综合重症监护病房医院感染目标性监测分析

目的 了解综合重症监护病房（ICU）住院患者医院感染发病率、器械相关感染发病率,分析相关危险因素,寻找有效预防与控制医院感染的关键环节及防控措施。方法 采取前瞻性目标性监测方法,对2012年1月-12月入住ICU 48 h以上的294例患者进行调查,主管医生填写ICU患者相关信息调查表,医院感染管理专职人员进行追踪、感染判断及结果统计分析。结果 294例患者中,发生医院感染61例,78例次,医院感染发病率为20.75%,医院感染例次发病率为26.53%。患者日医院感染发病率为16.01‰,患者日医院感染例次发病率为20.47‰,经患者平均病情严重程度调整后的患者医院感染例次发病率为7.48%。呼吸机相关性肺炎（VAP）感染率为27.27‰,中心静脉相关血流感染率为6.58‰,导尿管相关泌尿道感染率为3.15‰。结论 ICU属于医院感染高危科室,在器械相关感染中,VAP感染发病率最高。需要通过监测不断发现问题,不断改进,加强对医务人员的医院感染防控知识培训、医务人员与医院感染专职人员密切沟通、医院感染控制措施的落实等降低ICU医院感染发病率及器械相关感染发病率。     

Selective Cerebrospinal Fluid Hypothermia: Bioengineering Development and In Vivo Study of an Intraventricular Cooling Device (V-COOL)

Hypothermia is a promising therapeutic strategy for severe vasospasm and other types of non-thrombotic cerebral ischemia, but its clinical application is limited by significant systemic side effects. We aimed to develop an intraventricular device for the controlled cooling of the cerebrospinal fluid, to produce a targeted hypothermia in the affected cerebral hemisphere with a minimal effect on systemic temperature. An intraventricular cooling device (acronym: V-COOL) was developed by in silico modelling, in vitro testing, and in vivo proof-of-concept application in healthy Wistar rats (n = 42). Cerebral cortical temperature, rectal temperature, and intracranial pressure were monitored at increasing flow rate (0.2 to 0.8 mL/min) and duration of application (10 to 60 min). Survival, neurological outcome, and MRI volumetric analysis of the ventricular system were assessed during the first 24 h. The V-COOL prototyping was designed to minimize extra-cranial heat transfer and intra-cranial pressure load. In vivo application of the V-COOL device produced a flow rate-dependent decrease in cerebral cortical temperature, without affecting systemic temperature. The target degree of cerebral cooling (− 3.0 °C) was obtained in 4.48 min at the flow rate of 0.4 mL/min, without significant changes in intracranial pressure. Survival and neurological outcome at 24 h showed no significant difference compared to sham-treated rats. MRI study showed a transient dilation of the ventricular system (+ 38%) in a subset of animals. The V-COOL technology provides an effective, rapid, selective, and safe cerebral cooling to a clinically relevant degree of − 3.0 °C.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01302-y.     

Hearing aid and cochlear implant use in children with hearing loss at three years of age: Predictors of use and predictors of changes in use

Objective: To examine usage patterns of hearing aids and cochlear implants in children up to three years of age, how usage changes longitudinally, and factors associated with device usage. Design: Parent report and Parent’s Evaluation of Aural/oral Performance of Children (PEACH) data were obtained at six and twelve months after hearing-aid fitting or cochlear implant switch-on, and again at three years of age. The effect of device use on auditory functional performance was investigated using the PEACH questionnaire. Study sample: Four hundred and thirteen participants from the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study were included for analysis. Results: For users of hearing aids, higher usage at three years was associated with higher maternal education, and more severe hearing loss. For users of cochlear implants, higher usage was associated with higher maternal education and the absence of additional disabilities. Higher PEACH scores were associated with higher usage scores. After allowing for the effects of demographic characteristics, device use was not a significant predictor of functional performance. Conclusions: Sixty-two percent of children achieved consistent use (> 75% of waking hours) within the first year of receiving a hearing aid or a cochlear implant, and 71% by three years of age.     

Incidence,severity and outcome of central line related complications in pediatric oncology patients; A single center study

BackgroundCentral venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment.MethodsAn audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman–Broviac® (HB), nontunneled, and peripherally inserted CVADs.ResultsA total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular.ConclusionsThe incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals.Type of studyPrognosis study (retrospective).Level of evidenceLevel II.     

我国医疗器械面临的市场机遇和竞争压力

本文介绍了我国医疗器械行业良好的增长形势,展示了我国医疗器械广阔的市场机遇,指出了国产医疗器械存在的竞争压力。     

Guidewire-Controlled Advancement of the Amplatz Thrombectomy Device

The Amplatz Thrombectomy Device (ATD) is a percutaneous rotational catheter proven to homogenize thrombus. The catheter design allows neither application over a coaxial running guidewire nor the use of the device as a monorail system. We report a technical modification that provides guided advancement of the catheter over a wire in order to prevent failure of application and to facilitate the interventional procedure. Received: 0/00/00/Accepted: 0/00/00     

Piggy-back pacing: implantation of pacemaker and defibrillator on top of each other.

Following the publication of several landmark trials, there has been a significant increase in the cardiac device implantation. Within this population there are a number of patients who have pre-existing cardiac devices that have been placed for a number of different conditions. While the usual approach is to remove the existing unit and replace it with a new device with the removal or capping of existing lead systems, this practice often sacrifices an existing unit that still possesses good battery longevity. We explored the possibility of separating the pacing and defibrillating functions by implanting a new device on the top of the old device in a 'piggy-back fashion'. We report a series of four cases (with various indications) with differing combinations of devices. The procedure was performed safely in every one of them, and no device-device interaction was noted. Combining the new with existing units in a 'piggy-back' manner may be a safe and cost-effective technique in the selected cases.