A new treatment is urgently needed to reduce the mortality of the disease. In this report, we developed a technology for mutation site insertion of a suicide gene (herpes simplex virus type 1- thymidine kinase) based on type II CRISPR RNA-guided endonuclease Cas9-mediated genome editing to treat liver cancers. We applied the strategy to 3 different mutations: S45P mutation of catenin beta 1, chromosome breakpoint of solute carrier family 45 member 2-alpha-methylacyl-CoA racemase gene fusion, and V235G mutation of SAFB-like transcription modulator. The results showed that the herpes simplex virus type 1-thymidine kinase insertion rate at the S45P mutation site of catenin beta 1 reached 77.8%, while the insertion rates at the breakpoint of solute carrier family 45 member 2 - alpha-methylacyl-CoA racemase gene fusion were 95.1%-98.7%, and the insertion at V235G of SAFB-like transcription modulator was 51.4%. When these targeting reagents were applied to treat mouse spontaneous liver cancer induced by catenin beta 1S45P or solute carrier family 45 member 2-alpha-methylacyl-CoA racemase, the mice experienced reduced tumor burden and increased survival rate. Similar results were also obtained for the xenografted liver cancer model: Significant reduction of tumor volume, reduction of metastasis rate, and improved survival were found in mice treated with the targeting reagent, in comparison with the control-treated groups. Our studies suggested that mutation targeting may hold promise as a versatile and effective approach to treating liver cancers.

Comparative evaluation of self-pressurized Air-Q® and Proseal™ LMA® in patients undergoing elective surgery under general anaesthesia: A randomized clinical trial.

Intra-cuff pressure of Air-Q self-pressurized laryngeal airways (Air-Q SP) balances airway pressure and adapts to patient's pharyngeal and periglottic structures, thus improves oropharyngeal leak pressure (OLP).This study was performed to compare efficacy of Air-Q SP with Proseal laryngeal mask airway (PLMA) in patients undergoing elective surgery. The study design was prospective, randomized and controlled. Ninety patients were randomly assigned to Air-Q SP or PLMA group. All patients were premedicated and shifted to operation theatre. Monitoring was instituted. After securing IV-line, induction with inj. Morphine + Propofol, relaxation with inj. Vecuronium was done. Supraglottic was inserted according to group allocation. Outcome measures were OLP, fibreoptic view of larynx, success rate, device insertion parameters, haemodynamic and respiratory parameters and post-operative laryngopharyngeal complications. Neostigmine + glycopyrrolate were given, device was extubated. All supraglottic airway devices (SADs) were successfully placed in two attempts. The mean initial OLP, OLP at 10 minutes, and device insertion time were significantly lower in Air-Q SP group. Fiber-optic laryngeal view grading was significantly better with Air-Q SP. No significant difference was observed with respect to rate of successful insertion in first attempt, ease of insertion, and manipulations required. The hemodynamic/respiratory parameters and post-operative sore throat in the two both groups were similar. Proseal LMA has a higher OLP than Air-Q SP but average insertion time was better, and fiber-optic grading of laryngeal view was shorter with Air-Q SP. However, Air-Q SP and Proseal LMA were both effective for lung ventilation.

1. Continuation and Complication Rates of Intrauterine Device Insertions with or without Sedation

1. Continuation and Complication Rates of Intrauterine Device Insertions with or without Sedation

Abstract 1123: Genomic characterization of radiotherapy-associated bladder cancer

Abstract Background: Bladder cancer (BCa) is the 4th most common cancer diagnosed in men, with 82,290 new cases predicted in 2023. As BCa frequently occurs at an advanced patient age, its diagnosis may follow radiotherapy (RT) for the treatment of prostate cancer. Currently, data is limited regarding the influence of RT on the clinical course and genomic landscape of subsequent BCa, mainly due to a paucity of samples. From prior studies, pelvic radiation confers an increased risk of BCa, with resulting tumors that are largely genomically similar to non-RT tumors with the exception of an increase rate of genomic insertions. Our current study looks to expand on these findings by characterizing the genomes of the largest cohort of RT-associated bladder cancers to date. Methods: We identified BCa cases from patients with a prior history of pelvic radiation for prostate cancer, and tumor only targeted sequencing was performed using Foundation Medicine (FMI) on FFPE tissue (n=41). For control cases (CTRL), patients with no prior record of pelvic radiation and who had previously underwent standard of care FMI sequencing were included (n=41). Sequencing data were re-aligned to hg38 and mutation calling was performed on the newly aligned sequences. Results: CTRL and RT cohorts had similar distributions of patients based on race and smoking status. While cT stage was similar between the two cohorts, the CTRL cohort was biased toward higher cN and cM stages with no difference in overall survival (median OS: CTRL = 20m, RT = 23m), though the advanced stage of the CTRL cohort could mask a worse prognosis in the RT cohort. Latency specific analysis revealed short latency tumors (&amp;lt;10 years from RT) had a significantly shorter overall survival than long latency tumors (p&amp;lt;0.01, HR=5.59, CI=1.81-17.3), and a numerically, but not significantly, shorter survival than CTRL patients (p=0.17, HR=1.55, CI=0.82-2.94). Long latency tumor patients had a significantly longer overall survival than CTRL patients (p&amp;lt;0.01, HR = 0.22, CI=0.07-0.63). In line with prior studies, RT samples had increased numbers of insertions (p&amp;lt;0.01). In addition, we also detected an increase in SNVs in the RT samples (p&amp;lt;0.01). Of note, KDM6A alterations were enriched within the RT cohort (CTRL = 10/41, RT = 30/41, p&amp;lt;0.001), with series of splice site mutations exclusive to RT samples (p&amp;lt;0.001). Conclusion: Patients diagnosed with BCa within a short interval following pelvic radiation have a worse prognosis. Genomic analysis showed RT-associated tumors having an increased number of insertions, SNVs, and KDM6A splice site mutations compared to non-RT tumors. Overall, the spectrum of recurrent alterations within the cohorts were consistent with previous studies, with the exception of the KDM6A mutations. To our knowledge, this is the first report of a RT-associated alteration in a specific gene in bladder cancer and additional studies will be needed to validate and understand the consequences of this finding. Citation Format: N. Ari Wijetunga, Kathryn H. Gessner, Krishna Kanchi, Sara E. Wobker, David Corcoran, Matthew D. Galsky, Matthew I. Milowsky, William Y. Kim, Tracy L. Rose, Jeffrey S. Damrauer. Genomic characterization of radiotherapy-associated bladder cancer [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 1123.

Comparison of the effects of paratracheal pressure and cricoid pressure on placement of the i-gel® supraglottic airway: a randomized clinical trial

PurposeAnesthesiologists can use supraglottic airway devices as a rescue technique for failed intubation even in patients with an increased risk of gastric regurgitation. In this randomized study, we aimed to evaluate the effects of cricoid pressure and paratracheal pressure on placement of the i-gel® (Intersurgical Ltd., Wokingham, Berkshire, UK).MethodsAfter induction of anesthesia in 76 adult patients, we inserted the i-gel under paratracheal or cricoid pressure, and assessed the success rate of i-gel insertion, resistance during insertion, time required for insertion, accuracy of the insertion location, tidal volumes, and peak inspiratory pressure with or without each maneuver after i-gel insertion.ResultsThe overall success rate of insertion was significantly higher under paratracheal pressure than under cricoid pressure (36/38 [95%] vs 27/38 [71%], respectively; difference, 24%; 95% confidence interval [CI], 8 to 40; P = 0.006]. Resistance during insertion was significantly lower under paratracheal pressure than under cricoid pressure (P < 0.001). The time required for insertion was significantly shorter under paratracheal pressure than under cricoid pressure (median [interquartile range], 18 [15–23] sec vs 28 [22–38] sec, respectively; difference in medians, −10; 95% CI, −18 to −4; P < 0.001). Fibreoptic examination of the anatomical alignment of the i-gel in the larynx revealed no significant difference in the accuracy of the insertion location between the two maneuvers (P = 0.31). The differences in tidal volume and peak inspiratory pressure with or without the maneuvers were significantly lower with paratracheal pressure than with cricoid pressure (P = 0.003, respectively).ConclusionsInsertion of the i-gel supraglottic airway was significantly more successful, easier, and faster while applying paratracheal pressure than cricoid pressure.Study registrationClinicalTrials.gov (NCT05377346); first submitted 11 May 2022.

First implantable cardiac defibrillator insertions in New South Wales, 2005-2020: an analysis of linked administrative data.

To determine the annual numbers of first ICD insertions in New South Wales during 2005-2020; to examine health outcomes for people who first received ICDs during this period. Retrospective cohort study; analysis of linked administrative health data. All first insertions of ICDs in NSW, 2005-2020. Annual numbers of first ICD insertions, and of emergency department presentations and hospital re-admissions 30 days, 90 days, 365 days after first ICD insertions; all-cause and disease-specific mortality (to ten years after ICD insertion). During 2005-2020, ICDs were first inserted into 16 867 people (18.5 per 100 000 population); their mean age was 65.7 years (standard deviation, 13.5 years; 7376 aged 70 years or older, 43.7%), 13 214 were men (78.3%). The annual number of insertions increased from 791 in 2005 to 1256 in 2016; the first ICD insertion rate increased from 15.5 in 2005 to 18.9 per 100 000 population in 2010, after which the rate was stable until 2019 (19.8 per 100 000 population). Of the 16 778 people discharged alive from hospital after first ICD insertions, 54.4% presented to emergency departments within twelve months, including 1236 with cardiac arrhythmias (7.4%) and 434 with device-related problems (2.6%); 56% were re-admitted to hospital, including 1944 with cardiac arrhythmias (11.5%) and 2045 with device-related problems (12.1%). A total of 5624 people who received first ICDs during 2005-2020 (33.3%) died during follow-up (6.7 deaths per 100 person-years); the survival rate was 94.4% at one year, 76.5% at five years, and 54.2% at ten years. The annual number of new ICDs inserted in NSW has increased since 2005. A substantial proportion of recipients experience device-related problems that require re-admission to hospital. The potential harms of ICD insertion should be considered when assessing the likelihood of preventing fatal ventricular arrhythmia.

Efficacy of a Novel Tapered Contrast Catheter for Endoscopic Ultrasound-Guided Hepaticogastrostomy: A Multicenter Study.

Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative for failed endoscopic retrograde cholangiopancreatography (ERCP), with current success rates of 65-84% considered suboptimal. A novel ERCP catheter (SHOREN, Kaneka Corporation, Osaka, Japan) with a tapered 3.3-French tip may facilitate smoother insertion, potentially improving outcomes. Methods: This retrospective analysis encompassed EUS-HGS procedures conducted from January 2021 to August 2023 at four institutions. The aim of this study was to compare the performance of conventional and novel ERCP contrast catheters regarding the success rate of single-attempt catheter insertion, failure rates, technical success rates, and incidence of adverse events. Results: The study included 48 patients; 26 underwent EUS-HGS using conventional catheters and 22 with the novel catheter. The novel catheter achieved higher success rates in single-attempt insertions (96.5% vs. 80.8%) and lower failure rates (4.6% vs. 7.7%). The occurrence of bile peritonitis was comparable between the two groups. Conclusions: The novel ERCP contrast catheter with a tapered tip appears to contribute to successful catheter insertion and is useful for EUS-HGS.

Ventriculoperitoneal shunt infection rate and other associated complications of VP shunt insertion in Abuja, Nigeria

BackgroundComplications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. MethodologyPatients who had VP shunt surgery over a period of two years (Jan 2015–December 2016) were evaluated retrospectively by reviewing their hospital records. The patients’ demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. ResultsA total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. ConclusionThe rate of shunt complications seen in this study compares fairly with studies in other parts of the world.

The Outcomes of Peripherally Inserted Central Catheter (PICC) Insertion in Pediatric Patients at Siriraj Hospital

Objective: Peripherally Inserted Central Catheters (PICC) are widely used for intermediate to long term venous access. Venipunctures and catheterizations in pediatric patients can be challenging and traumatizing to children’s veins due to frequent and painful needle sticks. This study aims to demonstrate the outcomes of PICC insertion and management in pediatric patients by the Anesthesia Line Service Team (ALiST) at Siriraj Hospital. Materials and Methods: This is a retrospective, descriptive study collecting data from January 2018 to December 2021. The inclusion criteria were pediatric patients aged 15 years and under, body weight equal to or exceeding 5 kg with no history of previous complicated central venous accesses. The primary outcome is the success rate of insertion. Results: 124 PICCs were inserted in pediatric patients. The median age of patients was 5.0 years, with a median height of 107.8 cm, and a median weight of 10.0 kg. The successful insertion rate was 96.92%, and all insertions were inserted using ultrasound-guided technique, with or without fluoroscopy. No acute complications were noted during insertion. Most patients received either intravenous sedation (39.5%) or general anesthesia (26.6%) during the procedure. The mean duration of catheter indwelling was 66.48 days. Reasons for removal of PICC included completion of therapy and patient demise (70.97%), catheter malformation (8.06%), accidental removal (4.03%), infection (8.06%), and patient non-adherence (1.61%). Conclusion: Our research demonstrates a notably high rate of successful PICC placement among pediatric patients, with data indicating a minimal occurrence of complications and an extended duration of catheter usage.

Detection of SARS-CoV-2 virus in middle ear effusions and its association with otitis media with effusion.

A large-scale outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) occurred in Shanghai, China, in early December 2022. To study the incidence and characteristics of otitis media with effusion (OME) complicating SARS-CoV-2, we collected 267 middle ear effusion (MEE) samples and 172 nasopharyngeal (NP) swabs from patients. The SARS-CoV-2 virus was detected by RT-PCR targeting. The SARS-CoV-2 virus, angiotensin-converting enzyme 2 (ACE2), and transmembrane serine protease 2 (TMPRSS2) expression in human samples was examined via immunofluorescence. During the COVID-19 epidemic in 2022, the incidence of OME (3%) significantly increased compared to the same period from 2020 to 2022. Ear symptoms in patients with SARS-CoV-2 complicated by OME generally appeared late, even after a negative NP swab, an average of 9.33 ± 6.272 days after COVID-19 infection. The SARS-CoV-2 virus was detected in MEE, which had a higher viral load than NP swabs. The insertion rate of tympanostomy tubes was not significantly higher than in OME patients in 2019-2022. Virus migration led to high viral loads in MEE despite negative NP swabs, indicating that OME lagged behind respiratory infections but had a favorable prognosis. Furthermore, middle ear tissue from adult humans coexpressed the ACE2 receptor for the SARS-CoV-2 virus and the TMPRSS2 cofactors required for virus entry.

Evolution of the use of intraosseous vascular access in prehospital advanced cardiopulmonary resuscitation: The IOVA-CPR study.

Obtaining vascular access is crucial in critically ill patients. The EZ-IO® device is easy to use and has a high insertion success rate. Therefore, the use of intraosseous vascular access (IOVA) has gradually increased. We aim to determine how IOVA was integrated into management of vascular access during out-of-hospital cardiac arrest (OHCA) resuscitation. Analysing the data from the OHCA French registry for events occurring between 1 January 2013 and 15 March 2021, we studied: demography, circumstances of occurrence and management including vascular access, delays and evolution. The primary outcome was the rate of IOVA implantation. Among the 7156 OHCA included in the registry, we analysed the 3964 (55%) who received cardiopulmonary resuscitation. The vascular access was peripheral in 3122 (79%) cases, intraosseous in 775 (20%) cases and central in 12 (<1%) cases. The use of IOVA has increased linearly (R2 = 0.61) during the 33 successive trimesters studied representing 7% of all vascular access in 2013 and 33% in 2021 (p = 0.001). It was significantly more frequent in traumatic cardiac arrest: 12% versus 5%; p < 0.0001. The first epinephrine bolus occurred significantly later in the IOVA group, at 6 (4-10) versus 5 (3-8) min; p < 0.0001. Survival rate in the IOVA group was significantly lower, at 1% versus 7%; p < 0.0001. The insertion rate of IOVA significantly increased over the studied period, to reach 30% of all vascular access in the management OHCA patients. The place of the intraosseous route in the strategy of venous access during the management of prehospital cardiac arrest has yet to be determined.

Robotic Precision vs. Human Dexterity—Benchtop Comparative Study of Free-Hand vs. Robotic-Assisted Puncture in Fluoroscopy-Guided Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) is the standard procedure for treating large kidney stones, especially those measuring over 20 mm or staghorn stones. Accurate placement of the tract into the renal collecting system of interest is crucial. Objective: To compare the free-hand puncture technique with robotic-assisted puncture during fluoroscopy-guided PCNL on a phantom kidney model in terms of efficiency and safety. A self-assessment of confidence levels after each puncture was recorded. Study Design: This prospective single-center benchtop study was conducted at the University Malaya Medical Centre (UMMC). Four urological residents participated and performed phantom punctures using both the free-hand bull’s eye technique and the automated needle targeting system with X-ray (ANT-X). Each resident performed a total of 60 punctures on the renal phantom models, with 30 punctures using the free-hand technique and 30 punctures using the ANT-X robotic-assisted system. Results: A total of 240 needle insertions were conducted, with 120 in the ANT-X group and 120 in the free-hand group. The success rate of needle insertions was 100% in both groups. However, the study revealed that the ANT-X group required, on average, an additional 51 s for needle puncture compared to the free-hand group (p &lt; 0.001). In terms of fluoroscopic exposure, the ANT-X group exhibited significantly lower radiation exposure compared to the free-hand group (p &lt; 0.001). Sub-analysis showed that puncture time remained consistent regardless of the technique used, but fluoroscopic screening time decreased with increasing participant experience. The ANT-X group also resulted in significantly lower radiation exposure during initial sessions compared to the free-hand technique. Surgeons’ self-assessment of confidence levels indicated a high level of confidence in needle puncture. Conclusions: Our benchtop study comparing the efficacy and safety between free-hand and ANT-X phantom punctures revealed comparable results. The needle puncture technique facilitated by the ANT-X system showed promising results in terms of reducing fluoroscopic exposure, albeit at the cost of longer operative times. This technology holds promise for novice surgeons who are in the early stages of their learning curve and might be useful for experienced surgeons looking to reduce radiation exposure.

Particle deposition and clogging as an Obstacle and Opportunity for sustainable energy

Fine particle motions have significant implications in porous media, manifesting in various natural phenomena and industrial applications. The movement of particles can lead to channel blockage, resulting in clogging. Depending on the context, clogging can be either advantageous or detrimental. At the scale of fine particles, physiochemical interactions play a crucial role in the clogging process. To examine the influence of these interactions, we have coupled the Derjaguin-Landau-Verwey-Overbeek (DLVO) theory into the Computational Fluid Dynamic-Discrete Element (CFD-DEM) approach. Aside from the physical properties of the fracture systems and the characteristics of fine particles, the injection rate also plays a pivotal role in clogging occurrence. Consequently, we investigated 10 different injection rates and modeled 20 simulation setups with identical particle insertion rates to concurrently analyze the effects of the DLVO theory and injection rate. Our study focused on examining the impact of these parameters on particle behavior in various regions of the domain, including particle-particle force, fluid-particle force, transitional velocity, rotational velocity, fluid velocity, and fluid-particle momentum exchange. Our findings reveal that the DLVO force significantly influences fluid and particle characteristics within the throat blockage. Our results indicated that DLVO consideration increased the particle concentrations by more than 40% before the throat. Moreover, our results demonstrate a transition between different injection rates, where a slight change in injection rate (i.e., 0.06μm/s) can change the system's behavior. We identified a critical fluid injection rate, whereby injecting fluid into the system at a rate surpassing the critical velocity can prevent clogging, while lower rates result in clogging occurrence.

The effect of minimizing central line days for very low birth weight infants through quality improvement

Blood culture proven sepsis is associated with increased mortality and morbidity. Given the extended hospitalization of very preterm infants, catheter-related blood stream infections (CRBSIs) play a substantial role in sepsis. The reported incidence of CRBSIs in neonates varies from 3.2 to 21.8 CRBSIs per 1000 catheter line days. Moreover, discrepancies in neonatal practices and potential neglect may lead to the unwarranted prolongation of central lines. This study aims to compare two distinct periods (Pre-QI vs. Post-QI) in relation to the central line insertion rate and duration, as well as blood culture proven sepsis, duration of total parenteral nutrition (TPN), and the progression of feeding. These factors are known to be associated with prolonged hospitalization and increased morbidities. A total of 210 very low birth weight infants (VLBWIs), defined as either less than 32 weeks of gestational age (GA) or weighing less than 1500 g, were admitted to the Neonatal Intensive Care Unit (NICU) at Seoul St. Mary’s Hospital, The Catholic University of Korea, between January 2020 and June 2023. Fourteen infants were excluded from the study as they did not survive beyond 1 month of life, and one was excluded due to a congenital anomaly. Consequently, the analysis included 195 VLBWIs. The Quality Improvement (QI) initiative began in January 2022, marking the division into two distinct epochs: the Pre-QI period, encompassing the years 2020 to 2021, and the Post-QI period, spanning from 2022 to 2023. The primary outcome measures included PICC insertion rates, duration, and feeding advancement or feeding-related complications. The hospital outcome measures were also compared between the two periods. A total of 195 VLBWI were included in the analysis. The birth weight was significantly lower in the pre-QI period, with an average of 1023 g compared to 1218 g (P < 0.001). Severe BPD ≥ moderate was significantly lower in the post-QI period (36.2% vs. 53.9%) (P < 0.001) along with shorter mechanical ventilation days (12 ± 29 vs. 22 ± 27) (P = 0.046). The PICC insertion rate was significantly decreased from 95.6% in pre-QI period compared to 55.2% in post-QI period (P < 0.001) along with a notable reduction in blood culture-proven sepsis (25.6% vs. 10.5%, P = 0.008). CRBSI rate was reduced from 1.3 to 1.1 per 1000 catheter days in the post-QI period. Moreover, the time required to achieve full enteral feeding of 100 mL/kg/day was significantly shorter in the post-QI (24 ± 23 vs. 33 ± 25) (P = 0.006). Multivariable logistic regression analysis for sepsis revealed that both birth weight and pre/post QI consistently demonstrated an association with lower sepsis rates in the Post-QI period. QI has the potential to reduce the burden of unnecessary interventions and blood culture proven sepsis rate along with CRBSI rate, thereby, optimizing the better care of very preterm babies.

Evaluation of Training Contracts for Young People in Spain, Germany, and France

Youth unemployment is one of the greatest concerns to labour authorities. To try to reduce its intensity and to improve the labour market insertion rates of the youngest working-age population, most European Union (EU) countries have opted, among other measures, for job training. This is an action that seeks to combine work with training. Spain is one of the countries with the greatest problems of labour market integration for young people, in contrast to other countries such as Germany or France. The Spanish case is also characterised by the application of a set of actions that have not always had the desired success, despite being framed within the EU Youth Guarantee Programme. The results from this research indicate that improvements can be made in the application of training contracts in Spain, based on the approach used in other countries.

Factors Associated With Nasogastric Tube Placement-Related Complications in a Single Academic Medical Center.

At our 710-bed academic medical center, nine (9) patients sustained injuries during nasogastric (NG) tube insertion attempts over a 16-month period (March 2021-July 2022). No injuries were reported during the comparable period before these events. This increase in reported events prompted an in-depth analysis to determine the root causes and implement a process improvement plan. Root cause analysis (RCA) of these events failed to identify risk factors or actionable themes. The RCAs demonstrated wide variation in the number of insertion attempts and techniques. A standard process was created to provide team members with guidance for escalation when NG tube placement was difficult. Although the complication rate for NG tube insertion was comparable with the criterion standard for large tertiary care institutions, we focused on minimizing risk and improving outcomes by creating a standard process for NG tube placement.