Success Rate Of Placement Research Articles

Declarative Secure Placement of FaaS Orchestrations in the Cloud-Edge Continuum

The decision-making related to the placement of applications made from orchestrated serverless functions onto Cloud-Edge infrastructures is a challenging problem as it must consider functional and non-functional requirements. In this article, we propose a novel declarative methodology to determine the placement of FaaS orchestration onto Cloud-Edge resources while satisfying all the requirements of the FaaS orchestrations and relying on information-flow analyses and padding techniques to prevent information leaks through side channels. A motivating example from Augmented Reality is used to showcase the open-source declarative prototype implementing our proposal. Besides, the prototype is assessed via simulation to evaluate execution times, placement success rates and energy consumption.

Effects of ultrasound with an automatic vessel detection system using artificial intelligence on the selection of puncture points among ultrasound beginner clinical nurses.

Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system. In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points. Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (<3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants. Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS.

Nasogastric tube insertion in anesthetized, intubated adult patients: A comparison between conventional blind insertion technique and “throat pack in situ” technique

Background: Correct placement of nasogastric tube (NGT) placement often becomes difficult in anesthetized, intubated adult patients due to lack of cooperation from patient and the propensity of the tube to travel the same course of path. Preexisting throat pack is supposed to resist the normal passage of the NGT as per common belief. Only one study has evaluated this in pediatric population and the result is encouraging. Aims and Objectives: Hence, the present study has been carried out in adult population to compare the success rate of correct placement of NGT in anesthetized intubated adult patients with the pharyngeal (throat) pack in its position in comparison with no throat pack. This is to examine the effect of preexisting throat pack whether it assists or resists the normal passage of the NGT. Materials and Methods: One hundred and eighty patients were recruited for this interventional and single-blind study. After induction of anesthesia and intubation, the patients were randomized to receive NGT insertion following either blind insertion of the NGT without a pharyngeal pack (group A, n=90) or receive the NGT placement in the same technique but after placement of a pharyngeal pack. The success rate of correct placement of NGT in the first attempt (primary outcome), the procedure time, and adverse events was recorded. Results: Successful insertion of NGT in first attempt was considerably higher in throat pack in situ group compared to blind insertion without a throat pack 81 (90%) versus 63 (70%), respectively (P=0.001). The procedure time for successful placement of NGT was found comparable between the two groups. Significant decrease in coiling is seen in “throat pack in situ” group compared with blind insertion technique (P=0.003). Conclusion: In view of considerable higher success rate and reduced adverse events, it can be concluded that the pre-existing appropriately placed throat pack can facilitate the placement of NGT instead of putting any hindrance.

Influence of arm position on the first pass success rates of ultrasound-guided infraclavicular axillary vein cannulation in spontaneously breathing patients: A randomised clinical trial.

Significant collapsibility during spontaneous respiration, deeper location, and smaller vein size are key challenging factors to safe infraclavicular axillary vein cannulation. Arm abduction reduces collapsibility, but interventional data supporting this observation is lacking. This study investigates the effect of neutral and abducted arm position on the first pass success rate of infraclavicular axillary vein cannulation in spontaneously breathing patients. One hundred and twelve patients were randomly assigned to two arm positions, neutral or abducted by 90° at the shoulder joint. Under ultrasound guidance, the infraclavicular axillary vein was cannulated using an in-plane approach. The primary outcome was the first pass success rate of guidewire placement in the infraclavicular axillary vein. The secondary outcome measures were the number of attempts for successful cannulation, failure rate, and catheter tip malposition. Fifty-two patients in the neutral arm and fifty-six patients in the arm abduction group were compared according to the intention to treat analysis. The abducted arm position was associated with a higher first pass success rate (RR = 3.39, 95% CI = 1.47-7.85; p = 0.004) with fewer attempts (p = 0.005), lower failure rate (RR = 1.37, 95% CI = 1.16-1.61; p = 0.000) and lower catheter tip malposition (1.5 vs 15.8%; p = 0.012) when compared to the neutral arm position. Abducted arm position resulted in a significantly higher first pass success rate with a lower failure rate and catheter tip malposition during ultrasound-guided infraclavicular axillary vein cannulation in spontaneously breathing patients.

Preliminary evaluation of SaCoVLM video laryngeal mask-guided intubation in airway management for anesthetized children

BackgroundsTo preliminary evaluate the application of novel SaCoVLM video laryngeal mask -guided intubation for anesthetized children.MethodsOne hundred twenty-four children with microtia (ages 5-15 years,) who required general intubation anaesthesia, were enrolled in the study. After induction of general anesthesia,guided tracheal intubation under direct vision of the SaCoVLM was performed. Our primary outcome was first-pass success rate of guided tracheal tube placement. Secondary outcome included glottic visualization grades, the first-attempt success rate of LMA placement, the time for LMA placement and time to endotracheal intubation as well as the time for LMA removal after successful intubation, the fiberoptic grade of laryngeal view, the baseline and postinduction hemodynamic parameters were also recorded,and the incidence 24 h complications after operation.ResultsThe first-pass success rate of guided tracheal tube placement was 91.1% (95%CI = 1.04–1.14), the status of glottic visualization was classified: grade 1 in 27cases, grade 2 in 36 cases, grade 3 in 41 cases and grade 4 in 20 cases. The first success rate of LMA placement was 92.7% (95%CI = 1.03–1.13), the time for LMA insertion was 15.7 (±9.1) s, intubation time was 30.9 (±17.6) s and withdrawl time was 24.9 (±9.3) s. The incidence of postoperative sore throat at 2 h was 29%, and 16.1% at 24 h, without dysphagia and hypoxia.ConclusionThe SaCoVLM video laryngeal mask-guided intubation is feasible in children, with a high success rate, could be a new promising device to guide intubation in airway management.Trial registrationThis study was approved by the University’s Institutional Review Board and written informed consent was obtained from all subjects participating in the trial. The trial was registered prior to patient enrollment at clinicaltrials.gov (ChiCTR2200061481, http://www.chictr.org.cn. Principal investigator: Juan Zhi; Date of registration: 26/06/2022.

Preoperative alpha-blockers to facilitate ureteral access sheath (UAS) insertion: a systematic review and meta-analysis

Background: Recent studies have proposed the use of preoperative alpha-blockers to facilitate urethral access sheath (UAS) placement, but the definite role of this practice is still unclear. We aimed to evaluate the efficacy and safety of alpha-blocker use for UAS placement in intrarenal endoscopic procedures. Methods: The course of this study followed the preferred reporting items for systematic review and meta-analyses guidelines. Articles investigating the use of preoperative alpha-blockers for patients who underwent intrarenal endoscopic procedures were systematically reviewed from PubMed, EMBASE, and Scopus databases. Odds ratio (OR) with 95% confidence intervals (CIs) were applied for the outcome estimates. Analyses were performed with RevMan 5.4 software. The protocol of this study is enlisted in the registry of PROSPERO (CRD42022342811). Results: Six articles comprising 462 study populations were included in the review. Meta-analysis on the success rate of UAS placement showed a significant advantage of the alpha-blocker group compared to the control group (OR: 3.83; 1.83-8.00; 95% CI; p = 0.0004). Ureteral wall trauma was higher in the control group (OR: 0.38; 0.17-0.84; 95% CI; p = 0.02). Furthermore, there was no clear association between the UAS size and the success rate of UAS insertion. Conclusion: Preoperative alpha-blockers may increase the success rate of UAS insertion while decreasing the risk of ureteral wall injury in intrarenal endoscopic procedures.

Evaluation of Four Techniques to Administer Laryngeal Mask Airway.

Laryngeal mask airway (LMA) plays a crucial role in the field of modern anesthesia. There are different techniques to administer LMA. Here we aimed to compare the four methods of standard, 90° rotation, 180° rotation, and thumb placement in LMA mast placement. This is a clinical trial that was performed on 257 candidates of elective surgical operations requiring general anesthesia. All patients were categorized into four groups of LMA placement with index finger (standard method), mask placement with 90° rotation, 180° rotation method, and thumb finger group. We collected data regarding the success rates of LMA placement, the need for any manipulation when placing the mask, LMA placement time, failure of mask placement, presence of blood on the LMA, and laryngospasm and sore throats 1 hour after surgery in patients. The 90° rotation method had a significantly higher first attempt success rate than that in the other three methods (98.4%, P = 0.02). Total success rate in 90° rotation method was also significantly higher than the other techniques (100%, P < 0.001). The need for any manipulation when placing the mask (1.6%, P = 0.01), presence of blood on the LMA mask (1.6%, P = 0.33), and frequency of sore throats 1 hour after surgery (21.9%, P = 0.14) were also lower in 90° rotation method than that in the other methods. The 90° rotation method had significantly higher success rate and lower failure rate regarding the mask placement compared to other three methods.

Efficacy and safety of a novel vena cava filter on pulmonary embolism prophylaxis: a prospective, multicenter, randomized, parallel, positive-controlled, noninferiority clinical trial.

There are different types of vena cava filter (VCF) available in clinical practice. However, limited data exist to determine whether one type is superior to another, and no single VCF is universally recommended in clinical guidelines. The objective of this study was to investigate the safety and efficacy of a novel VCF, Octoparms, for the prevention of pulmonary embolism (PE) and to compare it with the Celect filter. This multicenter, randomized, open-label, parallel, positive-controlled, noninferiority trial was conducted in 10 centers across 6 provinces in China from October 2017 to March 2019. Patients who had confirmed lower extremity deep vein thrombosis or PE or who were at risk of PE with a clinical indication for VCF placement due to contraindication to or failure of anticoagulant therapy were included in the trial. The sample size for this trial was based on the assumption that the clinical success rate would be 95% and the noninferiority margin would be 10% for both filters. Each patient underwent baseline testing and was randomized using a web-based central system. Any additional interventions or standard treatments patients received along with the VCF placement were recorded. The primary endpoint was the overall clinical success rate, including technical and clinical success of filter placement and retrieval. The secondary endpoint was the safety of filter placement and retrieval, encompassing procedure-related and filter-related complications. A total of 188 patients were included and were divided into two groups: the Octoparms group (n=94) and the Celect group (n=94). Baseline characteristics and demographics were comparable between the two groups (P>0.05). Technical and clinical success rates for filter placement were achieved in 100% (188/188) of patients. The median dwelling time was 12.0 days (range, 4-190 days). Ten VCFs were left in situ as permanent devices. Of the remaining 178 patients, technical success and clinical success rates for filter retrieval were both achieved in 100% of cases (178/178). Clinical success rates were 92.6% (87/94) for the Octoparms group and 96.8% (91/94) for the Celect group, with a difference of -4.2% (hazard ratio 2.441, 95% confidence interval 0.612-9.741; P=0.206). The lower limit was greater than the noninferiority margin of -10%. Eight patients experienced a total of eight procedure-related complications. No filter-related complications, such as migration, deformation, inferior vena cava (IVC) penetration, peripheral organ damage, or IVC stenosis/occlusion, were observed (P>0.05). The Octoparms filter exhibited a high rate of clinical success and a low rate of complications during placement and retrieval, demonstrating noninferiority to the Celect filter.

Current Approaches and Problems Faced by Orthopedic Surgeons in All-Inside Arthroscopic Meniscus Repairs

Objective All-inside meniscal sutures are frequently the treatment of choice in arthroscopic practice. However, the literature contains limited evidence of the technical issues experienced during the procedure. We aimed to evaluate the technical difficulties encountered during the placement of all-inside meniscal repair sutures according to the surgeon’s experience and the success rate of the suture placement. Materials and Methods We invited orthopaedic surgeons across the country to complete a questionnaire through an online platform. Participants were asked to answer 10 questions about their demographic information, general surgical approach to meniscal tears, and experience with intraoperative complications specific to all- inside meniscus sutures. We performed a correlation analysis using the SPSS program to evaluate the statistical significance of the data we obtained. Results A total of 100 orthopedic surgeons participated in our study. Of these, 37% had been working as an orthopedic surgeon for more than 10 years. Twenty-five percent performed more than two arthroscopic knee surgeries per week. Fifty-six percent of the surgeons were protective for the displaced red-white zone meniscal tears. Although 90% of the participants stated that the technique was more effortless, only 12% thought the clinical results were better than the other techniques. More than 50% of the participants indicated that they had difficulty when placing the sutures successfully. The most common problem was the inability to fix the meniscus sufficiently and the deformation of the instruments inside the joint. When we compared the complications according to the surgeon's experience, even among the surgeons who performed more than 100 arthroscopic surgeries per year, 34% had trouble successfully applying these sutures. Conclusion Although all-inside meniscus sutures are generally believed to decrease the operative time and to be technically more straightforward, even the most experienced surgeons have difficulty in applying these sutures, and the reliability of these sutures is low.

Treatment Outcomes of 94 Cases of Pipeline Embolization Device in a Single Center: Predictive Factors of Incomplete Aneurysm Occlusion.

This study aimed to report the outcome of an endovascular treatment with a pipeline embolization device (PED) at a single center. We also examined the predictive factors for an incomplete occlusion after the PED placement. The subjects were 94 patients with 109 aneurysms who underwent the PED placement at our single center from June 2015 to September 2022. As treatment outcomes, we investigated the PED placement success rate, perioperative morbidity and mortality, postoperative cranial nerve improvement rate, and the classification of angiographic result at 6 months after the PED placement. Furthermore, the predictors of an incomplete occlusion were investigated in detail. One hundred nine aneurysms locations were: C1 (9), C2 (30), C3 (15), C4 (53), and C5 (2) in the internal carotid artery segments. Perioperative morbidity, including the asymptomatic ones, occurred in 10 cases (10.6%). Among these 10 cases, the modified Rankin Scale (mRS) improved to preoperative mRS after 90 days in 9 cases except 1 case. On the other hand, no perioperative mortality was observed. The postoperative cranial nerve improvement rate was 84.4%, and 61.7% of patients had a complete occlusion in the follow-up angiography, 6 months after the PED placement. Predictive factors for an incomplete occlusion after the PED placement were the elderly aged 70 years or older (P-value = 0.0214), the elderly aged 75 years or older (P-value = 0.0009), and the use of anticoagulants (P-value = 0.0388) in an univariate analysis. Further, the multivariate analysis revealed that the elderly aged 75 years or older was a predictive factor of an incomplete occlusion in this study. We summarized the outcomes of the PED treatment at our single center. In this study, the elderly aged 75 years or older was a predictive factor of an incomplete occlusion after the PED placement.

Image quality and related outcomes of the ShuntScope for catheter implantation in pediatric hydrocephalus—experience of 65 procedures

PurposeVentricular catheter implantation in pediatric hydrocephalus can become a highly challenging task due to abnormal anatomical configuration or the need for trans-aqueductal stent placement. Transluminal endoscopy with the ShuntScope has been invented to increase the rate of successful catheter placements. This study aims to evaluate ShuntScope’s image qualities and related surgical outcomes in the pediatric population.MethodsA retrospective analysis of all pediatric patients undergoing ventricular catheter placement using the ShuntScope from 01/2012 to 01/2022 in the author’s department was performed. Demographic, clinical, and radiological data were evaluated. The visualization quality of the intraoperative endoscopy was stratified into the categories of excellent, medium, and poor and compared to the postoperative catheter tip placement. Follow-up evaluation included the surgical revision rate due to proximal catheter occlusion.ResultsA total of 65 ShuntScope-assisted surgeries have been performed on 51 children. The mean age was 5.1 years. The most common underlying pathology was a tumor- or cyst-related hydrocephalus in 51%. Achieved image quality was excellent in 41.5%, medium in 43%, and poor in 15.5%. Ideal catheter placement was achieved in 77%. There were no intraoperative complications and no technique-related morbidity associated with the ShuntScope. The revision rate due to proximal occlusion was 4.61% during a mean follow-up period of 39.7 years. No statistical correlation between image grade and accuracy of catheter position was observed (p-value was 0.290).ConclusionThe ShuntScope can be considered a valuable addition to standard surgical tools in treating pediatric hydrocephalus. Even suboptimal visualization contributes to high rates of correct catheter placement and, thereby, to a favorable clinical outcome.

Central Venous Access: Conventional Seldinger Versus Ultrasound-Guided Technique to Reduce Associated Complications in A School Hospital

Hypertension and diabetes are the main comorbidities and risk factors for complications related to the placement of central venous accesses,these complications are extremely frequent when performed by the conventional Seldinger technique. Through this study, an attempt was made to establish the frequency and reduction of complications when comparing placement by internal medicine resident using conventional marking techniques of seldinger versus ultrasound guided in emergency service in 76 patients. The results through the chi square test with a p value of 0.05, showed successful placement: Increases the chance of success when using Ultrasound by 57% (RR: 1.57) successful placement rate was achieved with the use of ultrasound of 91.6% versus 52% in patients with conventional technique, the Reduction of risk of arterial complications with the use of ultrasound was 26% (RR: 0.74), the reduction risk of pneumothorax with ultrasound was 86% (RR: 0.14) and reduction of infectious complications with Ultrasound was 86% (RR: 0.14). Time required for placement of the central venous access was significantly shorter with ultrasound when analyzed with U-Mann Whitney with P value: 0.002, There were 6 catheter-associated infections per thousand catheter days in the conventional technique group versus 1 in the Ultrasound group (with an average hospital days associated with infection of 11.2). The main associated comorbidities HBP, DM-2, Cancer and Obesity, with higher prevalence in the ultrasound placement group. Ultrasound considerably reduced the number of mechanical, vascular or infectious complications associated with placement of central venous accesses, becoming a valuable tool for internal medicine resident physicians.

Clinical efficacy and safety of endobronchial one-way valves for the treatment of bronchopleural fistula

Objective: To investigate the efficacy and safety of interventional endobronchial one-way valves (EBV) for the treatment of peripheral bronchopleural fistula (BPF). Methods: A total of 33 patients with peripheral BPF who underwent EBV implantation in Endoscopy Center of Shanghai Pulmonary Hospital from August 2017 to December 2021 were selected as the research objects. All the patients were diagnosed with peripheral BPF before the implantation surgery. The detailed medical records of the patients were collected, and the etiology, lesion location, treatment method and operation process, treatment efficacy and postoperative complications were analyzed to evaluate the efficacy and safety of EBV implantation. Results: Of the 33 patients in our study, 26 were male and 7 were female. The median age was 54.7 (28-86) years. There were 18 cases of BPF after thoracic surgery (54.5%), 6 cases of chronic obstructive pulmonary disease complicated with spontaneous pneumothorax (18.2%), and 12 cases of pulmonary tuberculosis and non-tuberculous mycobacterial infection with spontaneous pneumothorax (36.4%). A total of 63 valves were inserted in the 33 cases, and a maximum of valves and at least one were inserted in a single case. The lesions were located in the right lower lobe in 16 cases (48.5%) and the left upper lobe in 12 cases (36.4%). Of the 33 patients undergoing EBV placement, 22 (66.7%) were successful, with chest drainage tube indwelling duration of (88.5±36.6) days and (29.6±11.4) days, respectively, before and after EBV treatment. The time from EBV placement to successful withdrawal of EBV was (102.2±31.3) days. During a postoperative follow-up of 6 months after EBV treatment, the main complications were 29 cases with attachment of secretions to the EBV (90.6%) and 13 cases (40.6%) with mild granulation proliferation. In addition, there were five patients with moderate to severe granulation proliferation (15.6%), one with valve displacement or shedding (3.1%), and one with bleeding (3.1%). Conclusions: In this study, the success rate of EBV placement and occlusion was 66.7%. Transbronchoscopic EBV placement in the treatment of peripheral BPF is a effective treatment with relatively minor complications.

Current practice for the treatment of obstructive left-sided colon cancer in China: a nationwide cross-sectional survey.

This study surveyed the current practice of surgical treatment of obstructive left-sided colon cancer (OLCC) in China. All colorectal surgery departments at tertiary or secondary hospitals in China were invited to complete a web-based questionnaire between August 27 and September 2, 2020. Overall, completed questionnaire were received from 357 hospitals. Emergency surgery was the mainstay of treatment for OLCC, with the open approach accounting for up to 61.62%. The stoma rate of emergency surgery was up to 80%, mainly due to inadequate bowel preparation and severe edema of colon walls. Hartmann's procedure (61.62%) was the most preferred operation. A total of 243 hospitals (68.7%) reported that they would consider the use of a self-expanding metallic stent (SEMS) as a bridge for elective surgery. More than 50% of the hospitals participating in this study reported the success rate of SEMS placement, as well as the resolution rate of obstruction more than 80%, and the stent-related perforation rate was < 5%. A total of 126 hospitals considered carrying out a strategy ofSEMS followed by neoadjuvant chemotherapy prior to elective surgery and believed that it might further improve treatment outcomes. SEMS is a feasible option for the treatment of OLCC in addition to traditional emergency surgery, and its clinical benefits have been preliminarily recognized.

Comparison of Open and Ultrasound-Guided Placement of Central Venous Catheter in Children Weighing Less Than Five Kilograms; A Randomized Clinical Trial

Ultrasound is currently utilized to locate the internal jugular vein (IJV), reduce the complications of catheter placement, and increase the likelihood of accessing IJV. Therefore, the aim of the present study was to evaluate the effectiveness of ultrasound in reducing complications during catheter placement in children weighing less than 5 kg. The current randomized clinical trial was performed on 111 children weighing less than 5 kg who required a central venous catheter (CVC). Children were divided into two groups: in the first group (Seldinger group; n=55), a CVC was inserted using the Seldinger wire method under ultrasound guidance, and in the second group (open surgical cutdown (OSC); n=56), the catheter was inserted via the open method. Two weeks after catheter placement, patients were evaluated for thrombosis, catheter occlusion, catheter tip migration, infection, catheter removal, and catheter dysfunction. The success rate of catheter placement in the ultrasound-guided method was 85.5%. The incidence of thrombosis (3.6% vs. 5.4%), infection (1.8% vs. 7.4%), and bleeding (zero vs. 3.6%) was lower in the Seldinger group, but the difference was not significant (p ˃ 0.05). Hematoma (7.3% vs. 3.6%) occurred less frequently in the patients of the OSC group (p=0.33). Hemothorax, pneumothorax, catheter migration, and occlusion did not occur in any of the patients. In the OSC group, two deaths (3.6%) occurred due to underlying diseases. When ultrasound is used to insert a CVC in children weighing less than 5 kg, the incidence of complications is not significantly different compared to when the open method is employed.

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation.

Compared with nasogastric nutrition, nasojejunal nutrition may prevent some complications of critically ill patients by maintaining better nutritional status, and blind placement of nasojejunal dwelling feeding tubes is widely used. However, the visual placement seems to be safer and more effective than the blind placement, and is still seldom reported. We tried to develop visual placement of a nasojejunal feeding tube in intensive care unit patients. A total of 122 patients receiving mechanical ventilation were admitted to the Department of Critical Care Medicine of the Fifth Affiliated Hospital of Wenzhou Medical University and received the placement of nasojejunal feeding tubes. These patients were randomly and evenly assigned into two groups, one group receiving visual placement of nasojejunal dwelling feeding tubes and another group receiving blind placement. Actual tube placement was confirmed by X-ray. The primary outcome included the success rates of first placement of feeding tubes. The secondary outcome included the time of tube placement, complications, the total cost, heart rates and respiratory rates. The primary outcome showed that the success rates of first placement were 96.70% (59 cases/61 cases) in the visual placement group, and two cases failed due to pyloric stenosis and gastroparesis. The success rates were 83.6% (51 cases/61 cases) in the blind placement group and 10 cases failed due to either wrong placement or retrograde tube migration. The success rates in the visual placement group were higher than that in the blind placement group (P = 0.015). The secondary outcome showed that the time of tube placement in the visual placement group was shorter than that in the blind placement group (P < 0.0001). The cost of tube placement in the visual placement group was higher than that in the blind placement group (P < 0.0001). The statistical differences in complications, heart and respiratory rates were insignificant between the two groups (P > 0.05). Compared with the blind placement, the visual placement shortened the time of nasojejunal tube placement and increased success rates of first placement. The visual placement was more efficient, easy to operate, safe, and has potential clinical applications.

Evaluating the Optimal Operating Table Height for ProSeal-LMA™ Insertion.

ProSeal-Laryngeal Mask Airway™ (P-LMA™) is one of the commonly used laryngeal mask airways. Despite the proper insertion technique, suboptimal positioning and airway morbidity still occurs. This study explored the possibility of the operating table height position affecting successful P-LMA™ placement. A total of 138 patients aged between 18 and 65 years old with the American Society of Anesthesiologists (ASA) I or II status, who required general anaesthesia and had no contraindication towards the use of P-LMA™, were recruited. They were randomly positioned into three anatomical landmarks, which were umbilicus, lowest rib margin, and xiphoid. P-LMA™ was inserted following muscle paralysis, and the first successful placement was evaluated using positional and performance tests. Duration, ease of P-LMA™ insertion, and airway complications were compared. Demographic and airway features were comparable among all groups. The P-LMA™ placement success rate improved when the table height was positioned at the lowest rib margin (p=0.002). All three positions were comparable in terms of duration, ease of insertion, and airway morbidities. The lowest rib margin anatomical landmark can be used as a guide in achieving the optimal operating table height for successful P-LMA™ placement.

Efficacy and Accuracy of Using Magnetic Seed for Preoperative Non-Palpable Breast Lesions Localization: Our Experience with Magseed.

In this retrospective study we share our single-center experience using a magnetic seed for the preoperative localization of non-palpable breast lesions. Patients who underwent a preoperative localization with Magseed® (Endomagnetics, Cambridge, UK) placement between 2020 and 2022 were enrolled. Indications to Magseed placement have been established during multidisciplinary meetings prior to surgery and all patients underwent breast-conserving surgery (BCS). 45 patients were included. Magnetic seeds have been introduced under ultrasound guidance in 40 patients (88.9%) and under stereotactic guidance in 5 patients (11.1%). We registered a highly successful placement rate (97.8%), with only one case of migration (2.2%). After BCS, all the magnetic seeds were recovered (100% retrieval rate). The re-excision rate for positive margins was 0%. Our experience, with a highly successful placement and retrieval rate and a re-excision rate equal to 0%, is consistent with the encouraging literature published on Magseed so far, suggesting this technique to be extremely effective. Moreover, our single case of seed migration supports the existing data stating that Magseed migration is rare. In conclusion, despite acknowledging Magseed limitations, we highly value the advantages linked to this technique, and we, therefore, uphold its use.

Examination of the effectiveness of bedside nasojejunal tube placement using a portable imaging device with a flat panel detector.

Transporting pediatric patients with severe cardiovascular complications to the fluoroscopy room can be difficult. Therefore, we started using a portable imaging device with a flat panel detector (FPD) for nasojejunal tube (NJT) placement. The purpose of this study was to investigate the differences in length of time of NJT placement and dosage of radiation exposure using a portable imaging device with FPD versus fluoroscopy. Pediatric patients who underwent NJT placement between April 2016 and December 2018 were identified retrospectively from the clinical records. The age, sex, body weight, and height of each child at the time of the procedure as well as the procedure time, outcomes of the procedure, and dosage of radiation exposure was compared between the two groups. In 76 cases of NJT placement (41 patients), there was no significant difference in the success rate of NJT placement between the FPD (90%) and fluoroscopy groups (95%). However, the NJT placement time was significantly longer in the FPD group than in the fluoroscopy group (488 s vs 291 s). According to our calculations, the radiation dosage was lower in the FPD group than in the fluoroscopy group (136 μGy per procedure vs 2819 μGy per procedure). These results suggest that NJT placement using a portable imaging device with an FPD can be an effective method for children who are difficult to transport with an equal success rate and lower dosage of radiation exposure compared with conventional fluoroscopy.

Real Time Ultrasound-Guided Thoracic Epidural Catheterization with Patients in the Lateral Decubitus Position without Flexion of Knees and Neck: A Preliminary Investigation.

Objectives: For some patients, such as pregnant women, it can be difficult to maintain the ideal "forehead to knees" position for several minutes for epidural catheter placement. We conducted this study to investigate the feasibility of real-time ultrasound-guided (US) epidural catheterization under a comfortable lateral position without flexion of knees and neck. Materials and Methods: 60 patients aged 18-80 years with a body mass index of 18-30 kg/m2 after general surgery were included. In a comfortable left lateral position, thoracic epidural catheterization was performed under real-time US for postoperative analgesia. The visibility of the neuraxial structures, procedural time from needle insertion to loss of resistance in the epidural space, the number of needle redirections, success rate of epidural catheter placement and postoperative analgesic effect were recorded. Results: In the paramedian oblique sagittal view, the well visible of vertebral lamina, intervertebral space and posterior complex under ultrasound were as high as 93.33%, 81.67% and 70.00%, respectively. The success rate of thoracic epidural catheterization was as high as 91.67%, and the satisfactory postoperative analgesic effect was 98.2% for patients without nausea, pruritus and other discomfort. Discussion: Thoracic epidural catheterization with patients in the lateral position without flexion of knees and neck under real time ultrasound guidance has a high success rate and strong feasibility. This visual manipulation makes epidural catheterization not only "easier" to perform, but also reduces the requirements of the procedure.