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This study aimed to determine the sensitivity and specificity of sterile shoulder needle aspiration and cultures obtained during arthroscopic and mini-open procedures for detecting periprosthetic shoulder infections using tissue cultures from revision surgery as the gold standard. All shoulder arthroplasty patients who underwent a synovial fluid puncture between August 2012 and February 2018 were selected. In addition, arthroplasty patients with cultures obtained during arthroscopic or mini-open procedures between May 2014 and May 2021 were selected. When sterile punctures or biopsy procedures were followed by revision surgery with collection of 6 tissue cultures, patients were included in the study and efficacy measures were calculated. Fifty-six patients were included in this study (with 57 punctures) and underwent analysis of puncture results after exclusions. Positive puncture results were found for Cutibacterium acnes, Staphylococcus aureus, Staphylococcus hominis, Actinomyces neuii, and Proteus mirabilis. These puncture cultures showed a sensitivity of 20.0% and specificity of 90.6%. From May 2014 to May 2021, 51 biopsy procedures were performed (15 arthroscopic and 36 mini-open); 37 biopsy procedures were included in this study (12 arthroscopic and 25 mini-open) for analysis after exclusions. Positive culture results were found for C acnes, Staphylococcus epidermidis, Staphylococcus saccharolyticus, and Streptococcus species. Arthroscopic biopsy cultures showed a sensitivity of 60.0% and specificity of 85.7%. For the mini-open biopsy cultures, the sensitivity and specificity were 66.7% and 85.7%, respectively. Sterile punctures for culture have a low sensitivity and a high specificity for diagnosing periprosthetic shoulder infections. Tissue cultures obtained during mini-open and arthroscopic procedures have a higher sensitivity for detecting periprosthetic shoulder infections. [ABSTRACT FROM AUTHOR]

BACKGROUND: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and metaanalysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. METHODS: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. RESULTS: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35-0.73]), major (MH-OR, 0.51 [95% CI, 0.35-0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38-0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39-0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29-0.90]; MH-OR, 0.44 [95% CI, 0.20-0.99], respectively). CONCLUSIONS: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. [ABSTRACT FROM AUTHOR]

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Background--Radial artery wall might be damaged after cannulation for cardiac catheterization. We investigated structural changes of the radial artery wall after catheterization to understand whether these might predict radial pulsation loss or occlusion and local pain or functional impairment of the upper extremity. Methods and Results--Ninety patients underwent transradial coronary angiography or intervention and were scanned with a high-resolution 40-MHz ultrasound before cannulation and at 3 hours and 30 days after procedure. Acute injuries of the radial artery occurred in all patients: dissection and intramural hematoma were the most common. However, these phenomena did not predict loss of radial pulsation or occlusion, local pain, or functional impairment at 30 days. Overall, the radial artery lumen was significantly reduced distal to the puncture site. Radial artery intima and total wall thickness increased 3 hours after puncture and persisted at 30 days. Radial occlusion and pulsation loss were observed in 3.9% and 9.2% of patients, respectively, at 30 days. Smaller radial artery lumen at baseline increased the risk of radial pulsation loss at 30 days (odds ratio, 1.23; P=0.049). The number of radial puncture attempts predicted pulsation loss (odds ratio, 2.64; P=0.027), occlusion (odds ratio, 3.49; P=0.022), and symptoms (odds ratio, 2.24; P=0.05) at 30-day follow-up. Conclusions--After catheterization, radial artery puncture site is associated with increased intima and total wall thickness and with modest decrease of inner lumen diameter. Acute injuries of the vessel wall were ubiquitous, but contrary to repeated puncture attempts, did not seem to affect postprocedural radial occlusion or loss of pulsation. [ABSTRACT FROM AUTHOR]

The gene SLC4A5 encodes the Na+-HCO3 cotransporter electrogenic 2, which is located in the distal nephron. Genetically deleting Na+-HCO3 cotransporter electrogenic 2 (knockout) causes Na+-retention and hypertension, a phenotype that is diminished with alkali loading. We performed experiments with acid-loaded mice and determined whether overactive epithelial Na+ channels (ENaC) or the Na+-Cl- cotransporter causes the Na+ retention and hypertension in knockout. In untreated mice, the mean arterial pressure was higher in knockout, compared with wild-type (WT); however, treatment with amiloride, a blocker of ENaC, abolished this difference. In contrast, hydrochlorothiazide, an inhibitor of Na+-Cl- cotransporter, decreased mean arterial pressure in WT, but not knockout. Western blots showed that quantity of plasmalemmal full-length ENaC-α was significantly higher in knockout than in WT. Amiloride treatment caused a 2-fold greater increase in Na+ excretion in knockout, compared with WT. In knockout, but not WT, amiloride treatment decreased plasma [Na+] and urinary K+ excretion, but increased hematocrit and plasma [K+] significantly. Micropuncture with microelectrodes showed that the [K+] was significantly higher and the transepithelial potential (Vte) was significantly lower in the late distal tubule of the knockout compared with WT. The reduced Vte in knockout was amiloride sensitive and therefore revealed an upregulation of electrogenic ENaC-mediated Na+ reabsorption in this segment. These results show that, in the absence of Na+-HCO3 cotransporter electrogenic 2 in the late distal tubule, acid-loaded mice exhibit disinhibition of ENaC-mediated Na+ reabsorption, which results in Na+ retention, K+ wasting, and hypertension. [ABSTRACT FROM AUTHOR]

Object The objective is to identify the care of nursing team to children before the peripheral venous puncture and describe the feelings of the child punctured by nursing professionals. Method Exploratory-descriptive study carried out with 59 children, through a form, between October 2010 and January2011 in a pediatric hospital in Fortaleza, Brazil. Results: Fear and pain were the most reported feelings of children when they were punctured (69.4%) by the nursing team. Conclusion: It was concluded that fear is still a very clear feeling among the infant clientele, thus demonstrating the need for greater attention in preparing children for venous puncture. Therefore, it shows the importance of further discussions, training and awareness of the nursing team that works care for children with peripheral venous puncture. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Pharyngo-oesophageal stricturing is common following treatment of head and neck cancers. Absolute dysphagia secondary to total stenosis, although rare, is particularly debilitating and presents a significant therapeutic challenge. We present a strategy for managing total neopharyngeal stenosis following pharyngolaryngo-oesophagectomy (PLOG). Presentation of case: A 71-year-old female developed total neopharyngeal stenosis following PLOG with gastric interposition for squamous cell carcinoma of the proximal cervical oesophagus/post-cricoid. A transcervical, percutaneous, radiologically guided procedure was performed to restore lumenal patency, which enabled resumption of oral feeding. Discussion: Established treatments for pharyngo-oesophageal strictures are frequently limited by complications in patients with complex strictures or total stenoses. Whilst several interventions have been described, recent interest has focussed on combined antegrade/retrograde endoscopic procedures dilating a pre-existing gastrostomy site for access. This was not possible in our patient due to the surgically altered anatomy which posed a unique therapeutic challenge. Conclusion: This is the first reported percutaneous, transcervical, radiologically guided technique to treat neopharyngeal stenosis following PLOG. It demonstrates a novel and efficacious approach which may be considered in the management of this rare but significant complication. [Copyright &y& Elsevier]

The article discusses the results of a randomized controlled trial that aims to measure the difference in pain scores for newborns who were held and swaddled during routine heel lance procedures and those lying on their backs. The Neonatal Inventory Pain Scale (NIPS) was used to measure pain in 42 neonates from a large tertiary hospital. It found that neonates who were helped experienced less pain.

Purpose: We evaluated which clinical factors influence the outcome of primary transurethral puncture for ureterocele. Materials and Methods: A total of 45 patients (47 ureteroceles) underwent primary transurethral incision between 1994 and 2008 at 2 institutions. Age at and mode of presentation, upper tract status, ureterocele site, preoperative vesicoureteral reflux and the corresponding upper pole or kidney function were analyzed to identify which factors influenced the need for secondary surgery. Results: Transurethral puncture was the only treatment in 24 of 45 patients (53%) while 21 (47%) required further surgery. After transurethral puncture secondary surgery was required in 56% of patients who presented prenatally vs 27% of those who presented postnatally (p = 0.165), in 18% with a single system vs 58% with a duplex system (p = 0.036), in 30% with intravesical vs 63% with ectopic ureterocele (p = 0.039) and in 61% vs 37% with ureterocele units with vs without preoperative vesicoureteral reflux (p = 0.148). Fisher''s 2-tailed exact test revealed an inconsistent distribution of negative prognostic factors, including duplex systems, ectopic ureterocele and vesicoureteral reflux at presentation, in prenatally vs postnatally and in asymptomatically vs symptomatically presenting subgroups. Conclusions: Upper tract status and ureterocele site influence the outcome of primary transurethral puncture as a definitive procedure. After puncture secondary surgery is least likely in patients with a single system and intravesical ureterocele. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the endothelial cell damage by detecting the circulating Tie2 mRNA level in a rat model of sepsis. Methods: The model of sepsis was established by cecal ligation and puncture (CLP) in 90 rats which were divided into 6 groups: normal, sham, CLP-3 h, CLP-6 h, CLP-12 h and CLP-24 h. Serum biochemical markers were detected by automatic biochemical analyzer. Serum IL-6 was measured with enzyme linked immunosorbent assay. The vascular permeability of liver, kidney, lung and heart was detected with Evans blue. Circulating endothelial cells (CEC) were separated using density gradient separation and counted. Total RNA of whole blood were extracted and the mRNA levels of two endothelial specific genes, Tie2 and vascular endothelial growth factor receptor 2 (VEGFR 2), were measured by quantitative real-time PCR. Results: The level of serum biochemical indexes increase d after CLP. The amount of s erum IL-6 in C LP-6 h, 12 h, and 24 h group was increased 6.5-fold (P<0.05), 8.4-fold (P<0.01), and 13.3-fold (P<0.001) compared with normal group (170.68 pg/ml±42.46 pg/ml) respectively (F=14.319, P<0.001). Significantly increased organ vasopermeability of liver, kidney, lung and heart was observed after CLP respectively. The number of CEC peaked (11.83±1.94) 3 hours after CLP compared with normal control (5.33±1.21, P<0.05), and then decreased gradually (F=54.183, P<0.001). The mRNA level of Tie2 in CLP-3 h group (3.47±1.47) was also markedly higher than that in other groups (F=10.640, P<0.001). Conclusion: Using quantitative real-time PCR to measure the level of Tie2 mRNA in peripheral blood is a simple and relatively sensitive method to evaluate the damage of endothelial cells. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the self-sealing capacity of vial stoppers in two common radiopharmaceuticals after more than 10 needle punctures. Methods:. Assessment of self-sealing capacity was performed according to the self-sealing capacity test described in United States Pharmacopeial Convention (USP) General Chapter <381>. Groups of 10 vials of technetium (Tc)-99m sulfur colloid and Tc-99m tetrofosmin were tested for maintenance of self-sealing capacity following 10 punctures with 22-, 20-, and 18-gauge needies. Each vial was sequentially retested after additional sets of 10 punctures until failure of self-sealing capacity or until a total of 100 punctures, whichever came first. Results: The median number of needle punctures with maintenance of self-sealing ability before failure for 22-, 20-, and 18-gauge needles was >100 (range all >100), >100 (all >100), and 60 (30-90), respectively, for sulfur colloid and >100 (all >100), >100 (50 to >100), and 50 (20-70), respectively, for tetrofosmin. Incidentally, coring particles were observed frequently in vials after many punctures with 18-gauge needles, but infrequently with 20-gauge and rarely with 22-gauge needles. Conclusion: Vial stoppers in two radiopharmaceutical products demonstrated robust self-sealing capacity, substantially exceeding the USP standard of 10 punctures with a 21-gauge needle. Coring particles were frequently observed after many punctures when using larger-bore needles but rarely when using smaller-bore needles. Under conditions commonly used, failure of self-sealing capacity and generation of coring particles are not anticipated to be problems encountered when puncturing vial stoppers of these two products substantially more than 10 times. [ABSTRACT FROM AUTHOR]

Objective: The diagnosis and treatment of cesarean scar pregnancy (CSP) is challenging. The objective of this study was to evaluate the diagnostic method, treatments, and long-term follow-up of CSP. Study Design: This is a retrospective case series of 26 patients between 6-14 postmenstrual weeks suspected to have CSP who were referred for diagnosis and treatment. The diagnosis was confirmed with transvaginal ultrasound. In 19 of the 26 patients the gestational sac was injected with 50 mg of methotrexate: 25 mg into the area of the embryo/fetus and 25 mg into the placental area; and an additional 25 mg was administered intramuscularly. Serial serum human chorionic gonadotropin determinations were obtained. Gestational sac volumes and vascularization were assessed by 3-dimensional ultrasound and used to monitor resolution of the injected site and outcome. Results: The 19 treated pregnancies were followed for 24-177 days. No complications were observed. After the treatment, typically, there was an initial increase in the human chorionic gonadotropin serum concentrations as well as in the volume of the gestational sac and their vascularization. After a variable time period mentioned elsewhere the values decreased, as expected. Conclusion: Combined intramuscular and intragestational methotrexate injection treatment was successful in treating these CSP. [ABSTRACT FROM AUTHOR]