Risk Factors for Early Port Infections in Adult Oncologic Patients

PurposeThe purpose of this study was to retrospectively investigate risk factors for chest port (port) infections within 30 days of placement (early port infections) in adult oncologic patients.Materials and MethodsThis single-institution, three-center retrospective study identified 1,714 patients (868 males, 846 females; median age 60.0 years old) who underwent port placement between January 2013 and August 2017. All patients received an intravenous antibiotic prior to port placement. The median absolute neutrophil count was 5,260 cells/μL, the median white blood cell (WBC) count was 7,700 cells/μL, and the median serum albumin was 4.00 g/dL at the time of port placement. Double-lumen ports were most commonly implanted (74.85%) more frequently in an outpatient setting (72.69%). Risk factors for early port infections were elucidated using univariate and multivariate proportional subdistribution hazard regression analyses.ResultsA total of 20 patients (1.2%) had early port infections; 15 patients (0.9%) had positive blood cultures. The mean time to infection was 20 days (range, 9–30 days). The port-related 30-day mortality rate was 0.2% (4 of 1,714 patients). Most bloodstream infections were attributed to Staphylococcus spp. (n = 11). In multivariate analysis, hematologic malignancy (hazard ratio [HR], 2.61; 95% confidence interval (CI), 1.15–5.92.; P = .02), hypoalbuminemia (albumin <3.5 g/dL; HR, 3.52; 95% CI: 1.48–8.36; P = .004), leukopenia (WBC <3,500 cells/μL; HR, 3.00; 95% CI: 1.11–8.09; P = .03), and diabetes mellitus (HR, 3.71; 95% CI: 1.57–8.83) remained statistically significant risk factors for early port infection.ConclusionsHematologic malignancy, hypoalbuminemia, leukopenia, and diabetes mellitus at the time of port placement were independent risk factors for early port infections.     

Anaesthesia for endoscopic surgery

Anaesthesia for endoscopic airway surgery involves unique challenges. The anaesthetist and surgeon are working in close anatomical proximity and the concept of shared airway is never more relevant. Understanding the planned procedure and the needs of the surgeon for access to the surgical field will enable the provision of anaesthesia and airway management using a variety of techniques. Planning for safe induction, maintenance and emergence of anaesthesia will also be guided by the specific pathology and patient characteristics and requires effective communication between the surgeon and anaesthetist.     

“Locking in” a rare pathogen

Since its identification as a unique species in 1982, Escherichia hermannii has only recently been implicated as a pathogenic organism in human diseases. Literature search indicates removal of hemodialysis catheter as being essential to the success of treatment for bacteremia with this organism. However, having no alternative access for hemodialysis led to the attempt to salvage the catheter with the use of Antibiotic lock therapy. This case highlights Antibiotic lock therapy as an indication in Escherichia hermanii Catheter related Bloodstream infection.     

Ventral stream sensitivity in “healthy” preterm-born adolescents: Psychophysical and neuropsychological evaluation

Background

Deficits of motion processing have been reported in premature and very low birth-weight subjects during infancy, childhood and adolescence. Less is known about ventral stream functioning in preterms.

Aim

The aim of this study is to investigate ventral stream functioning in a sample of “healthy” adolescents born preterm with normal outcome and without brain damage.

Study design

We enrolled thirty preterm-born adolescents (mean age: 14.2 years, mean gestational age 28.9 weeks, mean birth weight 1097 g), and 34 age-matched term-born controls (mean age: 14.5 years). All subjects were administered a psychophysical test known as “Form Coherence Task” and a comprehensive standardized battery of neuropsychological tests suitable for investigating ventral stream functioning including Street Completion Test, Poppelreuter–Ghent Test and the first part of the Visual Object and Space Perception (VOSP) battery. Dorsal stream visual functioning was investigated by the second part of the VOSP.

Results

Preterm (PT) subjects showed the same results in all “ventral” tasks with respect to full-term controls without any correlation to gestational age or birth weight. We found a significant negative correlation between Form Coherence Task and Letters Task (p = .014) and between Form Coherence and Silhouette Tasks (p = .017). No correlation was observed between Form Coherence Task and Street and Ghent Tests. A statistical difference was instead found between PTs and controls in two tasks of the VOSP battery that mostly involve the dorsal stream.

Conclusions

Preterm birth per se (in absence of evident brain lesions) is not sufficient to compromise the development of ventral pathway.     

A Compressible Conserved Discrete Unified Gas-Kinetic Scheme with Unstructured Discrete Velocity Space for Multi-Scale Jet Flow Expanding into Vacuum Environment

The mechanism of jet flow expanding into vacuum environment (or extremely low density environment) is important for the propulsion unit of micro-electro-mechanical systems (MEMS), the thruster of spacecraft, the attitude control system of satellite, etc.. Since its flow field is often composed of local continuum region and local rarefied region, the jet flow into vacuum has noteworthy multi-scale transportation behaviors. Therefore, the numerical study of such flows needs the multi-scale schemes which are valid for both continuum and rarefied flows. In the past few years, a series of unified methods for whole flow regime (from continuum regime to rarefied regime) have been developed from the perspective of the direct modeling, and have been verified by sufficient test cases. In this paper, the compressible conserved discrete unified gas-kinetic scheme is further developed and is utilized for predicting the jet flows into vacuum environment. In order to cover the working conditions of both aerospace and MEMS applications, the jet flows with a wide range of inlet Knudsen (Kn) numbers (from 1E-4 to 100) are considered. The evolution of flow field during the entire startup and shutdown process with Kn number 100 is predicted by the present method, and it matches well with the result of analytical collisionless Boltzmann equation. For Kn numbers from 1E-4 to 10, the flow field properties such as density, momentum, and pressure are investigated, and the results are provided in details, since the published results are not sufficient at the present stage. The extent and intensity of the jet flow influence are especially investigated, because they are strongly related to the plume contamination and momentum impact on objects facing the jet, such as the solar paddles which face the attitude control thruster during the docking process.     

Visual and visuomotor processing of hands and tools as a case study of cross talk between the dorsal and ventral streams

A major principle of organization of the visual system is between a dorsal stream that processes visuomotor information and a ventral stream that supports object recognition. Most research has focused on dissociating processing across these two streams. Here we focus on how the two streams interact. We tested neurologically-intact and impaired participants in an object categorization task over two classes of objects that depend on processing within both streams—hands and tools. We measured how unconscious processing of images from one of these categories (e.g., tools) affects the recognition of images from the other category (i.e., hands). Our findings with neurologically-intact participants demonstrated that processing an image of a hand hampers the subsequent processing of an image of a tool, and vice versa. These results were not present in apraxic patients (N?=?3). These findings suggest local and global inhibitory processes working in tandem to co-register information across the two streams.     

血液透析中股静脉单针与双腔针的应用

目的 :比较股静脉单针与留置双腔针的优缺点 ,以选择更佳的血液透析通路。方法 :回顾对照研究 ,79例用股静脉单针 ,4 3例用股静脉双腔针的血流量、KT/V值和相关并发症等。结果 :最大血流量股静脉单针为 2 4 0± 32ml,双腔留置针为 2 0 0± 4 8ml;KT/V值分别是 0 8± 0 5 ,1 0± 0 5 ,股静脉双腔留置针出现血流量不足、感染、导管堵塞等并发症的发生率明显高于股静脉单针 ,各指标差异均有显著性 (P <0 0 5 )。结论 :股静脉单针是一种更理想的临时性血液透析通路     

Prolonged high-frequency jet ventilation in a patient with bronchopleural fistula. An alternative mode of ventilation

We report a case of bronchopleural fistula (BPF) in a patient submitted to conventional mechanical ventilation in which high frequency jet ventilation (HFJV) was applied during five consecutive days. Gas exchange was adequate, the bronchial secretions could easily be cleared and the patient adapted comfortably to HFJV. In spite of PEEP levels between 4 and 8 mm Hg, the leak through the BPF ceased completely.     

主动按压减压结合高频通气对心肺复苏犬的循环效应影响

目的　比较标准心肺复苏、主动按压减压心肺复苏、主动按压减压结合高频通气心肺复苏三种复苏法对心肺复苏循环效应影响 ;评价主动按压减压结合高频通气用于心肺复苏的可行性。方法　将9条犬经电击致颤制成心搏骤停模型 ,每只犬先后实施三种复苏法 ,①标准心肺复苏 ;②主动按压减压心肺复苏 ;③主动按压减压结合高频通气心肺复苏 ,实验顺序由随机法确定 ,每种复苏方法进行 5min ,待循环动力学稳定后记录收缩压、舒张压、心输出量。结果　收缩压、舒张压、心输出量均为主动按压减压结合高频通气模式大于主动按压减压心肺复苏模式 (P <0 0 1) ;主动按压减压心肺复苏模式大于标准心肺复苏模式 (P <0 0 1)。标准心肺复苏模式和主动按压减压心肺复苏模式胸外按压停顿期血压降至零 ,而主动按压减压结合高频通气心肺复苏模式血压持续稳定。结论　主动按压减压心肺复苏优于标准心肺复苏模式。主动按压减压结合高频通气心肺复苏模式既可产生较高的动脉血压、心输出量 ,又可提供充分的气体交换 ,值得进一步研究和推广应用