A case review of a patient experience of photopheresis using a peripherally inserted central catheter

Extracorporeal photopheresis (ECP) is a cell based immunomodulatory therapy in which the patient is attached intravenously to a cell separating machine. During ECP a patient's blood is collected via either a central venous access device (CVAD) or a peripherally inserted 16G arterial venous fistula needle in either one or both antecubital fossa. However, patients presenting for ECP with GVHD repeatedly present a challenge to the ECP team due to poor venous access resulting from previous therapies and skin changes. The use of peripherally inserted central venous catheters (PICCs) offers an alternative route of vascular access for this cohort of patients. Here we present a case report of a patient successfully treated with ECP following the insertion of a PICC line.     

星点设计-效应面法优化丁香苦苷聚乳酸-羟基乙酸纳米粒的制备工艺

目的优化丁香苦苷聚乳酸(Syr)-羟基乙酸共聚物[poly(lactic-co-glycolic acid),PLGA]纳米粒(Syr-NPs)的处方。方法采用纳米沉淀法制备Syr-NPs,以包封率、载药量、平均粒径以及总评"归一值"为评价指标,采用星点设计-效应面法考察PLGA质量浓度(A)、丁香苦苷质量浓度(B)、水相与有机相比例(C)3因素考察对包封率、载药量、平均粒径以及总评归一值的影响,以星点设计-效应面法选取最佳处方条件进行预测分析。结果最优处方工艺为PLGA质量浓度为9.63 mg/mL,Syr质量浓度为12.88 mg/mL,有机相与水相的比例为1∶9.46,制得的Syr-NPs的包封率、载药量、平均粒径分别为(27.86±0.87)%、(7.02±0.15)%、(110.0±1.20)nm。结论该方法稳定可行,可用于优化包载Syr的PLGA纳米粒处方与制备工艺。     

Utilization and Complications of Central Venous Access Devices in Oncology Patients

Purpose: To describe how central venous access devices (CVADs) are utilized for ambulatory oncology patients and to evaluate the rate of complications. Method: Single institution retrospective study of oncology patients with CVADs who received systemic treatment at the Walker Family Cancer Centre (WFCC) between 1 January and 31 December 2018. Results: A total of 480 CVADS were placed in 305 patients, of which 408 (85%) were peripherally inserted central catheters (PICCs) and 72 (15%) were implanted vascular access devices (PORTs). The incidence of early and late complications was 9% and 24%, respectively. For the entire cohort, the rate of venous thromboembolism (VTE) was 16%, of which 9% were CVAD-related thrombosis (CRTs) and 7% were distant VTE. The CRT rates were similar for PICCs and PORTs (9% vs. 7%). A total of 6% of CVADs were complicated by infection (i.e., localized infections and bacteremia), with a total infection rate of 0.43 and 0.26 per 1000 indwelling days for PICCs and PORTs, respectively. The incidence of central line associated bloodstream infections (CLABSI) was greater for PICCs than PORTs, at a rate of 0.22 compared with 0.08 per 1000 indwelling days, respectively. The premature catheter removal rate was 26% for PICCs and 18% for PORTs. PORTs required more additional hospital visits. Conclusions: PICCs were utilized more frequently than PORTs and had a higher rate of premature removal. The rates of VTE and CRT were similar for both CVAD types. PORTs had a lower rate of infection per 1000 indwelling days. However, the management of PORT related complications required more visits to the hospital and oncology clinic.     

Nurse Practitioner Education in India: Challenges,Opportunities, and Implications

Critical care nursing is a postgraduate residency program that was initiated by the Indian Nursing Council to address the critical care service requirements for the increasing number of patients across India due to the increasing burden of communicable and noncommunicable diseases among its population. This article describes the experiences and challenges of a leading nursing institution in India, the Manipal College of Nursing (Manipal), in initiating and implementing the program. Additionally, the authors discuss the need for starting a critical care nurse practitioner program in India and the introduction of critical care nursing in the country. The government of India and the Indian Nursing Council have made a prudent decision to start a postgraduate residency program in critical care to address the requirement of the Indian population. Despite the infancy stage of this program, its graduates provide hope for competent care to critically ill patients. It is the most cost-effective method for a resource-scarce country such as India to fulfill the requirements of critically ill patients. However, further nationwide uniform policies are essential for credentialing, privileging, and creating appropriate employment for the graduates of the program.     

HIV相关淋巴瘤诊治进展

[摘要]　HIV相关淋巴瘤是常见的HIV相关肿瘤之一，在联合抗反转录病毒治疗（combination antiretroviral therapy, cART）出现之前，其治疗效果极差。在cART时代，HIV相关淋巴瘤的基础及临床研究取得了重大进展，这些为挖掘治疗新靶点提供了依据，使优化HIV相关淋巴瘤的诊治成为可能。本文对近年来HIV相关淋巴瘤的诊断和治疗进展进行综述。     

无创中心动脉压测量的现状与展望

心血管系统疾病是威胁居民健康的重要因素之一，居各种死因首位。因此，对人体心血管健康状况的监测和诊断尤为重要。相较于传统的外周动脉压，中心动脉压（central arterial pressure, CAP）与许多心血管事件发生有更高的相关性，通过测量CAP可以更加准确地反映人体血压的真实情况，并为诊断和疾病的预防提供重要依据。因此，实现高精度、高泛化能力、低成本的CAP无创测量方法一直是该领域的研究重点。结合国内外的相关文献，总结CAP测量现状，从参数测量与波形测量两个方面介绍相关的研究进展，并探讨现有方法的特点以及未来的发展方向。