Transcatheter aortic valve implantation of a CoreValve device using novel real-time imaging guidance

Thorough imaging of the aortic valve and related structures is highly important before and during transcatheter aortic-valve implantation. However, conventional aortography is limited for guiding precise valve placement and depends on contrast injections. A real-time imaging system capable of guiding the operator during Edwards-SPAIEN valve procedures has been introduced (C-THV, Paieon, Inc.). We describe the first application of the novel C-THV system during CoreValve implantation in a very challenging clinical scenario that required precise high implantation using minimal contrast.     

苦参碱对体外诱导人结肠HT29细胞凋亡作用的实验研究

[目的]研究苦参碱（matrine,MA）对体外诱导人结肠癌HT29细胞的凋亡作用及其机制。[方法]不同浓度MA（0-32mg／m1）作用HT29细胞24h后,流式细胞仪检测细胞凋亡,线粒体跨膜电位检测试剂盒（3C-1）检测线粒体膜电位（Apm）变化,分光光度法检测caspase-3,9酶活性,Westernblot法检测线粒体凋亡途径相关蛋白Bax、Bcl-2表达。[结果]MA显著诱导HT29细胞凋亡;16mg／mlMA作用HT29细胞24h后,caspase-9,-3酶活性明显升高;Westernblot结果显示：MA处理组促凋亡蛋白Pax表达明显升高,抗凋亡蛋白Bcl2表达明显降低。[结论]MA具有促进结肠癌细胞凋亡的作用,且具有剂量依赖性,其机制与线粒体凋亡途径有关。     

Continuous on-line glucose measurement by microdialysis in a central vein. A pilot study

Introduction

Tight glucose control in the ICU has been proven difficult with an increased risk for hypoglycaemic episodes. Also the variability of glucose may have an impact on morbidity. An accurate and feasible on-line/continuous measurement is therefore desired. In this study a central vein catheter with a microdialysis membrane in combination with an on-line analyzer for continuous monitoring of circulating glucose and lactate by the central route was tested.

Methods

A total of 10 patients scheduled for major upper abdominal surgery were included in this observational prospective study at a university hospital. The patients received an extra central venous catheter with a microdialysis membrane placed in the right jugular vein. Continuous microdialysis measurement proceeded for 20 hours and on-line values were recorded every minute. Reference arterial plasma glucose and blood lactate samples were collected every hour.

Results

Mean microdialysis-glucose during measurements was 9.8 ± 2.4mmol/l.No statistical difference in the readings was seen using a single calibration compared to eighth hour calibration (P =0.09; t-test). There was a close agreement between the continuous reading and the reference plasma glucose values with an absolute difference of 0.6+0.8mmol, or 6.8+9.3% and measurements showed high correlation to plasma readings (r = 0.92). Thelimit of agreement was 23.0%(1.94 mmol/l) compared to arterial plasma values with a line of equality close to zero.However, in a Clarke-Error Grid 93.3% of the values are in the A-area,and the remaining part in the B-area.Mean microdialysis-lactate was 1.3 ± 1.1mmol/l. The measurements showed high correlation to the blood readings (r = 0.93).

Conclusion

Continuous on-line microdialysis glucose measurement in a central vein is a potential useful technique for continuous glucose monitoring in critically ill patients, but more improvements and testingare needed.     

Learning orthopaedics: Assessing medical students' experiences of interprofessional training in an orthopaedic clinical education ward

Interprofessional training is becoming commonplace in undergraduate medical education. Orthopaedics is considered to be a setting that offers good opportunities for interprofessional training. Curriculum overload is a common problem, which has to be addressed with respect to content. The aim of this study was to assess medical students' experiences of interprofessional care during their orthopaedic training. Over a two-week period, medical, nursing, physiotherapy and occupational therapy students trained together in teams in an orthopaedic ward (Clinical Education Ward, CEW). A questionnaire was distributed to assess the impact of this new curriculum on medical students. A patient-satisfaction questionnaire was also administered to assess patients' satisfaction with the treatment provided by students at the CEW. In general, the medical students were satisfied with the interprofessional course in the CEW. Of the 178 medical students who took the course, 134 (75%) responded to the questionnaire. Total time devoted to orthopaedics was reported to be between 7 – 44% (mean). The total time regarding medical tasks was reported to be between 57 – 71% (mean). Results from the patient-satisfaction questionnaire showed that patients perceived CEW as highly satisfactory. The medical students reported generally satisfactory experiences of interprofessional orthopaedic training in general. In an interprofessional training context, professional supervision and role modeling takes on added importance, and may be regarded as essential ingredients in helping students to learn effectively within an authentic clinical setting.     

Clinical reasoning during simulation: Comparison of student and faculty ratings

A recently developed tool, the Lasater Clinical Judgment Rubric (LCJR), was used to evaluate nursing students’ clinical reasoning during simulated patient care scenarios. For two semesters, students and nursing faculty completed the clinical reasoning tool after participating in and observing students’ reactions to simulated emergent patient simulations. Scores were compared between nursing students and faculty and between programs, associate (AS) and baccalaureate of science (BS). Students’ scores differed statistically based on program, BS means greater than AS, but student and faculty ratings were rarely significantly different. Additional research across multiple programs for a larger sample size and additional testing of the clinical reasoning tool are needed. To promote more realistic self-appraisals, students may need more opportunities to self-assess clinical reasoning behaviors in conjunction with feedback on performance from faculty throughout the nursing program.