Arterial Anatomy of the Anterior Abdominal Wall: Evidence-Based Safe Sites for Instrumentation Based on Radiological Analysis of 100 Patients

Multiple medical interventions require percutaneous instrumentation of the anterior abdominal wall, all of which carry a potential for vascular trauma. We assessed the presence, position, and size of the anterior abdominal wall superior and inferior (deep) epigastric arteries to determine the safest site with respect to vascular anatomy of the rectus sheath. In a review of 100 arterial phase, contrast-enhanced abdominal computed tomography scans, anterior abdominal wall arteries were assessed bilaterally at three axial planes: transpyloric, umbilicus, and anterior superior iliac spine (ASIS). The mean age of patients was 69.2 years (SD ± 15), with 62 male and 38 female. An artery was visible least frequently at the transpyloric plane (5%), compared with the umbilicus (72–79%) and ASIS (93–96%), on the left (χ²(4) = 207.272; P < 0.001) and right (χ²(4) = 198.553; P < 0.001), with a moderate strength association (Cramer's V = 0.588 (left) and 0.575 (right)). The arteries were most commonly observed within the rectus abdominis muscle at the level of the umbilicus and ASIS on both sides (62–68%). The inferior epigastric artery was observed to be larger in diameter, start more laterally, and move medially as it travelled superiorly. These data suggest that the safest site to instrument the rectus sheath, with respect to vascular anatomy, is at the transpyloric plane. This information on anatomical variation of the anterior abdominal wall vasculature may be of particular interest to anesthetists performing rectus sheath block and surgeons during laparoscopic port insertion. Clin. Anat. 33:350–354, 2020. © 2019 Wiley Periodicals, Inc.     

‘12 tips for teaching environmental sustainability to health professionals’

Abstract

Background: As recognition of the health impacts of climate change and other environmental challenges increases, so too does the need for health care professionals to practice healthcare sustainably. Environmental sustainability in healthcare extends beyond our traditional understanding of environmental health, which is often limited to environmental hazards and disease. Health services, professional organizations, and training institutions are increasingly forming climate and sustainability position statements and policies accordingly. To prepare future health professionals for global environmental change, environmental sustainability must be meaningfully integrated into health curricula.

Aim: To provide educators with 12 tips for integrating environmental sustainability into health professional education.

Methods: The authors reviewed the literature relating to climate change, environmental sustainability and health, and health professional education. By combining findings from this search with reflections on their own experience in clinical and public health teaching across nursing and midwifery, paramedicine, medicine, and public health, the authors developed recommendations for integrating environmental sustainability into health professional education.

Results: These 12 tips can be used to teach students and qualified health professionals in nursing, allied health, and medicine to practice healthcare in an environmentally sustainable manner.

Conclusions: Empowering health professionals to practice environmentally sustainable healthcare has economic, social, health, and environmental benefits. Teaching environmental sustainability to health professionals enhances existing learning by updating curricula with the latest evidence of how environmental determinants of health are rapidly changing and enables both educators and students to make an important contribution to safeguarding human health, the environment, and healthcare for future generations.     

Spatial and quantitative mapping of glycolysis and hypoxia in glioblastoma as a predictor of radiotherapy response and sites of relapse

European Journal of Nuclear Medicine and Molecular Imaging - Tumor hypoxia is a centerpiece of disease progression mechanisms such as neoangiogenesis or aggressive hypoxia-resistant malignant cells...     

The Potential for Zinc Stable Isotope Techniques and Modelling to Determine Optimal Zinc Supplementation

It is well recognised that zinc deficiency is a major global public health issue, particularly in young children in low-income countries with diarrhoea and environmental enteropathy. Zinc supplementation is regarded as a powerful tool to correct zinc deficiency as well as to treat a variety of physiologic and pathologic conditions. However, the dose and frequency of its use as well as the choice of zinc salt are not clearly defined regardless of whether it is used to treat a disease or correct a nutritional deficiency. We discuss the application of zinc stable isotope tracer techniques to assess zinc physiology, metabolism and homeostasis and how these can address knowledge gaps in zinc supplementation pharmacokinetics. This may help to resolve optimal dose, frequency, length of administration, timing of delivery to food intake and choice of zinc compound. It appears that long-term preventive supplementation can be administered much less frequently than daily but more research needs to be undertaken to better understand how best to intervene with zinc in children at risk of zinc deficiency. Stable isotope techniques, linked with saturation response and compartmental modelling, also have the potential to assist in the continued search for simple markers of zinc status in health, malnutrition and disease.