Radiation-Shielding Devices: The Best Combination for Spine Interventional Procedures

PurposeAlthough many studies have examined the efficiency of various protective devices for reducing the dose of radiation exposure to physicians during interventional pain procedures, no study has compared the protective effect of these devices when they are used in combination. The purpose of this prospective experimental study was to determine the best combination of radiation-shielding devices.Materials and MethodsUsing anthropomorphic phantoms of a physician and patient, we measured the radiation protection efficiency (RPE) of each of the following protection methods and in combination during C-arm–guided simulated lumbar epidural injection: (a) personal protective equipment (PPE), (b) bedside curtain shield (Curtain), (c) x-ray tube filter (Filter), and (d) fluoroscopic collimation method (Collimation). We measured exposure doses using personal electronic dosimeters at the eye, thyroid, and gonad levels for 1 minute. Each experiment was repeated 15 times.ResultsThe radiation exposure dose and RPE with the best single-, double-, and triple-protection methods were as follows: PPE for the single-protection method (11.82 μSv/min, 80.04%), PPE + Collimation for the double-combination method (4.68 μSv/min, 92.09%), and PPE + Collimation + Curtain for the triple-combination method (3.08 μSv/min, 93.39%). Additionally, PPE + Collimation + Curtain + Filter for the quadruple-combination method resulted in a radiation exposure and RPE of 2.91 μSv/min and 93.61%, respectively, compared with nonprotection.ConclusionsThe best single-, double-, and triple-protection method was PPE, PPE + Collimation, and PPE + Collimation + Curtain, respectively. While preparing protective equipment, we recommend prioritizing equipment in this order.     

Pulmonary tuberculosis

We present a case of previously undiagnosed and unsuspected pulmonary tuberculosis (TB) identified on post mortem histology. The presentation of TB in the mortuary is reviewed and we present the key learning points regarding dealing with this infection in the post mortem patient.Trainees should appreciate that although a rare occurrence, pulmonary TB may go undiagnosed until after death, and given its ability to survive in the post mortem patient, the use of personal protective equipment is paramount.     

Protective equipment-related pressure ulcers in healthcare workers during COVID-19 pandemic: A systematic review

AimThis systematic review was carried out to examine pressure ulcers in healthcare staff due to the use of protective equipment during COVID-19 pandemic and the precautions taken to prevent these injuries.MethodRelevant studies were retrospectively searched. Seven English keywords identified from MESH were used while searching. The search was carried out in five international databases by trying various combinations of these words during February 15–25, 2021. This systematic review was updated by rescanning databases on December 20, 2021 and a total of 611 studies were attained.Results17 studies which met the study inclusion criteria, which were conducted mostly through online survey method in different study designs and which included a total of 24,889 healthcare professionals were examined. The incidence of PPE-related pressure ulcers was found to be between 30% and 92.8%. Grade I pressure ulcers were the most common (44.1%–82%). The incidence of skin problems except PPE-related pressure ulcers such as itching, redness and dry skin was found to be between 42.8–88.1%. Risk factors that frequently played a role in the development of PPE-related pressure ulcers and other skin problems were longer use of PPE and sweating. PPE-related pressure ulcers and other skin problems were more frequent over the nose (nasal bone/nasal bridge), ears, forehead and cheeks. PPE-related itching, redness and dry skin mostly occurred. Several dressing applications were found to be effective in the prevention of PPE-related pressure ulcers and other skin problems that might develop especially on the facial region.ConclusionPPE-related pressure ulcers and other skin problems were found to be higher among healthcare professionals. Data regarding the sealing of dressing applications against viral transmission in the prevention of PPE-related pressure ulcers and other skin problems are limited. It is estimated that future studies will be performed to prevent device-related pressure ulcers in healthcare workers. It is suggested that there is a need to conduct studies with larger samples where expert researchers make observations for pressure ulcers in order to determine the prevalence and incidence of PPE-related pressure ulcers.     

手术动力设备电磁兼容测试中工况选取的探索

目的介绍手术动力设备的电磁兼容测试方法,为多功能手术动力设备测试提供指引。方法通过对常见手术动力设备的不同功能逐一测试得出的结果进行比对,分析不同功能在同一检测项目中的差异。结果传导发射(Conduction Emission,CE)与负载引起的功率变化有关,辐射发射(Radiation Ernission,RE)与负载引起的功率变化无必然联系。静电放电(Electrostatic Discharge,ESD)与负载刀头到设备输入插口的插入损耗有关。结论可选择输入功率较大的负载进行CD和RE测试;电路原理不明确时,还可通过频谱仪预测判断后,选择出现最大幅值的负载进行RE测试;ESD测试选择插入损耗最小的负载测试;其余抗扰度项目可选取任一负载测试。     

中药渗漉提取工艺研究进展

渗漉法是将经过处理的药材粉末置于渗漉器中,不断加入溶剂,并收集渗漉液的一种中药常用提取方法,具有设备简单,操作容易,适用药材范围广,能有效提取热不稳定成分或组分等优点,但也存在溶剂消耗量大,提取耗时长,后续浓缩工艺能耗大等不足。该文主要综述了中药渗漉常见设备类型、工艺影响因素、参数优化方法以及过程监测方面的研究进展。分析文献后认为粉末粒度、溶剂组成、浸渍时间、渗漉流速、溶剂用量是渗漉工艺的重要影响因素。目前在渗漉工艺在线监测时采用近红外光谱技术较多,偏最小二乘法是常用的定量建模方法。笔者认为借鉴"质量源于设计"理念进行工艺控制,深入探究渗漉工艺机制并研发工艺控制方法是今后的发展趋势,所以应该深入探索过程建模技术,完善过程优化技术,研发过程监测技术。构建渗漉过程模型时可考虑借鉴柱色谱工艺的机制模型和经验模型。优化渗漉工艺参数时应考虑药材品质变化的影响,也需要研发更加简便易用的方法以监测渗漉过程状态和渗漉液关键性质。     

血液净化中心设备管理研究进展

血液净化中心是医院血液透析患者开展血液净化治疗的主要场所。在血液净化中心开展血液净化治疗的患者通常来说免疫功能低下,容易发生感染,并且对设备具有较强的依赖性。因此血液净化中心设备管理质量直接影响着血液透析中心的血液净化治疗效果。这便要求血液净化中心应该不断加强设备管理,提高设备管理质量,为患者的治疗提供更好的服务。因此近些年人们对于血液净化中心设备管理的重视程度不断提高,很多专家关于血液净化中心的设备管理开展了很多研究工作,本文将近些年的研究进展进行综述,以期为血液净化中心的设备管理提供借鉴。     

Pediatric surgery during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on pediatric surgery. The infection is often asymptomatic and atypical in children, while overlapping presentations with other infectious diseases generate additional diagnostic challenges. The high probability of missed pediatric cases and the invasive nature of surgery generate great concern for widespread transmission in this setting. Current guidelines suggest that triage of cases should be made on a case-by-case basis by a multidisciplinary team of experts. Decision-making can be assisted by classifying cases as elective, urgent, or an emergency according to the risks of delaying their surgical management. A workflow diagram should ideally guide the management of all cases from admission to discharge. When surgery is necessary, all staff should use appropriate personal protective equipment, and high-risk practices, such as aerosol-generating tools or procedures, should be avoided if possible. Furthermore, carefully designed organizational protocols should be established to minimize transmission while ensuring the uninterrupted operation of pediatric surgery units. For example, surgical teams can be divided into small weekly rotating groups, and healthcare workers should be continuously monitored for COVID-19 symptoms. Additionally, team protocols in the operating room can optimize communication and improve adherence to personal protective equipment use. Isolated operating rooms, pediatric intensive care units, and surgical wards should be specifically designed for suspected or confirmed COVID-19 cases. Finally, transportation of patients should be minimal and follow designated short routes. All these measures can help mitigate the effects of the COVID-19 pandemic on pediatric surgery units.