Procedure Protocol Research Articles

A Combination of Ultrasound Characteristics with Macroscopic and Biochemical Features to Diagnose the Etiology of Lymphocytic Pleural Effusions

Objectives: The primary aim of this study was to improve the diagnosis of lymphocytic pleural effusions (LPEs) by combining their ultrasound characteristics with their macroscopic and biochemical features. Methods: This prospective, single-center, clinical observational study was conducted over a period of three years. The possible malignant etiology of LPEs was assessed using several diagnostic criteria: 1. ultrasound characteristics of the LPEs; 2. typical combinations of macroscopic and ultrasound features; and 3. the logistic regression method with three parameters—pleural nodularity, absence of fibrin, and serum protein concentration. Results: Eighty-four patients with LPEs were included in this study. Pleural nodularity (first criterion) was an ultrasound characteristic that yielded the best individual results (p < 0.001) in the differentiation of malignant and nonmalignant etiologies of LPEs (accuracy 73.81%). The combination of the second and third criteria yielded the best results in the prediction of a malignant etiology of LPEs (sensitivity 90.48%, specificity 83.33%, PPV 84.44%, NPV 89.74%, accuracy 86.90%). Based on the results of this prospective study, a protocol for the diagnostic procedure of lymphocytic pleural effusions without a definitive fluid diagnosis has been proposed. Conclusions: A combination of the ultrasound characteristics of LPEs and their macroscopic and biochemical features has improved the predictive accuracy for the malignant etiology of LPEs.

Designing Enhanced Recovery After Surgery Protocols in Neurosurgery: A Contemporary Narrative Review.

Enhanced Recovery After Surgery (ERAS) protocols have revolutionized the approach to perioperative care in various surgical specialties. They reduce complications, improve patient outcomes, and shorten hospital lengths of stay. Implementation of ERAS protocols for neurosurgical procedures has been relatively underexplored and underutilized due to the unique challenges and complexities of neurosurgery. This narrative review explores the barriers to, and pioneering strategies of, standardized procedure-specific ERAS protocols, and the importance of multidisciplinary collaboration in neurosurgery and neuroanesthsia, patient-centered approaches, and continuous quality improvement initiatives, to achieve better patient outcomes. It also discusses initiatives to guide future clinical practice, research, and guideline creation, to foster the development of tailored ERAS protocols in neurosurgery.

Combined Infraclavicular-Suprascapular Nerve Blocks Compared With Interscalene Block for Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Double-blind, and Comparative Clinical Trial

BACKGROUND: The gold standard postoperative analgesia protocol for arthroscopic rotator cuff repair procedures is the interscalene block (ISB), which prevents the significant consequences of phrenic nerve block associated with hemidiaphragmatic paralysis (HDP). The infraclavicular brachial plexus block (BPB) combined with the suprascapular nerve block (SSNB) had the same analgesic efficacy as the infraclavicular BPB alone, with no effect on respiration. OBJECTIVES: Therefore, the study aimed to assess the HDP and analgesic efficacy of both approaches in controlling pain following arthroscopic rotator cuff repair surgeries. STUDY DESIGN: A prospective, randomized, double-blind, and comparative clinical trial. SETTING: The study comprised 66 patients. They were separated into 2 equal parallel groups 33 patients each: the ISB group and the costoclavicular and suprascapular block (CSB) group. METHODS: The ISB group obtained the ISB followed by the general anesthesia. The CSB group received infraclavicular blockade using the costoclavicular approach and SSNB followed by general anesthesia. RESULTS: Considering morphine utilization during the first day following the operation, the groups demonstrated an insignificant difference. The CSB group showed a decreased rate of diaphragmatic paralysis. LIMITATIONS: There was no control group. And, the blocks might take a long time to be performed up to 30 minutes. Also, there were no validated criteria to define HDP based on M-mode ultrasound measurements. CONCLUSIONS: The employment of the costoclavicular block in combination with the suprascapular block may provide a comparable analgesic potency to the sole use of the standard ISB with no HDP. KEY WORDS: Interscalene block, costoclavicular block, suprascapular nerve block, hemidiaphragmatic paralysis

Synthesis of Composite Titanate Photocatalyst via Molten Salt Processing and Its Enhanced Photocatalytic Properties.

Photocatalysis plays a pivotal role in environmental remediation and energy production and improving the efficiency of photocatalysts, yet enhancing its efficiency remains a challenge. Titanate has been claimed to be a very promising material amongst various photocatalysts in recent years. In this work, a novel composite photocatalyst of sodium titanate and potassium titanate was synthesized via a simple hydrothermal and molten salt calcination method. Low melting point nitrate was added in the calcination process, which helps reduce the calcination temperature. The as-prepared composite sample showed excellent photocatalytic performance compared with commercial P25 in the visible light range. According to the characterization of XRD, SEM, TEM, BET, UV-Vis, and photocatalytic property testing, the composite's photocatalytic performance results are due to the dual optimization brought about by the layered structure and composite of titanium salts forming a heterojunction. We believe that the composite has significant application potential for the use of titanate in the field of photocatalysis. Notably, this study employed well-documented synthesis methods and adhered to established protocols for experimental procedures.

Safety and safety protocols for living donor nephrectomy in Italy

Living donor kidney transplantation (LDKTx) is recommended by all scientific societies. Living donor nephrectomy (LDN) is probably one of the safest surgical procedures, but it carries some risk for healthy donors. The aim of this study is to provide a snapshot of LDKTx activities in Italy and ask about safety measures implemented in LDN. Data on LDKTx were extracted from the national database. Safety measures were examined through a specific survey. Between 2001 and 2022 40,663 kidney transplants (31.4 per million population-pmp) were performed, including 4731 LDKTx (3.7 pmp). There was no postoperative death of the donor. After a median follow-up of 52.2 months [IQR:17.9–99.5], the 10-year donor survival rate was 93.38% (CI:97.52–98.94). There was evidence of renal disease in 65 donors (1.8%), including 42 (1.1%) with stage III end-stage renal disease. Twenty-nine out of 35 transplant centers (TC) involved in LDKTx responded to the survey (82.9%). Six TCs (21.4%) had a total experience of 20 or fewer LDN. Minimally invasive LDN was the first choice at 24 TC (82.8%). At 10 TC (37.0%) only one surgeon performed LDN. Nineteen TCs (65.5%) had a surgical safety checklist for LDN and 14 had a postoperative surveillance protocol. The renal artery was occluded in 3 TCs (10.3%) mainly by non-transfixion methods (including clips). Redundancy of key safety systems in the operating room was available in 22 of 29 centers (75.8%). In summary, LDKTx should be further implemented in Italy. Donor safety should be improved through the implementation of a national procedural protocol.

Use of a New Standardized Unfractionated Heparin Protocol for Left-Sided Ablation Procedures Improves Time in the Therapeutic ACT Range

Objectives: This study evaluated whether a novel standardized heparin dosing protocol used during atrial fibrillation catheter ablation resulted in a higher percentage of therapeutic activated clotting time (ACT) values compared to historic nonstandardized procedures. DesignA retrospective cohort study SettingThis study was conducted at Ochsner Medical Center, the largest tertiary care teaching hospital in New Orleans, LA ParticipantsPatients undergoing catheter-based atrial fibrillation ablation InterventionsWe implemented a standardized heparin protocol and enrolled patients between November 2020 and March 2021. The historic controls consisted of patients who underwent atrial fibrillation ablation between April 2020 and September 2020. Heparin administration in the control group was based on physician preference and was nonstandardized. Measurements and Main ResultsThe primary endpoint was the percentage of intraprocedural ACTs in therapeutic range (≥300 to <450 s). Secondary endpoints included first measured ACT at ≥300 s and percent of measured ACTs in the supratherapeutic range (>450 s). Comparisons were performed using chi-squared tests or Fisher exact tests. Patients in the intervention group had a higher mean percentage of ACTs in the therapeutic range compared to the control group (84.9% vs. 75.8%, p<0.001). More patients in the intervention group reached therapeutic ACT on the first measurement compared to the control group (70.3% vs. 31.2%, p<0.001). Conclusion: During catheter-based cardiac ablation procedures, a novel standardized unfractionated heparin dosing protocol resulted in a higher percentage of ACTs in the target range and a higher proportion of initial ACTs in the therapeutic range compared with baseline nonstandardized heparin dosing.

Pain Management Strategies for Botulinum Toxin Type A Injections in Children: A Comprehensive National Survey and Procedural Protocol.

Botulinum toxin type Ainjections are a first-line treatment forspasticity in children. Our purpose is to delineate the national landscape concerning pain management for botulinum toxin type A injections in pediatric patients and to formulate a protocol grounded in current scientific evidence. We conducted a nationwide survey targeting physical medicine and rehabilitation specialists performing botulinum toxin type A injections for focal spasticity in children in Portugal. We conducted a literature review to compare the survey results with clinical guidelines, good practice manuals, and protocols published in the literature. Finally, we developed a procedural protocol for pain management in botulinum toxin procedures. The survey was completed by 17 out of 18 identified specialists. All but one use some form of periprocedural analgesia. Five do not use any type of sedation. The majority do not assess pain during the procedures. From the reviewed articles, we obtained 23 articles, 19 of which provided data for detailed analysis. A prevailing concern centers around pain management during botulinum toxin procedures in children. Nevertheless, a distinct absence of uniformity persists in appraising and managing procedure-related pain. This notion is further underscored by the marked heterogeneity and paucity of published literature within this realm. The systematic implementation of a procedural protocol thus becomes highly crucial.

Procedural simulation in venipuncture for medical undergraduates and its transfer to the bedside: a cluster randomized study.

Simulation is accepted as an effective method of learning procedural skills. However, the translational outcomes of skills acquired through simulation still warrants investigation. We designed this study to assess if skills laboratory training in addition to bedside learning (intervention group [IG]) would provide better learning results than bedside learning alone (control group [CG]) in the context of venipuncture training. This prospective, cluster-randomized, single-blind study took place at the Faculty of Medicine, University of Kelaniya, Sri Lanka. Seventeen clusters of second-year medical students were randomly assigned to either IG or CG. The IG trained on venipuncture in the skills laboratory, receiving instruction after modified Payton's Four Step Method. Following the training, students of both IG and CG underwent bedside learning for one month. Afterward, students of both groups performed venipuncture on actual patients in a clinical setting. An independent, blinded assessor scored students' performance using the Integrated Procedural Protocol Instrument (IPPI) and a checklist. Patients assessed students' performance with the Communication Assessment Tool (CAT). Eight and nine clusters were randomized to the intervention and control groups, respectively. IG completed significantly more single steps of the procedure correctly (IG: 19.36 ± 3.87 for checklist items; CG: 15.57 ± 4.95; p < 0.001). IG also scored significantly better on IPPI ratings (median: IG: 27 (12) vs. CG: 21 (8); p < 0.001). Rated by patients, students' communication skills did not significantly differ between the two groups. Simulation-based venipuncture training enabled students to perform the procedure on actual patients with a higher technical accuracy than students who learned venipuncture at the bedside. Students were able to transfer the skills acquired through venipuncture training at the skill laboratory to the bedside.

EFFECTS OF DETOMIDINE AND DEXMEDETOMIDINE ON PHYSIOLOGICAL PARAMETERS AND ANESTHETIC RECOVERY IN TAPIRUS TERRESTRIS ANESTHETIZED WITH KETAMINE, GLYCERYL GUAIACOL ETHER, AND MIDAZOLAM.

The aim of this study was to compare the effects of two anesthetic induction protocols for long procedures carried out in the field in Tapiridae. Sixteen tapirs were divided into two groups (n=8) receiving either detomidine (DET) or dexmedetomidine (DEX) for anesthetic induction. All animals were anesthetized by intramuscular administration of a combination of ketamine (1.5 mg/kg), midazolam (0.2 mg/kg), plus either DET (0.04 mg/kg) or DEX (0.007 mg/kg). Anesthetic maintenance was by continuous infusion of ketamine, midazolam, and glyceryl guaiacol ether at 2 mg/kg per hour, 0.1 mg/kg per hour, and 100 mg/kg per hour, respectively). The animals were kept anesthetized for a total of 50 min to allow physical examination and collection of biological material as part of a research program, and physiological variables (heart rate [HR], respiratory rate, oxyhemoglobin saturation [SpO2], rectal temperature [RT], mean arterial pressure [MAP], blood glucose [GLI], and cortisol) and electrocardiogram were recorded during anesthesia. Anesthetic recovery was monitored by two researchers who were not informed of the induction protocol group. The recorded results were statistically evaluated. In both groups there was an initial increase in MAP, which subsequently decreased; RT gradually decreased during anesthesia; HR and GLI increased throughout the procedure; SpO2 was below normal throughout the procedure. Cortisol levels were significantly higher in the DEX group than in the DET group. Also, the animals in the DEX group had a longer recovery time than those in the DET group. On the basis of the results, we conclude that the combination of alpha-2 agonists and midazolam, ketamine, and glyceryl guaicol ether is an appropriate protocol for the anesthesia of tapirs in the field. However, in moderately extended procedures oxygen supplementation is recommended. Additionally, DEX resulted in fewer cardiovascular effects and longer-lasting sedation than DET.

Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey.

Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation. The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs). We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022. A single questionnaire was sent to a sole referent physician in each ED. The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet. Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%). In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.

Pre-clerkship procedural training in venipuncture: a prospective cohort study on skills acquisition and durability

BackgroundThe effectiveness of simulation-based training for skill acquisition is widely recognized. However, the impact of simulation-based procedural training (SBPT) on pre-clerkship medical students and the retention of procedural skills learned through this modality are rarely investigated.MethodsA prospective cohort study was conducted among pre-clerkship medical students. Learners underwent SBPT in venipuncture in the skills laboratory. Assessments were conducted at two main points: 1) immediate assessment following the training and 2) delayed assessment one year after training. Learner self-assessments, independent assessor assessments for procedural competency, and communication skills assessments were conducted in both instances. The students were assessed for their competency in performing venipuncture by an independent assessor immediately following the training in the simulated setting and one-year post-training in the clinical setting, using the Integrated Procedural Protocol Instrument (IPPI). The student’s communication skills were assessed by standardized patients (SP) and actual patients in the simulated and clinical settings, respectively, using the Communication Assessment Tool (CAT).ResultsFifty-five pre-clerkship medical students were recruited for the study. A significant increase was observed in self-confidence [mean: 2.89 SD (Standard Deviation) (0.69)] and self-perceived competency [mean: 2.42 SD (0.57)] in performing venipuncture, which further improved at the delayed assessment conducted in the clinical setting (p < 0.001). Similarly, the IPPI ratings showed an improvement [immediate assessment: mean: 2.25 SD (1.62); delayed assessment: mean: 2.78 SD (0.53); p < 0.01] in venipuncture skills when assessed by an independent assessor blinded to the study design. A significant difference (p < 0.01) was also observed in doctor-patient communication when evaluated by SPs [mean: 2.49 SD (0.57)] and patients [mean: 3.76 SD (0.74)].ConclusionSimulation-based venipuncture training enabled students to perform the procedure with confidence and technical accuracy. Improved rating scores received at a one-year interval denote the impact of clinical training on skills acquisition. The durability of skills learned via SBPT needs to be further investigated.

FRI148 Adrenal Vein Sampling: Intra-protocol Hormonal Variability

Abstract Disclosure: C. Lee: None. Z. Salman: None. J. Shields: None. A.F. Turcu: None. Background: Primary aldosteronism (PA) might arise from one or both adrenal glands. Treatment of PA relies on determining the relative contribution of aldosterone from the two adrenal glands. Adrenal vein sampling (AVS) is essential to identifying patients with lateralized PA (LPA), who benefit from surgery. AVS procedure and interpretation protocols differ between centers. Variability in AVS lateralization has been primarily attributed to cosyntropin use and lateralization index (LI) thresholds. However, data on intra-protocol variability are lacking. Methods: We retrospectively reviewed the clinical records of patients with PA who underwent AVS at University of Michigan between January 2015 and December 2022. In our center, AVS is performed both before and after cosyntropin stimulation, and 6 sets of paired adrenal vein and peripheral serum are obtained: 3 at baseline, and 3 between 5-30 min after cosyntropin stimulation. We included patients who had successful adrenal vein catheterization and valid data from 6 time points. A LI≥4 was considered indicative of LPA. We assessed the rates of inconsistent AVS results within baseline and cosyntropin stimulated samples as proportion of sets in which 1/3 LIs provided different subtyping results than the other 2/3. Results: Of 361 patients included, 107 (29.6%) patients had at least one inconsistent LI. Of these, 74 (20%) patients had an inconsistent LI within the basal sets, 45 (12%) within the cosyntropin stimulated sets, and 12 (3.3%) patients had a discrepant result in both baseline and cosyntropin stimulated sets. The highest outlier rates were observed in the first basal sample (30.3%), followed by the third basal sample (21.9%), the first post-cosyntropin sample (16.0%), and the last post-cosyntropin sample (13.5%). Patients with one intra-protocol outlier were younger (mean age 52.2 ± 11.5 vs. 56.2 ± 10.8 years), but there were no sex, race distribution, or BMI differences between the two groups. Conclusions: The intra-procedural AVS data variability is almost twice as high in basal vs. post-cosyntropin stimulation sampling, particularly in the initial set, likely mediated by acute ACTH fluctuations during the procedure. Our results emphasize the importance of obtaining multiple AVS data sets, in order to best inform the decision for or against surgery. Presentation: Friday, June 16, 2023

Towards a harmonized bronchopulmonary dysplasia definition: a study protocol for an international Delphi procedure

IntroductionBronchopulmonary dysplasia (BPD) remains the most common complication of preterm birth with lifelong consequences. Multiple BPD definitions are currently used in daily practice. Uniformity in defining BPD is important for...

Metastasis of tongue cancer locatedunilaterally, not crossing the midline,to the lymph nodes of the neck.

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; In recent years, there has been a steady increase in the incidence of tongue cancer. Rapid asymptomatic growth, early metastases, and crossing lymphatic drainage of the tongue reduce the chances of successful therapy. The presence of metastases in cervical lymph nodes is also an important prognostic factor.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; The aim of the study is a retrospective analysis of the incidence of unilateral and bilateral metastases within the cervical lymphatic system in patients with unilateral tongue cancer that does not cross the midline.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; A retrospective study of a group of patients hospitalized and treated for malignant tongue cancers at the Clinical Ward of Cranio-Maxillo-Facial Surgery of the Department of Otolaryngology and Laryngological Oncology of the Military Institute of Medicine-National Research Institute in Warsaw in 2012-2023. As many as 106 patients treated for unilateral tongue cancer that has not crossed the midline were selected, who also underwent unilateral or bilateral cervical lymphadenectomy, apart from primary tumor resection and reconstruction. The analysis was based on the medical records of the patients, results of imaging and histopathological examinations, and surgical procedure protocols.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; In a group of 106 patients with unilateral tongue cancer, in whom the cancer did not cross the midline, 47 patients underwent unilateral lymphadenectomy, of which 16 had lymph node metastases. Bilateral lymph node removal was performed in 59 patients. In 26 cases metastases were detected only in ipsilateral lymph nodes, and in 13 cases metastases were found in contralateral lymph nodes. Among 106 patients, occult metastases were detected in 21 patients.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Due to the crossing of the lymphatic drainage of the tongue, which allows for the possibility of contralateral metastases, and the impact of the operation on oncological efficacy, it is reasonable to perform bilateral cervical lymphadenectomy.&lt;/br&gt.

Diagnostic Performance and Safety Profile of Robotic-assisted Bronchoscopy: A Systematic Review and Meta-Analysis.

Rationale: Conventional electromagnetic navigation bronchoscopy and other guided bronchoscopic modalities have a very desirable safety profile, but their diagnostic yield is only 60-70% for pulmonary lesions. Recently, robotic-assisted bronchoscopy (RAB) platforms have been introduced to improve the diagnostic performance of bronchoscopic modalities. Objectives: To determine the diagnostic performance and safety profile of RAB (using shape-sensing and electromagnetic navigation-based platforms) by performing a systematic review and meta-analysis. Methods: The PubMed, Embase, and Google Scholar databases were searched to find studies that reported on the diagnostic performance and/or the safety profile of one of the RAB systems. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Meta-analysis was performed using MedCalc version 20.118. Pooled diagnostic yield was calculated using a Freeman-Tukey transformation. We planned to use a random-effects model if the I2 index was >40%. Results: Twenty-five studies were included: 20 including diagnostic and safety analyses and 5 including only safety analyses. The pooled diagnostic yield of RAB (20 studies, 1,779 lesions) was 84.3% (95% confidence interval, 81.1-87.2%). The I2 index was 65.6%. On the basis of our subgroup analyses, the heterogeneity was likely driven by differences in study designs (prospective vs. retrospective) and procedural protocols (such as different RAB systems). Lesion size > 2 cm, the presence of a computed tomography bronchus sign, and concentric radial endobronchial ultrasound view were associated with a statistically significant increase in the odds of diagnosis with RAB. The overall rates of pneumothorax, need for tube thoracostomy, and significant hemorrhage were 2.3%, 1.2%, and 0.5%, respectively. Conclusions: RAB systems have significantly increased the diagnostic yield of navigational bronchoscopy compared with conventional systems such as electromagnetic navigation bronchoscopy, but well-designed prospective studies are needed to better understand the impact of various factors, such as the use of three-dimensional imaging modalities, cryobiopsy, and specific ventilatory protocols, on the diagnostic yield of RAB.

Newborn Hearing Screening and Beyond: A Continuing Journey in the Philippines

Newborn Hearing Screening and Beyond: A Continuing Journey in the Philippines

Analysis of factors influencing the organizational capacity of Institutional Review Boards In China: a crisp-set Qualitative Comparative Analysis based on 107 cases

BackgroundInstitutional Review Boards (IRBs) play a vital role in safeguarding the rights and interests of both research participants and researchers. However, China initiated the establishment of its own IRB system relatively late in comparison to international standards. Despite commendable progress, there is a pressing need to strengthen the organizational capacity building of Chinese IRBs. Hence, this study aims to analyze the key factors driving the enhancement of organizational capacity within these committees.MethodThe cross-sectional survey for this research was conducted from July 2020 to January 2022. Following the statistical grouping based on the "2020 China Health Statistical Yearbook", a systematic investigation of IRBs in various provinces of China was carried out. In-depth interviews and questionnaire surveys were conducted with the chairpersons and administrative executives (or secretaries) of highly cooperative IRBs. Subsequently, data were collected from 107 IRBs. Qualitative Comparative Analysis (QCA) was employed as the method to analyze the factors influencing the organizational capacity of medical ethics committees and explore the diverse combinations of these factors.ResultsThrough a singular necessary condition analysis, the variable "protection of rights and interests" emerges as a critical factor contributing to the robust construction of Institutional Review Boards Institutional Review Boards (IRBs). Conversely, the variables of "lack of member ability, absence of review process, and deficiency in the supervision mechanism" collectively constitute a sufficient condition leading to weaker IRB construction. The state analysis uncovers three interpretation modes: member ability-oriented (M1), system process-oriented mode (M2), and resource system-oriented mode (M3).ConclusionsThe results of this study are effectively explicable using the "Triangular Force" model proposed for the hypothesis of IRBs' organizational capacity, which provides a solid foundation for the development of organizational capabilities in IRBs. To enhance the organizational capacity of IRBs in China, it is imperative to elevate the competence of committee members and strengthen team development. This can be achieved by establishing a comprehensive regulatory framework and refining procedural protocols. Moreover, clarifying the organizational structure and optimizing resource allocation are essential steps in bolstering the overall organizational capabilities of these committees.

Effectiveness and safety of an atropine/midazolam and target controlled infusion propofol-based moderate sedation protocol during percutaneous endoscopic transgastric jejunostomy procedures in Parkinson's disease: a real-life retrospective observational study.

Patients with Parkinson's disease (PD), often elderly with various comorbidities, may require a continuous intestinal infusion of carbidopa/levodopa gel by the placement of a percutaneous endoscopic gastrostomy (PEG) with a jejunal tube (PEG-J) to improve their motor outcome and quality of life. However, it is unclear what is the best procedural sedation protocol for PEG-J procedures. Fifty patients with PD and indication for PEG-J procedure (implantation, replacement, removal) underwent, from 2017 to 2022, a sedation protocol characterized by premedication with atropine (0.01 mg/Kg i.v.), midazolam (0.015-0.03 mg/Kg i.v.) and induction with bolus propofol (0.5-1 mg/Kg i.v.) as well as, finally, sedation with continuous infusion propofol (2-5 mg/Kg/h i.v.) by Target Controlled Infusion (TCI) technique. Ninety-eight per cent of patients experienced no intraprocedural or peri-procedural adverse events. All the procedures were technically successful. A good discharge time was recorded. The vital parameters recorded during the procedure did not vary significantly. A PEG-J procedure conducted within 30 min showed a significant advantage over end-tidal carbon dioxide (EtCO2). Indeed, the latter showed some predictive behavior (OR: 1.318, 95% CI 1.075-1.615, p = 0.008). In the real world, this sedation protocol showed a good safety and effectiveness profile, even with reduced doses of midazolam and a TCI propofol technique in moderate sedation.

Assessment of crown dimensions of primary teeth in a selected sample of Indian children - An odontometric study

Abstract Introduction: The size and shape of the tooth are important sources of information for anthropology, forensic odontology, and clinical dentistry. Different populations, and even individuals within the same population, may have variations in the odontometric characteristics of their teeth, which limits the applicability of the data across groups. Aim: To establish the normal odontometric data of primary teeth and examine the sexual dimorphism and its usefulness as a tool to identify the sex among young children. Materials and Methods: This cross-sectional study involved 150 children aged 3–5 years. The parents of the selected children were informed about the procedure protocol of the study and their written consent was obtained. The negative replica of the maxillary and mandibular teeth was obtained and dental casts were prepared. The mesiodistal, buccolingual, and crown height dimensions of each tooth were measured with a digital Vernier caliper. Two independent examiners measured each tooth’s dimensions three times, and the mean was analyzed. Results and Discussion: There was no significant difference between the teeth in the right and left quadrants. Males had larger odontometric dimensions than females. The sex of children based on odontometrics of primary teeth crowns could be determined with an accuracy of 98%, 72%, and 86% using mesiodistal, buccolingual, and crown height dimensions, respectively. Conclusions: There was a clear sexual dimorphism of the primary teeth. The odontometrics can be used as a low-cost and alternative tool for sex identification among children.

Changes in concentrations of potentially toxic elements during storage of hard river water samples at low temperatures using different sample preservation procedures

PurposeAccording to standard procedure recommended by the Water Framework Directive (WFD), dissolved concentrations of potentially toxic elements (PTEs) in river water are determined by inductively coupled plasma mass spectrometry (ICP-MS) in filtered (0.45 µm) and acidified (pH 2) samples. Properly prepared and stored composite samples can enhance the temporal representativity of monitoring without increasing analytical costs. For this purpose, the WFD recommends freezing, which can preserve the species integrity and prevent adsorption processes of PTEs.MethodsLow storage temperature in hard water samples can trigger precipitation of calcium carbonate (CaCO3) and subsequent co-precipitation of PTEs. To test and determine to what extent co-precipitation with CaCO3 can influence the determination of PTE concentrations, composite river water samples from two case study catchments in Hungary (Zagyva and Koppány) were prepared following two different sample preservation procedures. To study the behavior of PTEs in river water during storage, in the first procedure, samples were frozen, and they were thawed, filtered, and acidified directly prior to the analysis. In the second procedure, samples were filtered on-site and acidified prior to freezing to prevent precipitation of CaCO3 and then only thawed to carry out the chemical analyses. Concentrations of PTEs were determined by ICP-MS.ResultsA statistical evaluation of the results using Student’s t-test revealed significant differences between the two sample preservation procedures, suggesting that PTEs were largely co-precipitated with CaCO3 if the samples were not acidified prior to freezing.ConclusionWhen establishing protocols for sample preservation procedures, the phenomenon of co-precipitation of PTEs with CaCO3 should be considered if the samples were not acidified before freezing. Therefore, to prevent co-precipitation of PTEs with CaCO3, samples should be filtered and acidified before freezing.