Management and prevention of complications of subcutaneous intravenous infusion port

Subcutaneous intravenous infusion port (SIIP) has become an increasingly and widely adopted technique in the management of oncology patients. This route has been used not only for chemotherapy but also for parenteral nutrition provision, blood transfusion, medication administration, blood sample collection, hemodialysis, and so on. This system provides a safe vascular access with low complication rate which helps preventing patients from vascular infection and catheter associated thrombosis. In this study, we reviewed 1247 cases of breast cancer patients that had subcutaneous intravenous infusion port implanted for chemotherapy in our general surgery department from 1990 to 2008. The result indicates that complication decreases as our technique and experience mature. We hereby share our accrued experience and improved technique, hoping to be of help to young surgeons.     

Suspended Onion Particles and Potential Corneal Injury in Onion Harvesters

The authors suspected that suspended onion particles contributed to corneal ulcers in onion harvesters in southern Taiwan. In the present study, the authors used manikins to study suspended onion particles in fields in an effort to simulate typical conditions experienced by onion harvesters. An animal eye-exposure simulation study was also performed by the authors, who impacted suspended soil grains or onion particles onto the corneas of guinea pigs via aerosol generated from the Palas® dispersion nozzle. The average size of 25.9 μm for suspended particles collected during the digging of onions was the largest one of those for various harvesting activities. Some onion skin flakes were found in samples obtained from gathering and packing activities; the typical flake size was approximately 3.5 × 2.5 mm². The results of the animal study indicated that the size of soil grains has a demonstrable effect on the severity of corneal injury (p = .009). With respect to onion skin flakes, wind velocity was also associated significantly with the occurrence of corneal injury (p = .0004). A wind velocity threshold of 7 m/sec is recommended for the maintenance of safety, and if the wind speed exceeds this threshold level, workers should not engage in harvesting activities. Furthermore, use of appropriately designed goggles is necessary for the protection of onion harvesters who work in high-wind conditions.     

Impact of an In-Person Versus Web-Based Practice Standardized Patient Examination on Student Performance on a Subsequent High-Stakes Standardized Patient Examination

Background: Optimal methods of preparing students for high-stakes standardized patient (SP) examinations are unknown. Purposes: The purpose is to compare the impact of two formats of a formative SP examination (Web-based vs. in-person) on scores on a subsequent high-stakes SP examination and to compare students' satisfaction with each formative examination format. Methods: Clustered randomized trial comparing a Web-based module versus in-person formative SP examination. We compared scores on a subsequent high-stakes SP examination and satisfaction. Results: Scores on the subsequent high-stakes SP examination did not differ between the two formative formats but were higher after the formative assessment than without (p < .001). Satisfaction was higher with the in-person than Web-based formative assessment format (4.00 vs. 3.62 on a 5-point scale, p = .01). Conclusions: Two formats of a formative SP examination led to equivalent improvement in scores on a subsequent high-stakes examination. Students preferred an in-person formative examination to online but were satisfied with both.     

雷帕霉素抑制膀胱癌细胞生长及转移的实验研究

目的：探讨新型免疫抑制剂雷帕霉素（RPM）对膀胱癌细胞生长及转移的影响,探究其在肾移植患者膀胱肿瘤治疗中的作用与应用前景。方法：将雷帕霉素分别用5ng/ml,10 ng/ml,15ng/ml 3个浓度梯度处理T24膀胱癌细胞,分别在药物处理后12h,24h,36h应用MTT法检测上述不同药物浓度对细胞增殖的影响。流式细胞仪检测不同浓度RPM对人T24膀胱癌细胞株凋亡和细胞周期的影响;应用RT-PCR检测经不同浓度雷帕霉素处理后血管内皮生长因子（VEGF）mRNA的表达以及划痕法检测不同浓度雷帕霉素对于T24膀胱癌细胞迁移率的影响。体内实验用14只4-6周龄Balb/c裸鼠种植转移性人膀胱癌细胞构建荷瘤模型,观察雷帕霉素对肿瘤生长及自发转移的影响。结果：体外实验显示3种浓度的雷帕霉素明显抑制T24细胞的增殖,随着浓度的增加和作用时间的增加对于肿瘤的抑制性明显加强,其中24h时各浓度作用明显强于12h时各浓度,且各浓度之间差异明显（P〈0.05）。雷帕霉素使细胞停留在G0/G1期,并促进细胞凋亡;同时下调VEGF的基因表达（P〈0.05）。在划痕实验中雷帕霉素明显抑制膀胱癌细胞的迁移（P〈0.01）。体内实验中,鼠成瘤率达85.7%（12/14）。治疗3周后,空白对照组较RPM组肿瘤大且裸鼠明显消瘦（P〈0.05）;探查肺部和肝脏转移灶空白组明显较RPM组多（P〈0.05）。结论：雷帕霉素明显抑制膀胱癌细胞的生长及迁移,以雷帕霉素为基础的免疫抑制剂在肾移植患者膀胱肿瘤治疗中有良好的临床应用前景。     

Percutaneous drainage of chest abscesses in children

Seven patients ranging in age from 3 to 18 years underwent percutaneous drainage of eight intrathoracic abscesses. Five of the abscesses were mediastinal or paramediastinal and resulted from esophageal perforation or esophageal anastomotic leakage. The abscesses resolved in each case, with a mean catheter drainage time of 28 days and no need for surgical intervention. Three of the abscesses were intrapulmonary, and each lay adjacent to a pleural surface. All three lung abscesses resolved within 19-24 days, without thoracotomy or wedge resection.