Needle Point Research Articles

Abstract PR280

Background & Objectives: Central venous catheters (CVCs) are necessary for pediatric cardiac anesthesia, and malposition of these can lead to various complications (e.g., cardiac perforation, cardiac tamponade, inaccurate central venous pressure). The CVC tip should ideally be placed above the superior vena cava-right atrial junction. However, positioning the CVC tip properly, especially in small children, is difficult. We assumed that the puncture site (lower or higher part of the neck) affects depth of CVC, especially in infants. So, we examined the distance from puncture site to inferior border of clavicle as an anatomic landmark for determining the optimal CVC depth in infants. Materials & Methods: Consecutive infants in whom central catheters were inserted in the right internal jugular vein from December 2012 to November 2015 were evaluated retrospectively. After obtaining hospital IRB approval and informed consent, 32 infants undergoing surgery for congenital heart disease were enrolled in this study. Central venous catheterization was performed under real-time echo guidance. The distance between the insertion point of needle and inferior border of clavicle was measured perpendicularly using a sterile disposable ruler. The insertion depth of CVC was determined by adding 1-2 cm to the distance from the puncture site to inferior border clavicle depending on the patients’ physique. The longitudinal distance between the carina and the CVC tip was measured using chest radiography. We determined the ideal position of the tip of CVC was 1 cm above the carina, as the carina is 0.2-1.0 cm above the pericardial reflection in small children1). For ideal insertion depth of CVC, we calculated the difference between actual and ideal CVC tip position. Demographic data are presented as median (range). Simple linear regression analysis was performed using the least-squares method. Results: The median (range) demographics are as follows: age, 4 months (2 days-11 months); height 61 cm (40-71 cm); weight, 5.6 kg (2-8.4 kg). The optimal insertion depth of CVC showed higher correlation with distance from skin puncture site to the inferior border of the clavicle (r = 0.83 than the patient’s height (r = 0.48) and weight (r = 0.47). According to our results, insertion depth could be predicted using the formula: insertion depth (mm) = 14.4 + 0.96 × (distance from puncture site to inferior border clavicle) Conclusion: We determined that the distance between the insertion point of needle and inferior border of clavicle is useful to determine appropriate insertion depth of CVC in infants and is a practical surface landmark for determining the insertion depth of CVC in infants.

Semicolonized Mind

Semicolonized Mind

A Facile Approach to Prepare Novel Coral-like Ag3C6H5O7 Microstructures for Surface-enhanced Raman Scattering

Unique coral-like silver citrate (Ag3C6H5O7, SC) microstructures (CSCM), with a surface roughened by numerous short needle points in a dense array, have been fabricated via a one-step strategy in aqueous solution for the first time. Time-dependent morphological evolution experiments revealed the growth process. The as-prepared CSCM with nanoscale roughness exhibited excellent performance and supersensitivity as a surface-enhanced Raman scattering (SERS) substrate, indicating potential application in SERS-related detection.

Impulsivity and Stillness: NADA, Pharmaceuticals, and Psychotherapy in Substance Use and Other DSM 5 Disorders.

Pharmaceuticals and psychotherapy are commonly used in the management of impulsivity. The National Acupuncture Detoxification Association (NADA) protocol is an adjunctive therapy that involves the bilateral insertion of 1 to 5 predetermined ear needle points. One of the main benefits reported by patients, providers, and programs utilizing NADA is the sense of stillness, centering, and well-being. The induction of this attitude is seen as contributing to improved clinical outcomes including engagement and retention. The attitude of stillness is also suggestive of a pathway to mitigating impulsivity. Impulsivity is associated with substance use disorders and other DSM 5 diagnoses. Impulsivity has characteristics that are manifested clinically in behaviors such as disinhibition, poor self-control, lack of deliberation, thrill seeking, risk-taking. NADA holds promise as a useful treatment adjunct in the comprehensive management of disorders for which impulsivity is a prominent component.

The relationship of the musculocutaneous nerve to the brachial plexus evaluated by MRI

Axillary plexus blocks (AXB) are widely used for upper limb operations. It is recommend that AXB should be performed using a multiple injection technique. Information about the course and position of the musculocutaneous nerve (MCN) is of relevance for AXB performance. The objective of this study was to examine the position of the MCN and its relationship to the axillary sheath using MRI. 54 patients underwent an AXB with 40 ml of local anaesthetic before MRI examination. The course of the MCN and the position where it left the axillary sheath and perforated the coracobrachial muscle (MCN exit point), in relation to the axillary artery and the block needle insertion point in the axillary fold, were recorded. The MCN was seen clearly in 23, partly in 26, and not identified in five patients at the MCN exit point. The mean distance from the insertion point of the block needle in the axillary fold to the MCN exit point was 36.8 mm (SD = 18.9, range: 0–90.5). In 37 patients the MCN exit point was positioned inside the Q1 quadrant (lateral anterior to the axillary artery) and in 11 patients inside the Q2 quadrant (medial anterior to the axillary artery). There is a wide variability as to where the musculocutaneous nerve (MCN) leaves the axillary sheath. Therefore multiple injection techniques, or the use of a proximally directed catheter, should be appropriate to block the MCN.

Intentional and incidental encoding of item and associative information in the directed forgetting procedure

The intentional and incidental encoding of individual words and associations between pairs of words was examined using the item-based directed forgetting procedure. Item and associative recognition were both greater for word pairs followed by a remember (R) cue than a forget (F) cue. Associative discrimination for F-cued pairs was above chance in most conditions, demonstrating that relational informational is encoded incidentally. Item, but not associative, discrimination increased with longer presentation time prior to the cue, indicating that the encoding of item information benefited from maintenance rehearsal but the encoding of relational information did not (Experiments 1A and 1B). The incidental encoding of associations was, though, greater for pairs of words with pre-experimental associations (e.g., needle point), but these pre-experimental associations did not improve memory for pairs that participants tried to remember (Experiment 2). This pattern of results for R- and F-cued pairs mimicked the age-related associative deficit observed by Ahmad, Fernandes, and Hockley (Aging, Neuropsychology and Cognition, 22, 452-472 2015) in comparisons of associative memory between young and older adults.

Suturing Techniques for Optimal Surgical Outcomes

Surgical outcomes in cutaneous surgery are impacted by preoperative design, excision, and repair. Optimal suturing technique plays an important role in skin repairs and is achieved through appropriate selection of suture material and needle points, gentle handling of the tissue, and properly placed sutures. This review addresses the above key principles, strategies for correct knot tying, and situations where special sutures may promote a better outcome.

Defining the quality of acupuncture: the case of acupuncture for cancer-related fatigue.

The quality and dose of acupuncture used in a clinical trial affects the outcome, as with the quality and dose of any intervention. The dose of acupuncture treatment may be characterized by the frequency of treatment, needle type and depth, length of needle retention, point selection, and combination. The dose in trials of acupuncture has at times been described as low or inappropriate but is seldom assessed in systematic reviews of acupuncture trials. This article examines the research evaluating acupuncture for cancer-related fatigue to determine what characteristics of treatment may contribute to a quality acupuncture intervention. English and Chinese language databases were searched from inception to December 2013 for randomized controlled trials of acupuncture for the treatment of cancer-related fatigue. Assessment of the quality of the acupuncture intervention was undertaken using the domains and items from the NICMAN framework. Seven studies with a total of 690 patients were included. Four of the studies were designed as feasibility or pilot studies, and the other 3 studies were described as "effectiveness" trials. The treatment paradigm for the active intervention was based on traditional Chinese medicine in all studies, yet few of the studies were explicit as to how the active intervention was justified within a traditional Chinese medicine paradigm. Acupuncture point prescriptions were developed by a small consensus panel or based on typical points and/or "clinical experience." No discussion of traditional Chinese medicine theory or literature review was reported in any studies. Acupuncture point location was adequately described in 4 of the 7 studies. Frequency of treatment was twice per week in 2 studies; all others were once per week. Two studies did not apply needle manipulation or stimulation, and no justification was given. The 7 trials reviewed meet some criteria for a quality acupuncture intervention. However, frequently elements of the intervention were not addressed, and it is possible that the dosage trialed was suboptimal. Systematic reviews of acupuncture are likely to continue to be inconclusive while comparisons are conducted of heterogeneous interventions without providing.

Power Evaluation of High Intensity Focused Ultrasound Transducer Based on Acoustic Filed Measurement in Pre-focal Region

A novel technique for measurement of high intensity focused ultrasound output power of a transducer was introduced in this study. A needle point hydrophone, which was fixed in the pre-focal region of the transducer by a scanning system, was used to measure the acoustic pressure in both amplitude and phase. By using sound pressure method, the predicated power at pocus was calculated and compared with the actual measured one. It was found that the uncertainty between the measured and calculated acoustic power was about 10%. The near field measurement method is applicable to the evaluation of the focused transducer, and it can avoid the damage to measuring equipment of direct measurement.

Ferroelastic domain switching dynamics under electrical and mechanical excitations.

In thin film ferroelectric devices, switching of ferroelastic domains can significantly enhance electromechanical response. Previous studies have shown disagreement regarding the mobility or immobility of ferroelastic domain walls, indicating that switching behaviour strongly depends on specific microstructures in ferroelectric systems. Here we study the switching dynamics of individual ferroelastic domains in thin Pb(Zr0.2,Ti0.8)O3 films under electrical and mechanical excitations by using in situ transmission electron microscopy and phase-field modelling. We find that ferroelastic domains can be effectively and permanently stabilized by dislocations at the substrate interface while similar domains at free surfaces without pinning dislocations can be removed by either electric or stress fields. For both electrical and mechanical switching, ferroelastic switching is found to occur most readily at the highly active needle points in ferroelastic domains. Our results provide new insights into the understanding of polarization switching dynamics as well as the engineering of ferroelectric devices.

Faulty Needle-Tips: Are They a Clinical Hazard?

To the naked eye stainless steel, disposable acupuncture needles all look much the same, differing only in type of handle. But microscopically Xie and colleagues have shown some apparently shocking variations in needle-tip quality.1 A similar electron microscopic investigation 12 years ago found the same variety of faults: scratch marks, metallic scuff, lumps and irregularities of the needle surface, and stubbed, malformed or off-centre needle points (figure 1).2 Figure 1 Stubbed and malformed needle tips (×612.5). From Hayhoe et al .2 The first presterilised, single-use acupuncture needles were produced by the late Man Fong ‘Benny’ Mei, a coauthor of the original investigation. He was proud of his needles and believed them to be of excellent quality, so when he saw photomicrographs showing that his needles had tips as misshapen as those of most other types he went immediately to his factory in China to reassess quality control methods. Other distributors and manufacturers were equally surprised at the appearance of their own needles. The difficulty, of course, is the level of magnification necessary to see these needle-tip faults. Examined by the normal, naked eye, they are invisible. Xie's study used ×5000 magnification, although the earlier review had investigated a range of magnifications. With an ‘eye of faith’ the larger lumps and malformations could just be identified at lower powers, but for …

Bolton’s Ratios for Indian Population, Can We Follow The Ideal Standards Blindly?

Introduction: Various studies have been conducted which show that interarch tooth size relation differ with population. The aim of this study was to find out Bolton ratio in Indian population. Methods: Measurement were taken from 50 study models of randomly selected males and females with class I molar and canine relationship with ideal overjet and overbite, who had not undergone any orthodontic or cosmetic dental treatment previously. Needle point dividers were used to measure the greatest mesio-distal diameter of all teeth. From the obtained data, the Kolmogrov-Smirnov test, standard error of mean, standard deviation, coefficient of variation, coefficient of correlation were measured and used to assign statistical significance. Results: Increased anterior ratio (79.2284) & decreased overall ratio (90.9464) in selected Indian population were found in relation to Bolton’s ideal ratio. Conclusions: - Differences between original Bolton ratio and obtained ratio for Indians were significant, specific standards for Indians might be needed.

NSI: A major occupational hazards among the health care workers in Nepal

A percutaneous piercing wound as in needle stick injury is a typically set by a needle point, but possibly also by other sharp instruments or objects. These events are of concern because of the risk to transmit blood-borne diseases through the passage of the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the Human Immunodeficiency Virus (HIV), the virus which causes AIDS. The present study was done to determine the risk status regarding NSI among health care workers of Private Hospitals, Pokhara, Nepal. Samples were selected through purposive sampling. Self administered questionnaire & risk assessment tool were used to collect data. Study revealed that majority of health care workers were females (93%) with mean age of 22.66 years (±3.1). Sixty eight percent had got NSI, among them 41% had NSI more than 2times in life. Maximum NSI cases happened either by recapping of the needle (18%) or during disposal of sharps (16%) or while transferring a body fluid (blood) to a specimen bottle (15%). The study concludes that majority of health workers had NSI more than two times which denotes NSI is a major occupational hazard. Cases happened either by recapping of the needle or during disposal of sharps or while transferring a body fluid to a specimen bottle. DOI: http://dx.doi.org/10.3126/ijosh.v3i1.9098 International Journal of Occupational Safety and Health, Vol 3 No 1 (2013) 22-25

Simulation of the seat form of a negative corona discharge in a point-plane electrode system

A negative corona discharge in a point-plane electrode system is simulated. Equations for the transfer of electrons and ions are given as a drift-diffusion approximation. A mushroom-shaped corona seat is developed both in the model and experiment. There is determined the mechanism of this process: near the needle point within the corona sheath area, the charge structure is bipolar and causes the constriction of the field force lines, as well as the appearance of a narrow peak of intensity on the active electrode surface. On the contrary, in the space between the active and passive electrodes, there dominates a unipolar charge of negative ions, which is responsible for the repulsion of the field lines. The distortion of these lines leads to the formation of the mushroom glow of the corona discharge.

Determination of Polycyclic Aromatic Hydrocarbons in Wastewater by Single-Drop Microextraction Coupled to Capillary Gas Chromatography

This study describes an analytical method employing capillary gas chromatography (GC) using flame ionization detection (FID) that has been developed for the simultaneous determination of polycyclic aromatic hydrocarbons (PAHs) in wastewater, including naphthalene, 1-naphthol, 2-naphthol and anthracene. For this purpose, single-drop microextraction (SDME) was applied as a sample preparation technique. The SDME parameters such as types of extractants, volume of the microdroplet size, extraction time, stir rate and immersion depth of needle point were investigated and optimized. The method was linear in the ranges from 2.3 ×10-3to 70.0 μg·mL-1for naphthalene, 1-naphthol and anthracene, and 2.2 ×10-3to 50.0 μg·mL-1for 2-naphthol withR2≥ 0.9990. The SDME procedure allowed efficient recovery of the investigated PAHs ranging between 94 % and 104 % with a relative standard deviation (RSD) ≤4.2 for actual wastewater sampes spiked with 5, 10 and 20 μg·mL-1of PAHs, respectively. These results showed the potential of this technique for PAHs monitoring in wastewater samples. Furthermore, the investigated methods are simple, reliable, reproducible, and not expensive.

Determination of Chlorobenzenes in Wastewater by Single-Drop Microextraction Coupled to Capillary Gas Chromatography

This study describes an analytical method employing capillary gas chromatography (GC) using flame ionization detection (FID) that has been developed for the simultaneous determination of chlorobenzenes (m-dichlorobenzene (m-DCB),p-dichlorobenzene (p-DCB),o-dichlorobenzene (o-DCB) and 1,2,4-trichlorobenzene (1,2,4-TCB)) in wastewater. For this purpose, single-drop microextraction (SDME) was applied as a sample preparation technique. The SDME parameters such as types of extractants, volume of the microdroplet size, extraction time, stir rate and immersion depth of needle point were studyed and optimized. The method was linear in the ranges from 4.0×10-3to 40.0 μg·mL-1form-DCB,p-DCB ando-DCB, and 4.0×10-3to 30.0 μg·mL-1for 1,2,4-TCB withR2≥0.9955. The SDME procedure allowed efficient recovery of the investigated chlorobenzenes ranging between 80 % and 105 % with a relative standard deviation (RSD) ≤6.5 for actual wastewater sampes spiked with 2, 5 and 10 μg·mL-1of chlorobenzes, respectively. These results showed the potential of this technique for chlorobenzenes monitoring in wastewater samples. Furthermore, the investigated methods are simple, reliable, reproducible, and not expensive.

Determination of Volatile Halogenated Hydrocarbons in Wastewater by Single-Drop Microextraction Coupled to Capillary Gas Chromatography

Single-drop microextraction (SDME) coupled to capillary gas chromatography (GC) was established for the determination of seven volatile halogenated hydrocarbons in wastewater, including chloroform (CF), carbon tetrachloride (CT), trichloroethylene (TCE), bromodichloromethane (BDCM), perchlorethylene (PCE), dibromochloromethane (DBCM) and bromoform (BF). The SDME parameters such as extractants, extracting time，stirring rate and immerging depth of needle point were studyed and optimized. The abovementioned halogenated hydrocarbons were quantified by external standardization method using GC coupled with a flame ionization detector (FID). The linear regression calibration curves, detection limits (S/N=3) and the linear ranges of the method for determining each halogenated hydrocarbons were determined, respectively. The concentrations of componds abovementioned in a real wastewater sample, the average of the recoveries obtained in the spiked wastewater samples and the corresponding relative standard deviations were determined, respectively. The results showed the proposed method several attributes, friendly enviroment, economic and highly efficient pretreatment, less time, simplicity, sensitivity, accuracy and wide linear range and so on.

Determination of Phthalate Esters in Wastewater by Single-Drop Microextraction Coupled to Capillary Gas Chromatography

Single-drop microextraction (SDME) coupled to capillary gas chromatography (GC) was established for the determination of four phthalate esters in wastewater, including dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-octyl phthalate (DnOP) and butyl benzyl phthalate (BBP). The SDME parameters such as extractants, extracting time，stirring rate and immerging depth of needle point were studyed and optimized. The abovementioned phthalate esters were quantified by external standardization method using GC coupled with a flame ionization detector (FID). The linear regression calibration curves, detection limits (S/N=3) and the linear ranges of the method for determining each phthalate were determined, respectively. The concentrations of components abovementioned in a real wastewater sample, the average of the recoveries obtained in the spiked wastewater samples and the corresponding relative standard deviations were determined, respectively. The results showed the proposed method several attributes, friendly enviroment, economic and highly efficient pretreatment, less time, simplicity, sensitivity, accuracy and wide linear range and so on.

The Effects of Adding Elements of Zinc and Magnesium on Ag-Cu Eutectic Alloy for Warming Acupuncture

The warming acupuncture for hyperthermia therapy is made of STS304. However, its needle point cannot be reached to a desirable temperature due to heat loss caused by low thermal conductivity, and the quantification of stimulation condition and the effective standard establishment of warming acupuncture are required as a heat source. Accordingly, in this study, after Ag-Cu alloys with different composition ratios were casted and then mixed with additives to improve their physical and mechanical properties, the thermal conductivity and biocompatibility of the alloy specimens were evaluated for selecting suitable material. Ag-Cu binary alloys and ternary alloys added 5 wt% Zn or 2 wt% Mg were casted and then cold drawn to manufacture needles for acupuncture, and their physical properties, thermal conductivity, and biocompatibility were evaluated for their potential use in warming acupuncture. The results of this study showed that the physical and mechanical properties of the Ag-Cu alloys were improved by additives and that the thermal conductivity, machinability, and biocompatibility of the Ag-Cu alloys were improved by Mg addition.

The Point of the Needle

The Point of the Needle