RESUMEN

Peripheral nerve blocks provide a safe and reliable alternative in the anesthetic management of femur fractures in elderly subpopulations associated with significant comorbidities. Single-Insertion Multiple Nerve Block Anesthesia (SIMBA) is a technique where a single needle insertion is used to block all four nerves that supply the femur shaft: the femoral nerve, obturator nerve, lateral femoral cutaneous nerve, and sciatic nerve. The authors performed this technique in 11 cardiac compromised geriatric patients with midshaft/distal femur fractures, and the surgery was conducted successfully without any significant hemodynamic change and good postoperative analgesia.

Asunto(s)

Fracturas del Fémur , Nervio Femoral , Extremidad Inferior , Bloqueo Nervioso , Humanos , Bloqueo Nervioso/métodos , Anciano , Masculino , Fracturas del Fémur/cirugía , Anciano de 80 o más Años , Femenino , Extremidad Inferior/cirugía , Extremidad Inferior/inervación , Nervio Ciático , Nervio Obturador , Punciones/métodos

RESUMEN

Perclose ProGlide were created as preferred for puncture site closure of femoral artery. Femoral artery occlusion is one of the serious device-related complications. This report presents a continuous endovascular technique combined with peripheral cutting balloon (PCB) treatment for a case of a 32s woman diagnosed with lower extremity ischaemia caused by right superficial femoral artery (SFA) occlusion following the use of the Perclose ProGlide system in minimally invasive cardiac surgery. During the primary operation, limb ischaemia symptoms were relieved with vessel perfusion and reconstruction after regular balloon dilatation. A secondary operation was conducted 6 weeks later, and the obstructive lesions were recanalised without residual stenosis after PCB dilatation. No vessel-related adverse events such as dissection, rupture or distal embolisation occurred during the perioperative period. The patient recovered uneventfully after the operation, with complete alleviation of symptoms. Follow-up computed tomography angiography 3 month post-operatively revealed an undeformed shape and excellent patency of the right SFA.

Asunto(s)

Arteria Femoral , Humanos , Femenino , Arteria Femoral/cirugía , Arteria Femoral/diagnóstico por imagen , Adulto , Punciones , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Dilatación/métodos , Dilatación/instrumentación

RESUMEN

Arterial puncture is a painful procedure performed to assess patients' respiratory status. Pain is a stressful situation for unconscious patients as they cannot communicate their feeling verbally. To control patients' pain and prevent the adverse effects of painkillers, nonpharmacological pain management strategies have been solicited. The aim of this study is to investigate the effect of cryoanalgesia on unconscious patients' pain during arterial puncture. We adopted a quasi-experimental one-group research design. A sample of 86 unconscious patients in a surgical intensive care unit were recruited in this study. The intervention was applying an ice pack over the puncture site for 5 minutes before the arterial puncture procedure. Pain was assessed for 2 times; before and after application of cryoanalgesia. A statistically significant difference in participants' pain scores between pre-tests and post-tests was noted. For the intubated ventilated participants, the mean pain score before and after applying cryoanalgesia was 5.26 versus 4.00 (P ≤ .05). For the non-intubated or intubated non-ventilated participants, the mean pain score was 6.66 versus 4.63 (P ≤ .05). Cryoanalgesia is a feasible and effective method incorporate during arterial puncture along with standard procedure elements to achieve maximum pain reduction for unconscious patients during arterial punctures.

Asunto(s)

Manejo del Dolor , Humanos , Masculino , Femenino , Manejo del Dolor/métodos , Persona de Mediana Edad , Dimensión del Dolor , Unidades de Cuidados Intensivos , Punciones/efectos adversos , Adulto , Dolor/prevención & control , Dolor/etiología , Crioterapia/métodos , Anciano , Inconsciencia

RESUMEN

BACKGROUND: This study aimed to compare the effect of ultrasound-guided fascia iliaca compartment block with different puncture sites on postoperative analgesia in patients undergoing hip arthroplasty. METHODS: We searched the PubMed, Web of Science, EBSCO, Wiley Library, Embase, China National Knowledge Infrastructure, and Wanfang databases for literature on ultrasound-guided fascia iliaca compartment block through different puncture sites in hip replacement patients. The software package R (4.2.1) was used in the meta-analysis. RESULTS: The meta results showed the suprainguinal approach (SA) puncture pathway had a significantly longer operative time than the infrainguinal approach (IA) pathway (mean deviation [MD] = 0.97, 95% confidence interval [CI] [0.09, 1.84], P < .01) when performing orthopedic surgery. In terms of nerve block efficacy, only the block rates of the obturator nerve, lateral femoral cutaneous nerve, and femoral nerve groups did not show significant differences between the SA and IA pathways. In contrast, the results of the Meta combined effect size of visual analogue scale scores during postoperative activity showed that the SA puncture pathway significantly reduced patients' pain scores compared with the IA pathway at the T1 (3-6 h) and T2 (8 h) time points (MD = -0.39, 95% CI [-0.77, -0.01], P = .04 in the T1 group; MD = -0.58, 95% CI [-0.95, -0.21], P < .01). The differences in pain scores at the T3 (12 h) and T4 (24 h) time points were not significant, and in terms of adverse reaction rates, the differences in the incidence of pruritus, sedation, urinary retention, and nausea and vomiting were not significant. CONCLUSIONS: This study demonstrates that the SA puncture pathway has a significant advantage over the IA pathway in reducing active pain in early postoperative pain management without increasing the risk of adverse events. This finding supports the prioritization of SA pathway in clinical practice where postoperative pain control is considered. Future research should continue to explore the use of SA pathway in different patient populations and types of surgery, as well as their impact on long-term postoperative recovery, with the aim of optimizing individualized postoperative pain management strategies.

Asunto(s)

Artroplastia de Reemplazo de Cadera , Bloqueo Nervioso , Dolor Postoperatorio , Ultrasonografía Intervencional , Humanos , Bloqueo Nervioso/métodos , Bloqueo Nervioso/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/efectos adversos , Ultrasonografía Intervencional/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/etiología , Punciones/efectos adversos , Punciones/métodos , Fascia/inervación , Analgesia/métodos , Tempo Operativo , Dimensión del Dolor

RESUMEN

BACKGROUND: This study aimed to investigate the range of angles and depths necessary for effective entry into the TMJ using CBCT images, focusing on classical Holmlund Hellsing points and a two-needle approach. METHODS: A retrospective cohort of CBCT images from January 2020 to November 2023 was analysed using 3D analysis to determine the variance in the required angles and depths. RESULTS: The average age of the 68 participants included in the study was 29.5 ± 11.1, 58.8% of the participants were female and 41.2% were male. The anterior needle measurements showed a relatively low standard deviation(SD) in depth(SD:3.6) with a low variance coefficient(12.5%), whereas the axial and coronal angles exhibited greater variability(SD:9.1 and 7.6, respectively). For the posterior needles, moderate SDs in depth(SD:3.5) and greater variabilities in axial and coronal angles(SD:9.6 and 5.3, respectively) were observed. A weak negative correlation was observed between the axial angle of the posterior needle and age(p: 0.028, Pearson r: -0.29) Anterior needle depth (p:0.037) and posterior needle axial angle(p:0.014) were greater in males than females. The anterior needle depth in patients with temporamandibular disease was greater than in those without(p:0,03). CONCLUSION: There were significant differences in the angle measurements for both anterior and posterior needles, but lower variance in depth. The depths and angles of the needles did not correlate with age.

Asunto(s)

Artrocentesis , Tomografía Computarizada de Haz Cónico , Agujas , Humanos , Femenino , Masculino , Estudios Retrospectivos , Tomografía Computarizada de Haz Cónico/métodos , Adulto , Artrocentesis/métodos , Punciones/métodos , Persona de Mediana Edad , Adulto Joven , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/diagnóstico por imagen , Adolescente , Imagenología Tridimensional

RESUMEN

Quantifying the mechanical behavior of skin has been foundational in applications of cosmetics, surgical techniques, forensic science, and protective clothing development. However, previous puncture studies have lacked consistent and physiological boundary conditions of skin. To determine natural skin tension, excision of in situ porcine skin resulted in significantly different diameter reduction (shrinkage) in leg (19.5 %) and abdominal skin (38.4 %) compared to flank skin (28.5 %) (p = 0.047). To examine effects of initial tension and pre-conditioning, five conditions of initial tension (as percentage of diameter increase) and pre-conditioning were tested in quasistatic puncture with a 5 mm spherical impactor using an electrohydraulic load frame and custom clamping apparatus. Samples with less than 5 % initial tension resulted in significantly greater (p = 0.011) force at failure (279.2 N) compared to samples with greater than 25 % initial tension (195.1 N). Eight pre-conditioning cycles of 15 mm displacement reduced hysteresis by 45 %. The coefficient of variance was substantially reduced for force, force normalized by cutis thickness, displacement, stiffness, and strain energy up to 46 %. Pre-conditioned samples at physiological initial tension (14-25 %) resulted in significantly greater (p = 0.03) normalized forces at failure (278.3 N/mm) compared to non-conditioned samples of the same initial tension (234.4 N/mm). Pre-conditioned samples with 14-25 % initial tension, representing physiological boundary conditions, resulted in the most appropriate failure thresholds with the least variation. For in vitro puncture studies, the magnitude of applied initial tension should be defined based on anatomical location, through a shrinkage experimentation, to match natural tension of skin. Characterizing the biological behavior and tolerances of skin may be utilized in finite element models to aid in protective clothing development and forensic science analyses.

Asunto(s)

Piel , Animales , Porcinos , Ensayo de Materiales , Fenómenos Biomecánicos , Punciones , Fenómenos Mecánicos , Estrés Mecánico , Fenómenos Fisiológicos de la Piel , Pruebas Mecánicas

RESUMEN

In children, there are two main techniques for placing a tunneled central venous catheter: single-incision (single puncture) and conventional (two punctures). Both have unique advantages and disadvantages. The modified single-stick technique combines the two aforementioned techniques to access the central venous system in an optimized way. This technique is feasible to perform particularly in young children and has a short learning curve for adult interventional radiologists.

Asunto(s)

Cateterismo Venoso Central , Humanos , Cateterismo Venoso Central/métodos , Niño , Femenino , Preescolar , Masculino , Lactante , Punciones/métodos , Adolescente , Catéteres de Permanencia

RESUMEN

OBJECTIVE: To investigate the clinical significance of using 3D printing guides in modified unilateral puncture percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures (OVCF), and to explore a new method for preventing paravertebral vein leakage during PVP in conjunction with a previous study of the optimal puncture-side bone cement/vertebral volume ratio(PSBCV/VV%). METHODS: This retrospective study analyzed 99 patients who underwent unilateral puncture PVP between January 2023 and December 2023. Patients were divided into a guide plate group (46 patients) and a conventional group (53 patients). The guide plate group underwent modified unilateral puncture PVP with the guidance of 3D printing guides, while the conventional group underwent unilateral puncture PVP using the conventional pedicle approach. The distribution of bone cement, surgical outcomes, and the occurrence of cement leakage into paravertebral veins were observed in both groups. RESULTS: The guide plate group had significantly shorter operating time and required fewer fluoroscopies compared to the conventional group. The amount of bone cement volume (BCV) used in the guide plate group was higher, but the amount of bone cement volume on the puncture side(PSBCV), the PSBCV/VV%, and the rate of paravertebral vein leakage were lower in the guide plate group compared to the conventional group (P < 0.05). Within each group, significant improvements in anterior vertebral margin height, Cobb angle, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were observed at 1 day and 1 month postoperatively compared to preoperative values (P < 0.05). CONCLUSION: Using 3D printing guides in modified unilateral puncture PVP is a safe and effective method for treating OVCF. And it has the advantages of short operation time, less fluoroscopy, even distribution of bone cement, and a low rate of paravertebral vein leakage.

Asunto(s)

Cementos para Huesos , Fracturas por Compresión , Fracturas Osteoporóticas , Impresión Tridimensional , Fracturas de la Columna Vertebral , Vertebroplastia , Humanos , Estudios Retrospectivos , Fracturas por Compresión/cirugía , Fracturas por Compresión/diagnóstico por imagen , Femenino , Vertebroplastia/métodos , Masculino , Anciano , Fracturas Osteoporóticas/cirugía , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Persona de Mediana Edad , Anciano de 80 o más Años , Cementos para Huesos/uso terapéutico , Resultado del Tratamiento , Punciones/métodos , Relevancia Clínica

RESUMEN

BACKGROUND: Bleeding from the puncture tract after percutaneous transhepatic portal vein intervention can become life-threatening. To date, studies about tract embolization with gelatin sponge after percutaneous transhepatic portal vein intervention are only with small numbers of patients, or non-consecutive or pediatric patients with a relatively small sheath in diameter. PURPOSE: To evaluate the safety and efficacy of tract embolization with gelatin sponge strips after percutaneous transhepatic poral vein access. MATERIAL AND METHODS: Between September 2017 and February 2024, 100 consecutive patients (61 men, 39 women; mean age = 53 ± 15 years) underwent a total of 105 portal vein interventions using a percutaneous transhepatic approach. Tract embolization for the removal of 6-8 Fr sheath was performed using gelatin sponge strips in all procedures, including 71 portal vein embolization before major hepatectomy, 27 portal balloon venoplasty or stent placement after liver transplantation, and seven other interventions. RESULTS: No bleeding occurred after tract embolization with gelatin sponge strips. Minor portal vein thrombosis was detected in three procedures after liver transplantation and in one procedure for portal vein stenosis caused by essential thrombocytopenia. Thrombosis occurred in the punctured portal vein branch in all procedures. Thrombosis was not clinically relevant in any patient, and it was difficult to differentiate whether thrombosis was caused by sheath placement or the inserted gelatin sponge. CONCLUSION: Tract embolization with gelatin sponge strips after percutaneous transhepatic portal vein intervention is a safe and feasible method for preventing hemorrhage from the puncture tract.

Asunto(s)

Embolización Terapéutica , Esponja de Gelatina Absorbible , Vena Porta , Humanos , Vena Porta/diagnóstico por imagen , Masculino , Femenino , Embolización Terapéutica/métodos , Persona de Mediana Edad , Esponja de Gelatina Absorbible/uso terapéutico , Adulto , Anciano , Estudios Retrospectivos , Punciones , Resultado del Tratamiento

RESUMEN

Despite the high mortality rate, sepsis lacks specific and effective treatment options. Conventional antibiotics, such as TIENAM (TIE; imipenem and cilastatin sodium for injection), face challenges owing to the emergence of bacterial resistance, which reduces their effectiveness and causes adverse effects. Addressing resistance and judicious drug use is crucial. Our research revealed that aloin (Alo) significantly boosts survival rates and reduces inflammation and bacterial load in mice with sepsis, demonstrating strong antimicrobial activity. Using a synergistic Alo + TIE regimen in a cecal ligation and puncture (CLP)-induced sepsis model, we observed a remarkable increase in survival rates from 10 % to 75 % within 72 h compared with the CLP group alone. This combination therapy also modulated inflammatory markers interleukin (IL)-6, IL-1ß, and tumor necrosis factor (TNF)-α, mitigated tissue damage, regulated immune cells by lowering NK, activated CD8+ and CD4+ T cells while increasing peritoneal macrophages, and decreased the bacterial load in the peritoneal cavity. We noted a significant shift in the abdominal cavity microbiota composition post-treatment, with a decrease in harmful bacteria, such as Lachnospiraceae_NK4A136_group, Klebsiella, Bacillus, and Escherichia, and an increase in beneficial bacteria, such as Lactobacillus and Mucispirillum. Our study emphasizes the efficacy of combining Alo with TIE to combat sepsis, and paves the way for further investigations and potential clinical applications aiming to overcome the limitations of TIE and enhance the therapeutic prospects of Alo.

Asunto(s)

Ciego , Emodina , Ratones Endogámicos C57BL , Sepsis , Animales , Sepsis/tratamiento farmacológico , Sepsis/inmunología , Sepsis/microbiología , Emodina/farmacología , Emodina/uso terapéutico , Emodina/análogos & derivados , Ciego/cirugía , Ciego/microbiología , Ratones , Masculino , Ligadura , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Punciones , Modelos Animales de Enfermedad , Imipenem/uso terapéutico , Imipenem/farmacología , Citocinas/metabolismo , Quimioterapia Combinada , Microbioma Gastrointestinal/efectos de los fármacos , Antiinflamatorios/uso terapéutico , Antiinflamatorios/farmacología , Inflamación/tratamiento farmacológico , Microbiota/efectos de los fármacos , Carga Bacteriana/efectos de los fármacos

RESUMEN

Despite the high mortality associated with sepsis, effective and targeted treatments remain scarce. The use of conventional antibiotics such as TIENAM (imipenem and cilastatin sodium for injection, TIE) is challenging because of the increasing bacterial resistance, which diminishes their efficacy and leads to adverse effects. Our previous studies demonstrated that ulinastatin (UTI) exerts a therapeutic impact on sepsis by reducing systemic inflammation and modulating immune responses. In this study, we examined the possibility of administering UTI and TIE after inducing sepsis in a mouse model using cecal ligation and puncture (CLP). We assessed the rates of survival, levels of inflammatory cytokines, the extent of tissue damage, populations of immune cells, microbiota in ascites, and important signaling pathways. The combination of UTI and TIE significantly improved survival rates and reduced inflammation and bacterial load in septic mice, indicating potent antimicrobial properties. Notably, the survival rates of UTI+TIE-treated mice increased from 10 % to 75 % within 168 h compared to those of mice that were subjected to CLP. The dual treatment successfully regulated the levels of inflammatory indicators (interleukin [IL]-6, IL-1ß, and tumor necrosis factor [TNF]-α) and immune cell numbers by reducing B cells, natural killer cells, and TNFR2+ Treg cells and increasing CD8+ T cells. Additionally, the combination of UTI and TIE alleviated tissue damage, reduced bacterial load in the peritoneal cavity, and suppressed the NF-κB signaling pathway. Our findings indicate that UTI and TIE combination therapy can significantly enhance sepsis outcomes by reducing inflammation and boosting the immune system. The results offer a promising therapeutic approach for future sepsis treatment.

Asunto(s)

Ciego , Citocinas , Glicoproteínas , Sepsis , Animales , Sepsis/tratamiento farmacológico , Sepsis/inmunología , Sepsis/mortalidad , Glicoproteínas/uso terapéutico , Glicoproteínas/farmacología , Ligadura , Ciego/cirugía , Citocinas/metabolismo , Ratones , Masculino , Combinación Cilastatina e Imipenem/uso terapéutico , Modelos Animales de Enfermedad , Ratones Endogámicos C57BL , Globulinas , Punciones , Quimioterapia Combinada , Inflamación/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Cilastatina/uso terapéutico , Cilastatina/farmacología , Humanos , Antiinflamatorios/uso terapéutico , Antiinflamatorios/farmacología

RESUMEN

Transfemoral access is nowadays required for an increasing number of percutaneous procedures, such as structural heart interventions, mechanical circulatory support, and interventional electrophysiology/pacing. Despite technological advancements and improved techniques, these devices necessitate large-bore (≥12 French) arterial/venous sheaths, posing a significant risk of bleeding and vascular complications, whose occurrence has been related to an increase in morbidity and mortality. Therefore, optimizing large-bore vascular access management is crucial in endovascular interventions. Technical options, including optimized preprocedural planning and proper selection and utilization of vascular closure devices, have been developed to increase safety. This review explores the comprehensive management of large-bore accesses, from optimal vascular puncture to sheath removal. It also discusses strategies for managing closure device failure, with the goal of minimizing vascular complications.

Asunto(s)

Cateterismo Periférico , Remoción de Dispositivos , Arteria Femoral , Técnicas Hemostáticas , Punciones , Dispositivos de Cierre Vascular , Humanos , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Técnicas Hemostáticas/instrumentación , Técnicas Hemostáticas/efectos adversos , Remoción de Dispositivos/efectos adversos , Factores de Riesgo , Resultado del Tratamiento , Hemorragia/prevención & control , Hemorragia/etiología , Lesiones del Sistema Vascular/etiología , Lesiones del Sistema Vascular/prevención & control , Dispositivos de Acceso Vascular , Diseño de Equipo , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación

RESUMEN

OBJECTIVE: This study aimed to compare the efficacy of computed tomography (CT)-guided minimally invasive puncture and drainage (MIPD) and craniotomy for hematoma evacuation in the treatment of cerebellar hemorrhage. METHODS: This single-center prospective cohort study was conducted from January 2020 to February 2023. During the study period, 40 patients with cerebellar hemorrhage who underwent CT-guided MIPD treatment were enrolled in the CT-guided MIPD (CTGMIPD) group, and 40 patients with the cerebellar hemorrhage who had a propensity score matching that of the CTGMIPD group and who underwent craniotomy for hematoma evacuation were enrolled in the standard craniotomy (SC) group. The primary outcome indicators were the 6-month mortality of the patients and the proportion of survivors with a modified Rankin Scale (mRS) scores of 1 or 2. The secondary outcome indicators were the cerebellar hematoma volume, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, incidence of postoperative complications, length of hospital stay, and medical costs. In addition, data concerning the patients who died during the study period were further analyzed. RESULTS: At the 6-month follow-up, there was no significant difference in mortality between the two groups, although the proportion of patients with an mRS scores of 1 or 2 was significantly higher in the CTGMIPD group when compared with the SC group (P = 0.015). No significant differences were observed in the hematoma volume, NIHSS score, and GCS score between the two groups. By contrast, the incidence of postoperative complications, length of hospital stay, and medical costs were significantly lower in the CTGMIPD group than in the SC group (all P < 0.05). When compared with the SC group, the proportion of dead patients with a hematoma volume greater than 30 ml was higher in the CTGMIPD group (P = 0.03). Moreover, after stratification of the patients with a preoperative GCS score ≤8, the CTGMIPD group had a significantly higher mortality rate than the SC group (P = 0.04). CONCLUSION: The efficacy of CT-guided MIPD in the treatment of cerebellar hemorrhage is close to that of craniotomy for hematoma excavation, although the complication and disability rates of the former are significantly lower than those of the latter. When the preoperative hematoma volume is less than 30 mL or the preoperative GCS score is greater than 8, CT-guided MIPD represents a better choice for the treatment of cerebellar hemorrhage than craniotomy for hematoma evacuation.

Asunto(s)

Craneotomía , Drenaje , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Drenaje/métodos , Craneotomía/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Estudios Prospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Resultado del Tratamiento , Enfermedades Cerebelosas/cirugía , Enfermedades Cerebelosas/diagnóstico por imagen , Punciones/métodos , Adulto , Hematoma/cirugía , Hematoma/diagnóstico por imagen , Hemorragia Cerebral/cirugía , Hemorragia Cerebral/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Escala de Coma de Glasgow , Cirugía Asistida por Computador/métodos

RESUMEN

CONTEXT: Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network meta-analysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates. EVIDENCE ACQUISITION: Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines. RESULTS: One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain "during" heel prick, non-nutritive suckling (NNS) plus sucrose [SMD -3.15 (-2.62, -3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS. CONCLUSIONS: Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings.

Asunto(s)

Analgesia , Talón , Metaanálisis en Red , Manejo del Dolor , Humanos , Recién Nacido , Analgesia/métodos , Manejo del Dolor/métodos , Manejo del Dolor/normas , Dolor/prevención & control , Punciones/efectos adversos

RESUMEN

INTRODUCTION: The study aims to compare the accuracy and safety of robotic-assisted navigation puncture to freehand puncture during computed tomography (CT)-guided percutaneous needle insertion in the chest and abdomen. METHODS: A total of 60 patients required percutaneous puncture procedures, with 40 involving the chest and 20 involving the abdomen. Eligible patients were randomly assigned to two groups. The test group punctured using a robotic-assisted navigation system, whereas the control group punctured manually. The primary outcome assessment standards are single puncture success rates, with the number of needle modifications and CT scan timings during the procedure serving as supplementary outcome evaluation standards. The Wilcoxon rank sum test is used for the comparison. RESULTS: The puncture procedure's success rates after just one puncture: The test group punctures accurately without adjusting the puncture needle, while the control group uses an average number of 1.73 ± 1.20 pins. The once-puncture success rate of robot navigation puncture is considerably higher than that of bare-handed puncture (P < 0.001). The times of CT scan are necessitated when the puncture is in place: the average times in the test group is 3.03 ± 0.18 times, while the control group is 4.70 ± 1.24 times. CONCLUSION: In conclusion, the robotic-assisted navigation system improves puncture accuracy while reducing the need for needle corrections during percutaneous puncture procedures. It also shortens CT scans and reduces radiation exposure from X-rays.

Asunto(s)

Punciones , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Tomografía Computarizada por Rayos X/métodos , Persona de Mediana Edad , Punciones/métodos , Estudios Prospectivos , Anciano , Adulto , Abdomen/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Tórax/diagnóstico por imagen , Robótica/métodos

RESUMEN

OBJECTIVES: This study aimed to evaluate the accuracy of percutaneous computed tomography (CT)-guided puncture based on machine vision and augmented reality in a phantom. MATERIALS AND METHODS: The surgical space coordinate system was established, and accurate registration was ensured using the hierarchical optimization framework. Machine vision tracking and augmented reality display technologies were used for puncture navigation. CT was performed on a phantom, and puncture paths with three different lengths were planned from the surface of the phantom to the metal ball. Puncture accuracy was evaluated by measuring the target positioning error (TPE), lateral error (LE), angular error (AE), and first success rate (FSR) based on the obtained CT images. RESULTS: A highly qualified attending interventional physician performed a total of 30 punctures using puncture navigation. For the short distance (4.5-5.5 cm), the TPE, LE, AE, and FSR were 1.90 ± 0.62 mm, 1.23 ± 0.70 mm, 1.39 ± 0.86°, and 60%, respectively. For the medium distance (9.5-10.5 cm), the TPE, LE, AE, and FSR were 2.35 ± 0.95 mm, 2.00 ± 1.07 mm, 1.20 ± 0.62°, and 40%, respectively. For the long distance (14.5-15.5 cm), the TPE, LE, AE, and FSR were 2.81 ± 1.17 mm, 2.33 ± 1.34 mm, 0.99 ± 0.55°, and 30%, respectively. CONCLUSION: The augmented reality and machine vision-based CT-guided puncture navigation system allows for precise punctures in a phantom. Further studies are needed to explore its clinical applicability.

Asunto(s)

Realidad Aumentada , Fantasmas de Imagen , Tomografía Computarizada por Rayos X , Tomografía Computarizada por Rayos X/métodos , Humanos , Punciones/métodos , Cirugía Asistida por Computador/métodos

RESUMEN

BACKGROUND: The introduction of radial-specific equipment has made transradial (TR) aortoiliac (AI) endovascular therapy (EVT) more convenient. OBJECTIVES: The authors aimed to investigate the perioperative outcomes of the TR approach in patients undergoing AI EVT for symptomatic peripheral artery disease. METHODS: The COMFORT (Contemporary Strategy for Aortoiliac Intervention) registry was a prospective, multicenter, observational study enrolling patients with symptomatic peripheral artery disease undergoing AI EVT between January 2021 and June 2023. The primary outcome was perioperative complications, whereas the secondary outcomes included core laboratory-evaluated residual stenosis >30%, time to hemostasis, time to ambulation, 30-day patency, and 30-day limb symptoms. These outcomes were compared between TR and non-TR AI EVT after propensity score matching. RESULTS: The TR approach was selected for 231 of the 947 patients (24.3%). The TR approach was chosen more in patients with a higher ankle-brachial index, chronic total occlusion, aortic lesion, bare nitinol stent implantation, and plain angioplasty, whereas it was chosen less in patients with dialysis, a history of AI EVT, chronic limb-threatening ischemia, bilateral calcification, and simultaneous infrainguinal EVT (all P < 0.05). After propensity score matching, the incidence of perioperative complications did not differ significantly between the groups (TR group: 6.0% vs non-TR group: 5.1%; P = 0.69). The proportions of residual stenosis, 30-day patency, and 30-day limb symptoms were not significantly different (all P > 0.05); however, the time to hemostasis and the time to ambulation were shorter in the TR group (both P < 0.05). CONCLUSIONS: Non-TR AI EVT and TR AI EVT using radial-specific equipment were associated with a similar risk of perioperative complications. The TR approach helps shorten the time required for hemostasis and ambulation.

Asunto(s)

Procedimientos Endovasculares , Arteria Ilíaca , Enfermedad Arterial Periférica , Arteria Radial , Sistema de Registros , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Anciano , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Estudios Prospectivos , Arteria Radial/fisiopatología , Resultado del Tratamiento , Factores de Tiempo , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Arteria Ilíaca/cirugía , Persona de Mediana Edad , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/diagnóstico por imagen , Factores de Riesgo , Medición de Riesgo , Anciano de 80 o más Años , Cateterismo Periférico/efectos adversos , Stents , Punciones

Asunto(s)

Cateterismo Periférico , Procedimientos Endovasculares , Arteria Ilíaca , Arteria Radial , Humanos , Arteria Radial/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Cateterismo Periférico/efectos adversos , Procedimientos Endovasculares/instrumentación , Resultado del Tratamiento , Punciones , Factores de Riesgo , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/fisiopatología

RESUMEN

Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM sclerotherapy holds its place as the primary approach. This technique involves the administration of a sclerosing agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM sclerotherapy induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and sclerosing agents during VM sclerotherapy to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.

Asunto(s)

Soluciones Esclerosantes , Escleroterapia , Malformaciones Vasculares , Humanos , Escleroterapia/efectos adversos , Soluciones Esclerosantes/efectos adversos , Soluciones Esclerosantes/administración & dosificación , Malformaciones Vasculares/terapia , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/fisiopatología , Resultado del Tratamiento , Venas/diagnóstico por imagen , Venas/anomalías , Venas/fisiopatología , Radiografía Intervencional/efectos adversos , Flebografía , Punciones , Femenino

Asunto(s)

Punciones , Humanos , Marcapaso Artificial , Desfibriladores Implantables