Catheterization Time Research Articles

Application of B-ultrasound for localization and its impact on first-attempt success rates of nasogastric tube insertion in critically ill patients.

The objective of this study is to explore the application effect of B-ultrasound positioning in assisting nasointestinal tube implantation in critically ill patients. This study is a retrospective study. In this study, 90 cases of severe patients with nasointestinal tube implantation were included. According to the different ways of nasointestinal tube insertion received by patients, 61 patients with conventional blind insertion methods were included in the blind insertion group, and 29 patients with conventional methods and B-ultrasound assisted positioning were included in the B-ultrasound positioning group. The general clinical data, success rate of catheterization, catheterization time, pyloric passage rate, and target nutritional value time of the 2 groups were compared. The changes of the 2 groups after catheterization were compared by SOFA and APACHE II. The contents of albumin and lymphocyte count were compared between the 2 groups before and after catheterization. The time of target nutritional value of the patients of the B-ultrasound positioning group was markedly decreased comparing with the patients of the blind insertion group. The index of catheterization time of the patients between the blind insertion group and B-ultrasound positioning group had no obvious contrast. The APACHE II score and SOFA score of the patients of the B-ultrasound positioning group were obviously lower than the blind insertion group. The contents of lymphocyte count of the patients of the B-ultrasound positioning group were markedly increased comparing with the patients of the blind insertion group after catheterization, but the contents of albumin content had no obvious change. The scores of respiratory system, circulatory system, nervous system, and urinary system in the B-ultrasound positioning group were significantly higher than those in the blind insertion group, while the COPT scores were significantly lower than those in the blind insertion group. B-ultrasound assisted nasointestinal tube implantation is well tolerated in critically ill patients, and can effectively ameliorate the nutritional status and of the ill patients.

A nomogram for predicting the risk of postoperative fever in elderly patients undergoing endoscopic submucosal dissection of the upper gastrointestinal tract.

To explore the risk factors of postoperative fever in elderly patients undergoing endoscopic submucosal dissection (ESD). A total of 439 patients who met the inclusion criteria were enrolled in this study and randomly divided into training (n = 311) and validation (n = 128) cohorts at a ratio of 7:3. Independent risk factors were screened by single-factor and multiple-factor logistic regression analyses, and a nomogram was established using them. The nomogram was evaluated using receiver operating characteristic curve analysis, decision curve analysis, and calibration plot using the "rms" package in R software (R4.2.1). The study included 439 patients. Female (OR = 2.55, 95% CI: 1.5-4.33), diabetes (OR = 2.38, 95% CI: 1.17-4.85), operation time (OR = 1.01, 95% CI: 1-1.02) were lesion located in the esophagus (OR = 2.37, 95% CI: 1.44-3.88), maximum tumor diameter (OR = 1.3, 95% CI: 1.07-1.57), and placement of a urinary catheter (OR = 7.09, 95%CI: 1.43-35.17) were independent risk factors for postoperative fever in elderly ESD patients (P < .05). Female sex, diabetes, lesions located in the esophagus, lesion size, operation time, and placement of a urinary catheter are risk factors for postoperative fever in ESD patients, and patients with these risk factors should be vigilant for postoperative fever and receive appropriate treatment.

Transurethral versus open enucleation of the prostate in Sweden – a retrospective comparative cohort study

Objective: To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) &gt; 80 ml in a population in Sweden. Methods: 54 patients with ultrasound verified BPO &gt; 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review. Results: Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited. Conclusions: Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisation- and catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up.

No Critical Ultrasound, No Life: The Value of Point-of Care Critical Ultrasound in the Rescue of Critically Ill Infants.

Point-of-care critical ultrasound (POC-CUS) screening plays an increasingly important role in the treatment of critically ill infants. Without POC-CUS, the lives of many infants would not be saved in time and correctly. A premature infant with systemic multiple organ system dysfunction caused by fungal sepsis was treated and nursed under the guidance of POC-CUS monitoring, and the infant was ultimately cured. This premature infant had systemic multiple organ system dysfunction and disseminated intravascular coagulation (DIC) caused by fungal sepsis. In the hypercoagulable state of early-stage DIC, cardiac thrombosis could be found using ultrasound screening. For this case, right renal artery thrombosis was found via renal artery Doppler ultrasound examination. Due to the severity of this disease, ultrasound-guided peripherally inserted central catheter (PICC) insertion and ultrasound checks of the PICC tip's position were performed, which ensured the success of this one-time catheterization and shortened the catheterization time. Lung ultrasound is used for the diagnosis and differential diagnosis of pulmonary diseases, and to guide the application of mechanical ventilation. Because the abdominal circumference of the patient's markedly enlarged abdominal circumference, bloody stool, and absence of bowel sounds, abdominal ultrasonography was performed, which revealed a markedly enlarged liver, significant peritoneal effusion, and necrotizing enterocolitis. Guided by POC-CUS monitoring, we had the opportunity to implement timely and effective treatment that ultimately saved this critically ill patient's life. The successful treatment of this newborn infant fully reflects the importance of carrying out POC-CUS screening.

Vascular access modalities in a pediatric intensive care unit in tertiary hospital indications and outcomes: a single-center cross-sectional study

BackgroundVascular access is a mainstay of pediatric critical care. The selection of the route of access and equipment used will depend on patient- and provider-specific factors, which constantly need revision to achieve more effective assessment and management.ObjectiveTo evaluate the use, indication, and outcome of different vascular access modalities in critically ill children in the Emergency Pediatric Intensive Care Unit (ER-PICU) of a tertiary university hospital.Patients and methodsThis cross-sectional descriptive study was based on data collected by reviewing all modes of vascular access used for 168 consecutive patients admitted to ER-PICU during a 6-month period from May to October 2020.ResultsAmong the study group (n = 168), there were 92 males (54.8%) and 76 females (45.2%). The median age of cases was 18 months. 333 vascular access devices were observed: 219 peripheral (65.8%) and 114 central catheters (34.2%). Catheters lasted a total of 1920 catheter days. Central venous catheters lasted significantly more than peripheral lines (P < 0.001); median of 8.5 and 3 days, respectively. The incidence of peripheral line complications (35.2%) was found significantly higher compared to central venous catheters (22.8%) (P. = 0.021). Longer dwell time of central access was associated with a higher incidence of catheter-related bloodstream infection. The incidence of catheter-related bloodstream infection was 9.05 per 1000 catheter days. Mortality rate was 24.4%.ConclusionsDespite having lower incidence of complications than peripheral lines, central venous catheters’ complications are considered more serious. Dwell time of central venous catheters (CVC) should be revised daily to avoid the occurrence of infection.

The application of Foley catheter traction technique in extraperitoneal robot-assisted radical prostatectomy

ObjectivesTo describe a technique to improve exposure of prostate during extraperitoneal robot-assisted radical prostatectomy (EP-RARP).Material and methodsFrom March 2020 to June 2022, a total of 41 patients with prior intra-abdominal surgery underwent EP-RARP. Twenty-three patients improved exposure by traction of prostate through urinary catheter. The catheter traction prostatectomy (CTP) group was compared with the standard prostatectomy (SP) group using three robotic arms (18 patients) in terms of estimated blood loss (EBL), operative time, positive surgical margin rate, the recovery rate of urinary continence, Gleason score and postoperative hospital stays. Differences were considered significant when P < 0.05.ResultsThe operative time was lower in the CTP group (109.63 min vs. 143.20 min; P < 0.001). EBL in the CTP group was 178.26 ± 30.70 mL, and in the standard prostatectomy group, it was 347.78 ± 53.53 mL (P < 0.001). No significant differences with regard to postoperative hospital stay, recovery rate of urinary continence, catheterization time and positive surgical margin were observed between both groups. No intraoperative complications occurred in all the patients. After 6 months of follow-up, the Post-op Detectable prostate specific antigen was similar between the two groups.ConclusionCTP is a feasible, safe, and valid procedure in EP-RARP. Application of CTP improved the exposure of prostate, reduced operative time and blood loss in comparison with the conventional procedure.

Efficacy of Low Dose Intravenous Epinephrine Infusion in Improving Perioperative Outcomes in Patients Undergoing Transurethral Resection of Prostate: A Prospective Parallel Arm Double-Blind Randomized Control Trial

ObjectiveTo determine the efficacy of intraoperative low-dose intravenous epinephrine infusion in improving intraoperative bleeding and perioperative outcomes of TURP surgery. MethodsThis was a double-blinded, randomized control trial in which all patients undergoing bipolar TURP were included. Patients with uncontrolled hypertension, cardiac disease, and on anticoagulants were excluded. The study group received intravenous epinephrine, whereas the control group received normal saline at the same rate (0.05 μg/kg/min) throughout the procedure. Intraoperative blood loss was the primary outcome. The secondary outcomes were incidence of intraoperative hypotension (due to spinal anesthesia (SA)), resection time, indwelling catheter time, and length of hospitalization (LOH). ResultsThirty-six patients were included in each group. Demographic and clinical profiles were comparable with an overall median prostate size of 41 (34-52) gram in both groups. The primary objective, mean intraoperative blood loss in the study group was lower than the control group but statistically insignificant (67.91+/-18.7 ml vs 75.14+/-17.1 ml; p=0.086). Incidence of intraoperative hypotension was significantly lower in the study group (8.3% vs 33.3%; p= 0.01). Rest of the secondary outcomes, resection time (83 (64-111.5) min vs 86 (68-94.75) min; p=0.97), mean indwelling catheter time (p=0.94), postoperative complications (p=0.73), and LOH (p=0.87) were comparable. ConclusionsIn this first-of-its-kind trial, low-dose epinephrine infusion did not reduce intraoperative blood loss in patients undergoing TURP. However, it significantly reduced intraoperative hypotension, which complicates SA particularly in elderly population.

Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: Systematic review and meta-analysis.

Men with detrusor underactivity (DUA)and concomitant bladder outlet obstruction (BOO)due to benign prostatic enlargement (BPE)may present poorer functional outcomes after surgical desobstruction. This study aimed to evaluate the safety and efficacy of BPE surgery in men with DUA compared with those with normal detrusor contractility (NC). This review was performed according to the 2020 PRISMA framework. A comprehensive literature search was performed until May 7, 2023, using MEDLINE, EMBASE, and Cochrane Database. No date limits were imposed. Only comparative studies were accepted. The primary endpoint was to assess if there was any difference in short- and long-term functional outcomes after BPE surgery in men with DUA and NC. The secondary endpoint was to evaluate the differences in perioperative outcomes and postoperative complications between the two groups. Meta-analysis was performed using Review Manager (RevMan) software. There were 5 prospective nonrandomized studies and 12 retrospective studies, including 1701 DUA and 1993 NC patients. Regarding surgical procedures, there were eightTURP (transurethral resection of the prostate) studies, fourGreenLight PVP (photoselective vaporization of the prostate) studies, twoHoLEP (Holmium laser enucleation of the prostate) studies, oneGreenLight PVP/HoLEPstudy, oneHolmium laser incision of the prostate study, and onestudy did not report the type of surgery. We did not find a statistically significant difference between the two groups in terms of perioperative outcomes, including postoperative catheterization time, hospitalization time, urinary retention, need to recatheterization, transfusion rate, or urinary tract infections. Also, we found no significant differences in long-term complications, such as bladder neck stenosis or urethral stenosis. Posttreatment bladder recatheterization and retreatment rate for BPE regrowth could not be evaluated properly, because only one study reported these findings. When we analyzed functional outcomes at 3 months, those with NC had lower International Prostatic Symptom Score (IPSS),lower quality-of-life (QoL) score, better maximum flow rate (Qmax), and lower post-voiding residual (PVR)of urine. These results were maintained at 6 months postoperatively, with exception of PVR that showed no difference. However, at 12 and more than 12 months the functional outcomes became similar regarding IPSS and QoL. There were few data about Qmax and PVR at longer follow-up. In this meta-analysis, data suggest that BOO surgical treatment in patients with concomitant BPE and DUA appears to be safe. Despite patients with DUA may present worse functional outcomes in the short postoperative term compared with the NC population, IPSS and QoL scores become comparable again after a longer follow-up period after surgery.

Tubeless PCNL versus standard PCNL for the treatment of upper urinary tract stones: a propensity score matching analysis

PurposeIn this study, the feasibility of tubeless percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract stones was investigated.MethodsFrom January 2021 to December 2022, the clinical data of 273 patients who received tubeless PCNL (Group A) were studied. The control group includes clinical data from 302 patients (from January 2019 to October 2022) who received standard PCNL (Group B). The baseline characteristics were consistent between the two groups after using the propensity score matching (PSM) method. Compare the preoperative clinical characteristics, postoperative complications, residual stones, catheterization time, and hospital stay between the two groups.Results146 pairs of patients were successfully paired through PSM. There was no statistically significant difference in operative time, blood leukocyte counts, haemoglobin decrease, fever, urinary extravasation, sepsis, bleeding, blood transfusion rates, embolism, and residual stones after surgery between the two groups; Postoperative day 1 and discharge day, the VAS pain score in Group A was significantly lower than that in Group B. The catheterization time and hospitalization time of patients in Group A were significantly lower than those in Group B.ConclusionAccording to the inclusion and exclusion criteria, selecting suitable patients for tubeless PCNL is safe and effective, while significantly alleviating pain and reducing catheterization time and hospital stay.

Ultrasound guidance practices used for the placement of vascular accesses in intensive care units: an observational multicentre study

BackgroundCentral catheters expose ICU patients at risk of catheter-related bloodstream infections. A mechanism by which these infections occur is the contamination of the catheter during its insertion if aseptic techniques are not strictly applied. Recent studies suggest that the use of ultrasound guidance (USG) may increase the risk of catheter contamination during insertion. We assessed current practices regarding the use of USG during catheter insertion, with a focus on identifying breaches of the surgical asepsis required for this invasive procedure.MethodsIn 26 intensive care units, we evaluated the use of USG during catheter insertion, using a questionnaire addressed to intensivists and direct observation of their practices.ResultsWe analyzed 111 questionnaires and 36 observations of intensivists placing catheters. The questionnaires revealed that 88% of intensivists used USG for catheter insertion. Among those using USG, 56% had received specific training, 17% benefited from specific recommendations, 76% marked the insertion site before skin antisepsis, and during catheter insertion, 96% used sterile gel and 100% used a sterile sheath and sterile gloves. We identified potential deviations from strict aseptic technique, including contact between the sheath and the needle (19.4%), handling of the US system during catheter insertion (2.8%), and use of sterile devices, where they were not yet necessary (during the marking site or skin antisepsis), resulting in their contamination at the time of catheter insertion.ConclusionsInterventions aimed at ensuring compliance with measures to prevent CRBs should be organized to prevent an increase in infections associated with US-guided catheter insertion.

The role of irrigation fluid in transurethral resection of the prostate outcomes and surgeon performance.

Transurethral resection of the prostate (TURP) is the gold-standard for the treatment of benign prostate enlargement (BPE) associated with lower urinary tract symptoms (LUTS), after failure of conservative therapy. At present, only resection-rate (grams of prostate resected over time) is regarded as an efficiency parameter to evaluate the skill of the operator and to assess the outcome of the procedure. Five surgeons performed TURP using a Gyrus-type bipolar system in 123 patients with BPE/LUTS who came to our observation from June 2016 to December 2019. The amount of irrigation fluid used during the procedure was registered and correlated to the operating time, resection-rate, prostate adenoma weight, post-operative bladder irrigation time, intraoperative bleeding and days of catheterization. We found an inverse correlation between the amount of irrigation fluid used during TURP and the resection-rate recorded for all operators, according to Spearman's Correlation (r = -0.78, p = 0.002); a direct correlation was also found between the amount of irrigation fluid and the adenoma weight. Finally, we also found a direct correlation with intraoperative bleeding and the duration and amount of bladder irrigation during and after TURP. The amount of irrigation fluid used is proposed as a reliable parameter to estimate the efficiency of the endoscopic procedure as well to assess the skill of the operator and shortterm results. The observed data encourage the possibility of applying this new efficiency indicator to all endoscopic maneuvers.

Atrial fibrillation catheter ablation: electroporation against high-power short duration radiofrequency

Abstract Background Pulmonary vein isolation (PVI) is one of the cornerstones of rhythm-control therapy for symptomatic atrial fibrillation (AF) patients. The new ablation technologies of pulse field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) with the new QDOT® catheter have been recently introduced in the EP lab. Aims To evaluate and compare the efficacy, and safety of single-shot PFA and HPSDRA for PVI in AF symptomatic patients. Methods Single centre, retrospective study of consecutive patients undergoing PVI with PFA or HPSD between May-December 2022. Data on demographic, procedural and clinical/ electrocardiographic recurrence (assessed after a 3-months blanking period) were analysed. Comparative analysis between both techniques was performed. Results One hundred and ten consecutive patients were included (63 ± 11 years, 75% men), with a mean CHA2DS2-VASc score of 2±1 points, median LVEF of 61% [IQR 57-62%] and a median left atrial volume index (by CT scan) of 56 mL/m2 [IQR 51-67 mL/m2]. 55% patients presented paroxysmal-AF and 19 patients (17%) performed a redo ablation. 47% (n=52) patients performed HPSD and 53% (n=58) PFA (all with CARTO®3D system v.7 and high-density mapping). In the HPSD: median RF ablation time was 792 sec [IQR 614-919sec], while in PFA was 90 sec [IQR 30-138 sec]. Median time of catheter inside the LA for PFA was 18 min [IQR 2-33 min]. Comparing HPSD and PFA (Fig 1): median procedure time was similar (91 min [IQR 71-107 min] vs 89 min [IQR 66-111 min], p=0.261), while median fluoroscopy time was lower with HPSD (5.4 min [IQR 3.1-6.8 min] vs 13.2 min [IQR 10.3-15.6 min], p&amp;lt;0.001); posterior wall isolation (PWI) was performed in 5 (10%) HPSD vs 21 (37%) PFA patients (p&amp;lt;0.001). All PFA patients undergoing PWI had first pass isolation, while only 40% of HPSD had first pass isolation. When performed PVI only, PFA presents a lower median procedure time than HPSD (76 min [IQR 62-93 min] vs 97 min [IQR 69-135 min], p=0.048). There was only one major complication, a cardiac tamponade with PFA, treated with pericardiocentesis. At 3 months of follow-up, 17% (n=10) patients had clinical or electrocardiographic AF recurrence: 7 PFA patients and 3 HPSD patients (p=0.127). Conclusions PFA and HPSD were both feasible and safe. When undergoing PVI-only, procedure time was lower with PFA. In patients undergoing PWI, PFA achieved higher first pass isolation. Although still in its early real-world evaluation, both techniques seem to be efficient, providing low AF recurrence during follow-up.

Abstract 14483: Myeloid Cell Derived IL1b Contributes to Pulmonary Vascular Remodeling in Heart Failure With Preserved Ejection Fraction

Introduction: Pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is a common and highly morbid syndrome, but mechanisms driving PH-HFpEF are poorly understood. Hypothesis: We sought to determine whether a well-accepted murine model of HFpEF also displays features of PH, and we sought to identify pathways that might drive early remodeling of the pulmonary vasculature in HFpEF. . Methods: Eight-week-old male and female C57BL/6J mice received either L-NAME and high fat diet (HFD) or control water and diet for 2, 5, and 12 weeks. Db/db mice were studied as a second model of HFpEF. Early pathways regulating PH were identified by bulk and single cell RNA sequencing. Findings were confirmed by immunostain in lungs of mice or lung slides from clinically performed autopsies of PH-HFpEF patients. ELISA was used to verify IL1β in mouse lung, mouse plasma, and also human plasma from PH-HFpEF patients obtained at the time of right heart catheterization. Clodronate liposomes and an anti-IL1β antibody were utilized to deplete macrophages and IL1β, respectively, to assess their impact on pulmonary vascular remodeling in HFpEF in mouse models. Results: L-NAME/HFD treated mice developed PH, small vessel muscularization, and right heart dysfunction. Inflammation-related gene ontologies were over-represented in bulk RNA sequencing analysis of whole lungs, with an increase in CD68 + cells in both murine and human PH-HFpEF lungs. Cytokine profiling showed an increase in IL1β in mouse and human plasma. Finally, clodronate liposome treatment in mice prevented PH in L-NAME/HFD treated mice, and IL1β depletion also attenuated PH in L-NAME/HFD treated mice. Conclusions: We report a novel model for the study of PH and right heart remodeling in HFpEF, and we identify myeloid cell derived IL1β as an important contributor to PH in HFpEF.

Myeloid Cell Derived IL1β Contributes to Pulmonary Hypertension in HFpEF.

Pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF) is a common and highly morbid syndrome, but mechanisms driving PH-HFpEF are poorly understood. We sought to determine whether a well-accepted murine model of HFpEF also displays features of PH, and we sought to identify pathways that might drive early remodeling of the pulmonary vasculature in HFpEF. Eight-week-old male and female C57BL/6J mice received either Nγ-nitro-L-arginine methyl ester and high-fat diet or control water and diet for 2, 5, and 12 weeks. The db/db mice were studied as a second model of HFpEF. Early pathways regulating PH were identified by bulk and single-cell RNA sequencing. Findings were confirmed by immunostain in lungs of mice or lung slides from clinically performed autopsies of patients with PH-HFpEF. ELISA was used to verify IL-1β (interleukin-1 beta) in mouse lung, mouse plasma, and also human plasma from patients with PH-HFpEF obtained at the time of right heart catheterization. Clodronate liposomes and an anti-IL-1β antibody were utilized to deplete macrophages and IL-1β, respectively, to assess their impact on pulmonary vascular remodeling in HFpEF in mouse models. Nγ-nitro-L-arginine methyl ester/high-fat diet-treated mice developed PH, small vessel muscularization, and right heart dysfunction. Inflammation-related gene ontologies were overrepresented in bulk RNA sequencing analysis of whole lungs, with an increase in CD68+ cells in both murine and human PH-HFpEF lungs. Cytokine profiling showed an increase in IL-1β in mouse and human plasma. Finally, clodronate liposome treatment in mice prevented PH in Nγ-nitro-L-arginine methyl ester/high-fat diet-treated mice, and IL-1β depletion also attenuated PH in Nγ-nitro-L-arginine methyl ester/high-fat diet-treated mice. We report a novel model for the study of PH and right heart remodeling in HFpEF, and we identify myeloid cell-derived IL-1β as an important contributor to PH in HFpEF.

Single-port-plus-one robot-assisted laparoscopic modified Lich-Gregoir direct nipple ureteral extravesical reimplantation in children with a primary obstructive megaureter.

To introduce a new technique of single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation and ascertain its validity in the treatment of pediatric primary obstructive megaureter. Between January 2021 and November 2021, we retrospectively analyzed the clinical data of 12 children with primary obstructive megaureter who were admitted to the Department of Pediatric Surgery of Fujian Provincial Hospital. All 12 children were treated with single-port-plus-one robotic laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation. Five of them were female and seven were male, including nine cases were simple obstructive type, while the remaining three cases were obstructive with reflux type. The mean age of the children was 17.33 ± 6.99 (10-36) months and the mean follow-up time was 14.16 ± 1.75 (12-17) months. Changes in preoperative and first-year postoperative parameters were compared. The mean operative time for all 12 children was 123.58 ± 10.85 (110-145) min, with a mean internal operative time of 101.42 ± 0.85 (90-120) min, a mean operative bleeding time of 2.42 ± 0.67 (2-4) ml, and a mean hematuria duration of 16.08 ± 1.44 (14-19) h. The mean indwelling catheterization time was 2.25 ± 0.45 (2-3) days and the mean hospitalization time was 3.83 ± 0.39 (3-4) days. At the postoperative first year, the ureteral diameter, calyceal diameter, and anterior-posterior renal pelvic diameter were found to be significantly smaller than at the preoperative period (18.83 ± 3.21 mm vs. 6.83 ± 1.27 mm, 13.99 ± 3.58 mm vs. 3.5 ± 2.90 mm, and 34.92 ± 4.25 mm vs. 10.08 ± 1.88 mm, P < 0.001). There was a significant increase in renal cortical thickness and the percentage of differential renal function (3.63 ± 1.66 mm vs. 5.67 ± 1.88 mm, 33.75 ± 2.77 mm vs. 37.50 ± 1.31 mm, P < 0.001). The resolution rate of obstruction was 100% and no child developed DeNovo vesicoureteral reflux. The technique of modified Lich-Gregoir direct nipple ureteral extravesical reimplantation can help maintain the physiological direction of the ureter and at the same time enhance the effectiveness of antirefluxing in robotic surgery. The design of a single-port-plus-one wound can produce a cosmetic appearance by concentrating and hiding the wound around the umbilicus. This modified reimplantation procedure has the potential to become a promising technique in the robot-assisted treatment of primary obstructive megaureter.

The efficacy of administration of prazosin in reducing the risk of recurrent urethral obstruction in male cats

PICO Question In male cats presenting with urethral obstruction, does administration of prazosin compared with no administration of prazosin reduce the incidence of recurrent urethral obstruction within the first month of initial presentation? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed A total of three studies were included in this appraisal. Two of which were prospective double-blind clinical studies and one retrospective study. Strength of evidence Weak. Outcomes reported Both double-blind studies found no significant difference between prazosin administration and the development of recurrent urethral obstruction (rUO) when compared with a placebo. Both studies, however, did report that cats had a shorter urinary catheterisation time with prazosin administration. The retrospective study found no association between prazosin administration and the risk of rUO and found that after 14 days post discharge, significantly more 73/302 (24%) cats that received prazosin had experienced rUO compared to 11/86 (13%) of cats that did not. One study found side effects to the administration of prazosin which may be detrimental to the overall recovery. Conclusion Administration of prazosin does not reduce the risk of rUO within 30 days of presentation. However, the strength of evidence is weak and would benefit from further clinical studies. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Analysis of Risk Factors for Carbapenem Resistant Klebsiella pneumoniae Infection and Construction of Nomogram Model: A Large Case-Control and Cohort Study from Shanxi, China.

Healthcare-associated infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are now a global public health problem, increasing the burden of disease and public healthcare expenditures in various countries. The aim of this study was to analyse the risk factors for CRKP infections and to develop nomogram models to help clinicians predict CRKP infections at an early stage to facilitate diagnosis and treatment. The clinical data of patients with Klebsiella pneumoniae (KP) infections in our hospital from January 2018 to January 2023 were collected. 174 patients with CRKP infections and 219 patients with CSKP infections were selected for case-control study. 27 predictors related to CRKP infections were determined. The least absolute shrinkage and selection operator (Lasso) regression was used to screen the characteristic variables, Multivariate logistic regression analysis was performed on the selected variables and a nomogram model was established. The discrimination and calibration of the nomogram model were evaluated by receiver operator curves (ROC) and calibration curves. Six predictive factors of ICU stay, fever time, central venous catheterization time, catheter indwelling time, carbapenem use and tetracycline use screened by lasso regression were included in the logistic regression model, and the nomogram was drawn to visualize the results. The area under ROC curve of training set and validation set was 0.894 (95% CI: 0.857, 0.931) and 0.872 (95% CI: 0.805, 0.939); The results of decision curve analysis also show that the model has good prediction accuracy. This study established a nomogram to predict CRKP infection based on lasso-logistic regression model, which has certain guiding significance for early diagnosis of CRKP infections.

Ease of Internal Jugular Venous Cannulation by Anterior V/S Posterior Approach: A Randomized Interventional Study

Background: Percutaneous cervical central venous cannulation is now common practice during Perioperative care in major surgical procedures, critically ill patients in intensive care units for long term hyperalimentation and for rapid restoration of blood volume in cases of acute blood loss. Proper route of insertion is essential for its success. The objective of this study is to compare procedural parameters and complications associated with anterior and posterior approaches for Internal Jugular Venous cannulation.&#x0D; Methods: Our study was conducted as a prospective randomized interventional trail in 60 patients undergoing scheduled cardiac surgeries requiring Right internal jugular venous cannulation in a tertiary level hospital after obtaining clearance from ethics committee, patients were randomly allocated into two groups either Anterior approach (Group A; n=30) or Posterior Approach (Group B; n=30). Number of attempts, time for identification of IJV, duration of cannulation, ease of insertion, complications were compared in both the groups.&#x0D; Results: The number of attempts (p value 0.036), mean time taken for vein identification (p value 0.0003), catheterization time (p value &lt;0.001), incidence of arterial puncture and hematoma are less with posterior approach, ease of threading is comparable among both the group. There were no statistically significant intergroup differences with respect to the Age, Sex, ASA grade.&#x0D; Conclusion: The posterior approach is better than anterior approach for Internal Jugular Vein Cannulation, as it improves the success rate, permits easy threading of catheter, reduces access time and duration of cannulation, complications like arterial puncture, hematoma, pneumothorax are lesser in posterior approach.

Endoscopic Resection Improved High-Intensity Focused Ultrasound Ablation Outcomes for Prostate Cancer: A Meta-Analysis of Comparative Studies.

High-intensity focused ultrasound ablation (HIFU) is emerging as more data on its efficacy arises for prostate cancer (PCa). However, it is indefinite whether to combine endoscopic resection and uncertain to say who the ideal candidates are for the combined treatment. Therefore, we aimed to conduct a meta-analysis to compare outcomes of sole HIFU therapy with that of HIFU in combination with endoscopic resection in patients with localized PCa. Electronic databases were searched following the PRISMA guidelines and PICOS formats. The inclusion criteria were as follows: 1) studies on HIFU for PCa patients; 2) comparative studies on HIFU in combination with endoscopic resection for localized PCa men. Exclusion criteria include non-comparative studies and salvage HIFU therapy. Meta-analysis results were mainly present using forest plots. Sensitivity analysis and Egger's test were adopted to determine the stability and assess the publication bias. Six comparative studies with 767 patients were eligible, including 487 cases in the combination therapy group and 280 cases in the monotherapy group. There was no statistical difference in age, preoperative PSA levels, and prostate volume between two groups. No statistical difference was found in postoperative PSA nadir (MD = -0.02, 95%CI: -0.35 to 0.31, P = 0.90), disease-free survival rate (RR = 0.95, 95%CI: 0.83 to 1.09, P = 0.47), and preoperative IPSS score (MD = -0.69, 95%CI: -1.63 to 0.26, P = 0.15; I2 = 8%) between two groups. The combination therapy group had significantly lower postoperative IPSS score (MD = -5.49, 95%CI: -6.47 to -4.51, P < 0.001) and shorter catheterization time (MD=-13.70, 95%CI: -19.24 to -8.16, P < 0.001) than the monotherapy group. The rates of urinary incontinence (7.4% vs. 13.9%, RR = 0.45, 95%CI: 0.29 to 0.70, P = 0.0004; I2=4%), acute urinary retention (6.8% vs. 10.5%, RR=0.36, 95%CI: 0.14 to 0.89, P = 0.03; I2 = 0%), urinary tract infection (10% vs. 33%, RR = 0.27, 95% CI: 0.18 to 0.4, P < 0.001; I2 = 0%), epididymitis (1.2% vs. 15.7%, RR=0.11, 95% CI: 0.02 to 0.59, P = 0.01; I2 = 0%), and urethral stricture (7.1% vs. 23.2%, RR = 0.3, 95%CI: 0.18 to 0.51, P < 0.001; I2 = 0%) in the combination therapy group were all significantly lower than that in the monotherapy group. Sensitivity analysis revealed findings were convincing and no publication bias (P = 0.62) was observed using Egger's test. It appears that the addition of endoscopic resection to the HIFU operation might not impact oncologic outcomes and could show better functional outcomes compared to the HIFU monotherapy in localized PCa patients.

Comparison of Early Versus Late Urethral Catheter Removal After Transurethral Resection of the Prostate in Patients with Benign Prostate Hyperplasia

Objective: Transurethral resection of the prostate (TURP) is considered the standard in the surgical therapy of lower urinary tract symptoms related to benign prostate hyperplasia (BPH). However, there is no consensus on the timing of catheter removal. In this study, we aimed to compare the long-term effects of early and delayed removal of urethral catheters who underwent TURP. &#x0D; Methods: We prospectively analyzed a total of 91 patients who underwent TURP. Patients were randomized into two groups; the early (postop 1st-2nd days) and delayed (7th day) removal of the urethral catheter. After the surgery in 1, 3, and 6th months, we evaluated all patients regarding treatment success. In addition, international prostate symptom score (IPSS), quality of life (QoL), maximum flow rate, postvoid residual urine volume, and morbidities (hematuria, infection, urethral stricture, irritative symptoms, need for re-operation) were assessed at all visits.&#x0D; Results: After TURP, there was no statistical difference in urodynamic parameters, complications, IPSS, and QoL in both groups. Only in the 3rd-month, the maximum flow rate was higher in favor of the early group. Despite similar results in both groups, strictures occurred earlier in the early group than delayed group (respectively 1 and 3 months). &#x0D; Conclusion: These results suggest that there are no differences in efficacy and complications in groups of early or delayed urethral catheter removal after TURP. The results of long-term studies with large series should be awaited to reach a more definite conclusion. We have tried to shed light on a topic without consensus on the time of urethral catheterization after TURP.