Effort of breathing in children receiving high-flow nasal cannula.

PubMed

Rubin, Sarah; Ghuman, Anoopindar; Deakers, Timothy; Khemani, Robinder; Ross, Patrick; Newth, Christopher J

2014-01-01

High-flow humidified nasal cannula is often used to provide noninvasive respiratory support in children. The effect of high-flow humidified nasal cannula on effort of breathing in children has not been objectively studied, and the mechanism by which respiratory support is provided remains unclear. This study uses an objective measure of effort of breathing (Pressure. Rate Product) to evaluate high-flow humidified nasal cannula in critically ill children. Prospective cohort study. Quaternary care free-standing academic children's hospital. ICU patients younger than 18 years receiving high-flow humidified nasal cannula or whom the medical team planned to extubate to high-flow humidified nasal cannula within 72 hours of enrollment. An esophageal pressure monitoring catheter was placed to measure pleural pressures via a Bicore CP-100 pulmonary mechanics monitor. Change in pleural pressure (ΔPes) and respiratory rate were measured on high-flow humidified nasal cannula at 2, 5, and 8 L/min. ΔPes and respiratory rate were multiplied to generate the Pressure.Rate Product, a well-established objective measure of effort of breathing. Baseline Pes, defined as pleural pressure at end exhalation during tidal breathing, reflected the positive pressure generated on each level of respiratory support. Twenty-five patients had measurements on high-flow humidified nasal cannula. Median age was 6.5 months (interquartile range, 1.3-15.5 mo). Median Pressure,Rate Product was lower on high-flow humidified nasal cannula 8 L/min (median, 329 cm H2O·min; interquartile range, 195-402) compared with high-flow humidified nasal cannula 5 L/min (median, 341; interquartile range, 232-475; p = 0.007) or high-flow humidified nasal cannula 2 L/min (median, 421; interquartile range, 233-621; p < 0.0001) and was lower on high-flow humidified nasal cannula 5 L/min compared with high-flow humidified nasal cannula 2 L/min (p = 0.01). Baseline Pes was higher on high-flow humidified nasal cannula 8 L/min than on high-flow humidified nasal cannula 2 L/min (p = 0.03). Increasing flow rates of high-flow humidified nasal cannula decreased effort of breathing in children, with the most significant impact seen from high-flow humidified nasal cannula 2 to 8 L/min. There are likely multiple mechanisms for this clinical effect, including generation of positive pressure and washout of airway dead space.

Modification of Aortic Cannula With an Inlet Chamber to Induce Spiral Flow and Improve Outlet Flow.

PubMed

Darlis, Nofrizalidris; Osman, Kahar; Padzillah, Muhamad Hasbullah; Dillon, Jeswant; Md Khudzari, Ahmad Zahran

2018-05-01

Physiologically, blood ejected from the left ventricle in systole exhibited spiral flow characteristics. This spiral flow has been proven to have several advantages such as lateral reduction of directed forces and thrombus formation, while it also appears to be clinically beneficial in suppressing neurological complications. In order to deliver spiral flow characteristics during cardiopulmonary bypass operation, several modifications have been made on an aortic cannula either at the internal or at the outflow tip; these modifications have proven to yield better hemodynamic performances compared to standard cannula. However, there is no modification done at the inlet part of the aortic cannula for inducing spiral flow so far. This study was carried out by attaching a spiral inducer at the inlet of an aortic cannula. Then, the hemodynamic performances of the new cannula were compared with the standard straight tip end-hole cannula. This is achieved by modeling the cannula and attaching the cannula at a patient-specific aorta model. Numerical approach was utilized to evaluate the hemodynamic performance, and a water jet impact experiment was used to demonstrate the jet force generated by the cannula. The new spiral flow aortic cannula has shown some improvements by reducing approximately 21% of impinging velocity near to the aortic wall, and more than 58% reduction on total force generated as compared to standard cannula. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Risk factor for phlebitis: a questionnaire study of nurses' perception.

PubMed

Milutinović, Dragana; Simin, Dragana; Zec, Davor

2015-01-01

to assess nurses' perceptions of risk factors for the development of phlebitis, with a special focus on the perception of phlebitic potentials of some infusion medications and solutions. a cross-sectional questionnaire study, which included a sample of 102 nurses. Nurses recognized some factors that may reduce the incidence of phlebitis; however, more than half of the nurses were unaware that the material and diameter of the cannula can affect the incidence rate of phlebitis. Furthermore,underlying disease and high pH of medications or solutions were identified as potential risk factors, whereas low pH and low osmolality were not. Nurses identified Vancomycin and Benzylpenicillin antibiotics with the strongest phlebitic potential. Among other medications and intravenous fluids, Aminophylline, Amiodaronehydrochloride and Potassium chloride 7.4% were identified as potentially causing phlebitis. predisposing factors for phlebitis relating to patients and administered therapy were identified by nurses, while some cannula related risk factors, in particular its physicochemical properties and the time for cannula replacement, were not fully perceived.

Risk factor for phlebitis: a questionnaire study of nurses' perception

PubMed Central

Milutinović, Dragana; Simin, Dragana; Zec, Davor

2015-01-01

Abstract Objectives: to assess nurses' perceptions of risk factors for the development of phlebitis, with a special focus on the perception of phlebitic potentials of some infusion medications and solutions. Method: a cross-sectional questionnaire study, which included a sample of 102 nurses. Results: Nurses recognized some factors that may reduce the incidence of phlebitis; however, more than half of the nurses were unaware that the material and diameter of the cannula can affect the incidence rate of phlebitis. Furthermore,underlying disease and high pH of medications or solutions were identified as potential risk factors, whereas low pH and low osmolality were not. Nurses identified Vancomycin and Benzylpenicillin antibiotics with the strongest phlebitic potential. Among other medications and intravenous fluids, Aminophylline, Amiodaronehydrochloride and Potassium chloride 7.4% were identified as potentially causing phlebitis. Conclusion: predisposing factors for phlebitis relating to patients and administered therapy were identified by nurses, while some cannula related risk factors, in particular its physicochemical properties and the time for cannula replacement, were not fully perceived. PMID:26444170

Non-Invasive Mapping of Intraventricular Flow Patterns in Patients Treated with Left Ventricular Assist Devices

NASA Astrophysics Data System (ADS)

Miramontes, Marissa; Rossini, Lorenzo; Braun, Oscar; Brambatti, Michela; Almeida, Shone; Mizeracki, Adam; Martinez-Legazpi, Pablo; Benito, Yolanda; Bermejo, Javier; Kahn, Andrew; Adler, Eric; Del Álamo, Juan C.

2017-11-01

In heart failure patients, left ventricular (LV) assist devices (LVADs) decrease mortality and improve quality of life. We hypothesize echo color Doppler velocimetry (echo-CDV), an echocardiographic flow mapping modality, can non-invasively characterize the effect of LVAD support, optimize the device, thereby decreasing the stoke rate present in these patients. We used echo-CDV to image LV flow at baseline LVAD speed and during a ramp test in LVAD patients (Heartmate II, N =10). We tracked diastolic vortices and mapped blood stasis and cumulative shear. Compared to dilated cardiomyopathy (DCM) patients without LVADs, the flow had a less prominent diastolic vortex ring, and transited directly from mitral valve to cannula. Residence time and shear were significantly lower compared to healthy controls and DCMs. Aortic regurgitation and a large LV vortex presence or a direct mitral jet towards the cannula affected blood stasis region location and size. Flow patterns, residence time and shear depended on LV geometry, valve function and LVAD speed in a patient specific manner. This new methodology could be used with standard echo, hemodynamics and clinical information to find the flow optimizing LAVD setting minimizing stasis for each patient.

[Special cannulas for the puncture of implanted catheter port systems].

PubMed

Haindl, H; Müller, H

1989-04-01

The Huber-Point cannula is generally recommended for portal puncture. Two comparative studies are published that show no advantage in using Huber-point cannulas. This has been verified by technical investigations. A new type of non-coring cannula is described.

Globe stability during simulated vitrectomy with valved and non-valved trocar cannulas

PubMed Central

Abulon, Dina Joy; Charles, Martin; Charles, Daniel E

2015-01-01

Purpose To compare the effects of valved and non-valved cannulas on intraocular pressure (IOP), fluid leakage, and vitreous incarceration during simulated vitrectomy. Methods Three-port pars plana incisions were generated in six rubber eyes using 23-, 25-, and 27-gauge valved and non-valved trocar cannulas. The models were filled with air and IOP was measured. Similar procedures were followed for 36 acrylic eyes filled with saline solution. Vitreous incarceration was analyzed in eleven rabbit and twelve porcine cadaver eyes. Results In the air-filled model, IOP loss was 89%–94% when two non-valved cannulas were unoccupied versus 1%–5% when two valved cannulas were unoccupied. In the fluid-filled model, with non-valved cannulas, IOP dropped while fluid leaked from the open ports. With two open ports, the IOP dropped to 20%–30% of set infusion pressure, regardless of infusion pressure and IOP compensation. The IOP was maintained in valved cannulas when one or two ports were left open, regardless of IOP compensation settings. There was no or minimal fluid leakage through open ports at any infusion pressure. Direct microscopic analysis of rabbit eyes showed that vitreous incarceration was significantly greater with 23-gauge non-valved than valved cannulas (P<0.005), and endoscopy of porcine eyes showed that vitreous incarceration was significantly greater with 23-gauge (P<0.05) and 27-gauge (P<0.05) non-valved cannulas. External observation of rabbit eyes showed vitreous prolapse through non-valved, but not valved, cannulas. Conclusion Valved cannulas surpassed non-valved cannulas in maintaining IOP, preventing fluid leakage, and reducing vitreous incarceration during simulated vitrectomy. PMID:26445520

Handling of peripheral intravenous cannulae: effects of evidence-based clinical guidelines.

PubMed

Ahlqvist, Margary; Bogren, Agneta; Hagman, Sari; Nazar, Isabel; Nilsson, Katarina; Nordin, Karin; Valfridsson, Berit Sunde; Söderlund, Mona; Nordström, Gun

2006-11-01

This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses' care, handling and documentation of peripheral intravenous cannulae. Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses' care, handling and the documentation of peripheral intravenous cannulae in the patient's record. A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0.01) and the use of cannula size 0.8 mm increased by 22% (P < 0.001). Nurses' documentation of peripheral intravenous cannula improved significantly (P < 0.001). We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0.8 mm), as well as of the nurses' documentation in the patient's record. Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses' knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.

Ventricular flow dynamics with varying LVAD inflow cannula lengths: In-silico evaluation in a multiscale model.

PubMed

Liao, Sam; Neidlin, Michael; Li, Zhiyong; Simpson, Benjamin; Gregory, Shaun D

2018-04-27

Left ventricular assist devices are associated with thromboembolic events, which are potentially caused by altered intraventricular flow. Due to patient variability, differences in apical wall thickness affects cannula insertion lengths, potentially promoting unfavourable intraventricular flow patterns which are thought to be correlated to the risk of thrombosis. This study aimed to present a 3D multiscale computational fluid dynamic model of the left ventricle (LV) developed using a commercial software, Ansys, and evaluate the risk of thrombosis with varying inflow cannula insertion lengths in a severely dilated LV. Based on a HeartWare HVAD inflow cannula, insertion lengths of 5, 19, 24 and 50 mm represented cases of apical hypertrophy, typical ranges of apical thicknesses and an experimental length, respectively. The risk of thrombosis was evaluated based on blood washout, residence time, instantaneous blood stagnation and a pulsatility index. By introducing fresh blood to displace pre-existing blood in the LV, after 5 cardiac cycles, 46.7%, 45.7%, 45.1% and 41.8% of pre-existing blood remained for insertion lengths of 5, 19, 24 and 50 mm, respectively. Compared to the 50 mm insertion, blood residence time was at least 9%, 7% and 6% higher with the 5, 19 and 24 mm insertion lengths, respectively. No instantaneous stagnation at the apex was observed directly after the E-wave. Pulsatility indices adjacent to the cannula increased with shorter insertion lengths. For the specific scenario studied, a longer insertion length, relative to LV size, may be advantageous to minimise thrombosis by increasing LV washout and reducing blood residence time. Copyright © 2018 Elsevier Ltd. All rights reserved.

Clinical use of closed-system safety peripheral intravenous cannulas.

PubMed

Barton, Andrew

2018-04-26

Peripheral intravenous (IV) cannulas are the quickest and most effective way of gaining venous vascular access and administering IV therapy. Closed-system peripheral IV cannulas have been shown to be safe and more reliable than open, non-valved peripheral cannulas in clinical practice. This article introduces the Smiths Medical DeltaVen closed-system peripheral IV cannula and includes three case studies describing its use in clinical practice and associated patient outcomes.

Winged Metal Needles versus Plastic Winged and Nonwinged Cannulae for Subcutaneous Infusions in Palliative Care: A Quality Improvement Project To Enhance Patient Care and Medical Staff Safety in a Singaporean Hospital.

PubMed

Neo, Shirlyn Hui-Shan; Khemlani, Mansha Hari; Sim, Lai Kiow; Seah, Angeline Soek Tian

2016-03-01

A comparison of metal needles and plastic cannulae (winged and nonwinged) for continuous subcutaneous infusion was done during a quality improvement project to reduce device-induced complications at our hospital. Design, Setting, and Measurements: Data were collected on incidence of site reactions (bruising, swelling, erythema, and blisters); mechanical complications (kinking and dislodgement); device durability; type, and volume of medications; and incidence of needle-stick injuries. All infusion devices used for patients in the Palliative Care Service from February 3 to March 26, 2014 were studied. Devices examined were: winged metal needle (Venofix(®), 23G, B. Braun Melsungen AG, Melsungen, Germany), winged vialon cannula (BD Nexiva™, 24G, Becton Dickinson Infusion Therapy Systems Inc., Sandy, UT), and nonwinged polyurethane cannula (Introcan Safety(®), 24G, B. Braun Medical, Mundelein, IL). Thirty devices (10 per type) were used. Incidence of site reactions was 50.0%, 10.0%, and 0.0% for the metal needles, polyurethane cannulae, and vialon cannulae, respectively. Incidence of mechanical complications was 20.0% for the polyurethane cannulae and 0.0% for the metal needles and vialon cannulae. Duration of use was up to 60 hours, 83 hours, and 113 hours for the metal needles, polyurethane cannulae, and vialon cannulae, respectively. Daily volumes infused were up to 28.9 mL, 60.0 mL, and 29.4 mL for the metal needles, polyurethane cannulae, and vialon cannulae, respectively. No needle-stick injuries occurred. The winged vialon cannula was the most durable, with no site reactions or mechanical complications, tolerating a volume comparable to that of the metal needle. We suggest its utilization for continuous subcutaneous infusions and consideration of future randomized controlled trials with an integrated economic evaluation for further in-depth comparisons of subcutaneous indwelling devices.

Effect of cannula shape on aortic wall and flow turbulence: hydrodynamic study during extracorporeal circulation in mock thoracic aorta.

PubMed

Minakawa, Masahito; Fukuda, Ikuo; Yamazaki, Junichi; Fukui, Kozo; Yanaoka, Hideki; Inamura, Takao

2007-12-01

This study was designed to analyze flow pattern, velocity, and strain on the aortic wall of a glass aortic model during extracorporeal circulation, and to elucidate the characteristics of flow pattern in four aortic cannulas. Different patterns of large vortices and helical flow were made by each cannula. The high-velocity flow (0.6 m/s) was observed in end-hole cannula, causing high strain rate tensor (0.3~0.4 without unit) on the aortic arch. In dispersion cannula, a decreased strain rate tensor (less than 0.1) was found on the outer curvature of the aortic arch. In Soft-flow cannula (3M Cardiovascular, Ann Arbor, MI, USA), further decreased flow velocity (0.2 m/s) and strain (less than 0.2) were observed. In Select 3D cannula (Medtronic, Inc., Minneapolis, MN, USA), a high strain (0.4~0.5) was observed along the inner curvature of the aortic arch. In conclusion, end-hole cannula should not be used in atherosclerotic aorta. Particular attention should be paid both for selection of cannulas and cannulation site based on this result.

Bayes to the Rescue: Continuous Positive Airway Pressure Has Less Mortality Than High-Flow Oxygen.

PubMed

Modesto I Alapont, Vicent; Khemani, Robinder G; Medina, Alberto; Del Villar Guerra, Pablo; Molina Cambra, Alfred

2017-02-01

The merits of high-flow nasal cannula oxygen versus bubble continuous positive airway pressure are debated in children with pneumonia, with suggestions that randomized controlled trials are needed. In light of a previous randomized controlled trial showing a trend for lower mortality with bubble continuous positive airway pressure, we sought to determine the probability that a new randomized controlled trial would find high-flow nasal cannula oxygen superior to bubble continuous positive airway pressure through a "robust" Bayesian analysis. Sample data were extracted from the trial by Chisti et al, and requisite to "robust" Bayesian analysis, we specified three prior distributions to represent clinically meaningful assumptions. These priors (reference, pessimistic, and optimistic) were used to generate three scenarios to represent the range of possible hypotheses. 1) "Reference": we believe bubble continuous positive airway pressure and high-flow nasal cannula oxygen are equally effective with the same uninformative reference priors; 2) "Sceptic on high-flow nasal cannula oxygen": we believe that bubble continuous positive airway pressure is better than high-flow nasal cannula oxygen (bubble continuous positive airway pressure has an optimistic prior and high-flow nasal cannula oxygen has a pessimistic prior); and 3) "Enthusiastic on high-flow nasal cannula oxygen": we believe that high-flow nasal cannula oxygen is better than bubble continuous positive airway pressure (high-flow nasal cannula oxygen has an optimistic prior and bubble continuous positive airway pressure has a pessimistic prior). Finally, posterior empiric Bayesian distributions were obtained through 100,000 Markov Chain Monte Carlo simulations. In all three scenarios, there was a high probability for more death from high-flow nasal cannula oxygen compared with bubble continuous positive airway pressure (reference, 0.98; sceptic on high-flow nasal cannula oxygen, 0.982; enthusiastic on high-flow nasal cannula oxygen, 0.742). The posterior 95% credible interval on the difference in mortality identified a future randomized controlled trial would be extremely unlikely to find a mortality benefit for high-flow nasal cannula oxygen over bubble continuous positive airway pressure, regardless of the scenario. Interpreting these findings using the "range of practical equivalence" framework would recommend rejecting the hypothesis that high-flow nasal cannula oxygen is superior to bubble continuous positive airway pressure for these children. For children younger than 5 years with pneumonia, high-flow nasal cannula oxygen has higher mortality than bubble continuous positive airway pressure. A future randomized controlled trial in this population is unlikely to find high-flow nasal cannula oxygen superior to bubble continuous positive airway pressure.

Haemodialysis plastic cannulae - a possible alternative to traditional metal needles?

PubMed

Parisotto, Maria Teresa; Pelliccia, Francesco; Bedenbender-Stoll, Eva; Gallieni, Maurizio

2016-09-21

Haemodialysis plastic cannulae for arteriovenous fistulae (AVF) have been used for many years in Japan and recently this technique was introduced in Australia. Find answers to the following questions:What are the pros and cons of plastic cannulae versus traditional metal needles for AVF and arteriovenous graft (AVG)? Is the use of plastic cannulae instead of traditional metal needles an option for European dialysis units as well? If it is an option, for which patients should plastic cannulae be used? Literature search via PubMed and Google. Due to the characteristics of plastic cannulae, they seem to be well suited for restless patients, patients with unpredictable behaviour, children, and patients who are allergic to metal.However, the evidence base provided by studies on the use of cannulae is currently weak. More controlled randomised studies are needed.

21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Cardiopulmonary bypass vascular catheter, cannula... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to...

21 CFR 870.4210 - Cardiopulmonary bypass vascular catheter, cannula, or tubing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass vascular catheter, cannula... Devices § 870.4210 Cardiopulmonary bypass vascular catheter, cannula, or tubing. (a) Identification. A cardiopulmonary bypass vascular catheter, cannula, or tubing is a device used in cardiopulmonary surgery to...

21 CFR 868.5340 - Nasal oxygen cannula.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasal oxygen cannula. 868.5340 Section 868.5340...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5340 Nasal oxygen cannula. (a) Identification. A nasal oxygen cannula is a two-pronged device used to administer oxygen to a patient through...

21 CFR 868.5340 - Nasal oxygen cannula.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Nasal oxygen cannula. 868.5340 Section 868.5340...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5340 Nasal oxygen cannula. (a) Identification. A nasal oxygen cannula is a two-pronged device used to administer oxygen to a patient through...

21 CFR 868.5340 - Nasal oxygen cannula.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Nasal oxygen cannula. 868.5340 Section 868.5340...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5340 Nasal oxygen cannula. (a) Identification. A nasal oxygen cannula is a two-pronged device used to administer oxygen to a patient through...

21 CFR 868.5340 - Nasal oxygen cannula.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Nasal oxygen cannula. 868.5340 Section 868.5340...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5340 Nasal oxygen cannula. (a) Identification. A nasal oxygen cannula is a two-pronged device used to administer oxygen to a patient through...

21 CFR 868.5340 - Nasal oxygen cannula.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Nasal oxygen cannula. 868.5340 Section 868.5340...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5340 Nasal oxygen cannula. (a) Identification. A nasal oxygen cannula is a two-pronged device used to administer oxygen to a patient through...

Tracheostomy cannulas and voice prosthesis

PubMed Central

Kramp, Burkhard; Dommerich, Steffen

2011-01-01

Cannulas and voice prostheses are mechanical aids for patients who had to undergo tracheotomy or laryngectomy for different reasons. For better understanding of the function of those artificial devices, first the indications and particularities of the previous surgical intervention are described in the context of this review. Despite the established procedure of percutaneous dilatation tracheotomy e.g. in intensive care units, the application of epithelised tracheostomas has its own position, especially when airway obstruction is persistent (e.g. caused by traumata, inflammations, or tumors) and a longer artificial ventilation or special care of the patient are required. In order to keep the airways open after tracheotomy, tracheostomy cannulas of different materials with different functions are available. For each patient the most appropriate type of cannula must be found. Voice prostheses are meanwhile the device of choice for rapid and efficient voice rehabilitation after laryngectomy. Individual sizes and materials allow adaptation of the voice prostheses to the individual anatomical situation of the patients. The combined application of voice prostheses with HME (Head and Moisture Exchanger) allows a good vocal as well as pulmonary rehabilitation. Precondition for efficient voice prosthesis is the observation of certain surgical principles during laryngectomy. The duration of the prosthesis mainly depends on material properties and biofilms, mostly consisting of funguses and bacteries. The quality of voice with valve prosthesis is clearly superior to esophagus prosthesis or electro-laryngeal voice. Whenever possible, tracheostoma valves for free-hand speech should be applied. Physicians taking care of patients with speech prostheses after laryngectomy should know exactly what to do in case the device fails or gets lost. PMID:22073098

Tracheostomy cannulas and voice prosthesis.

PubMed

Kramp, Burkhard; Dommerich, Steffen

2009-01-01

Cannulas and voice prostheses are mechanical aids for patients who had to undergo tracheotomy or laryngectomy for different reasons. For better understanding of the function of those artificial devices, first the indications and particularities of the previous surgical intervention are described in the context of this review. Despite the established procedure of percutaneous dilatation tracheotomy e.g. in intensive care units, the application of epithelised tracheostomas has its own position, especially when airway obstruction is persistent (e.g. caused by traumata, inflammations, or tumors) and a longer artificial ventilation or special care of the patient are required. In order to keep the airways open after tracheotomy, tracheostomy cannulas of different materials with different functions are available. For each patient the most appropriate type of cannula must be found. Voice prostheses are meanwhile the device of choice for rapid and efficient voice rehabilitation after laryngectomy. Individual sizes and materials allow adaptation of the voice prostheses to the individual anatomical situation of the patients. The combined application of voice prostheses with HME (Head and Moisture Exchanger) allows a good vocal as well as pulmonary rehabilitation. Precondition for efficient voice prosthesis is the observation of certain surgical principles during laryngectomy. The duration of the prosthesis mainly depends on material properties and biofilms, mostly consisting of funguses and bacteries. The quality of voice with valve prosthesis is clearly superior to esophagus prosthesis or electro-laryngeal voice. Whenever possible, tracheostoma valves for free-hand speech should be applied. Physicians taking care of patients with speech prostheses after laryngectomy should know exactly what to do in case the device fails or gets lost.

Device specific analysis of neonatal aortic outflow cannula jet flows for improved cardiopulmonary bypass hemodynamics

NASA Astrophysics Data System (ADS)

Menon, Prahlad; Sotiropoulos, Fotis; Undar, Akif; Pekkan, Kerem

2011-11-01

Hemodynamically efficient aortic outflow cannulae can provide high blood volume flow rates at low exit force during extracorporeal circulation in pediatric or neonatal cardiopulmonary bypass repairs. Furthermore, optimal hemolytic aortic insertion configurations can significantly reduce risk of post-surgical neurological complications and developmental defects in the young patient. The methodology and results presented in this study serve as a baseline for design of superior aortic outflow cannulae based on a novel paradigm of characterizing jet-flows at different flow regimes. In-silico evaluations of multiple cannula tips were used to delineate baseline hemodynamic performance of the popular pediatric cannula tips in an experimental cuboidal test-rig, using PIV. High resolution CFD jet-flow simulations performed for various cannula tips in the cuboidal test-rig as well as in-vivo insertion configurations have suggested the existence of optimal surgically relevant characteristics such as cannula outflow angle and insertion depth for improved hemodynamic performance during surgery. Improved cannula tips were designed with internal flow-control features for decreased blood damage and increased permissible flow rates.

The Need of Slanted Side Holes for Venous Cannulae

PubMed Central

Park, Joong Yull

2012-01-01

Well-designed cannulae must allow good flow rate and minimize nonphysiologic load. Venous cannulae generally have side holes to prevent the rupture of blood vessel during perfusion. Optimizing side hole angle will yield more efficient and safe venous cannulae. A numerical modeling was used to study the effect of the angle (0°–45°) and number (0–12) of side holes on the performance of cannulae. By only slanting the side holes, it increases the flow rate up to 6% (in our models). In addition, it was found that increasing the number of side holes reduces the shear rate up to 12% (in our models). A new parameter called “penetration depth” was introduced to describe the interfering effect of stream jets from side holes, and the result showed that the 45°-slanted side holes caused minimum interfering for the flow in cannula. Our quantitative hemodynamic analysis study provides important guidelines for venous cannulae design. PMID:22291856

Systemic venous drainage: can we help Newton?

PubMed

Corno, Antonio F

2007-06-01

In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton.

In-line pressure within a HOTLINE® Fluid Warmer, under various flow conditions.

PubMed

Higashi, Midoriko; Yamaura, Ken; Matsubara, Yukie; Fukudome, Takuya; Hoka, Sumio

2015-04-01

Roller pump infusion devices are widely used for rapid infusion, and may be combined with separate warming devices. There may be instances however, where the pressures generated by the roller pump may not be compatible with the warming device. We assessed a commonly used roller pump in combination with a HOTLINE® Fluid Warmer, and found that it could generate pressures exceeding the HOTLINE® manufacturers specifications. This was of concern because the HOTLINE® manufacturer guideline states that not for use with pressure devices generating over 300 mmHg. Pressure greater than 300 mmHg may compromise the integrity of the HOTLINE® Fluid Warming Set. The aim of this study was to compare in-line pressure within a HOTLINE® Fluid Warmer at different infusion rates of a roller pump using various sizes of intravenous cannulae. The rapid infusion system comprised a 500 mL-normal saline bag, roller pump type infusion device, HOTLINE® Fluid Warmer (blood and fluid warmer system), and six different sizes of intravenous cannulae. In-line pressure was measured proximal to the HOTLINE® (pre-warmer) and proximal to the cannula (post-warmer), at flow rate of 50-160 mL/min. The in-line pressures increased significantly with increasing flow rate. The pre-warmer pressures exceeded 300 mmHg when the flow rate was ≥120 mL/min with 20-gauge, 48 mm length cannula, 130 with 20-gauge, 25 mm cannula, and 160 mL/min with 18-gauge, 48 mm cannula. However, they were <300 mmHg at any flow rates with 18-gauge, 30 mm cannula and 16-gauge cannulae. The post-warmer pressures exceeded 300 mmHg at the flow rate of 140 mL/min with 20-gauge, 48 mm cannula, and 160 mL/min with 20-gauge, 25 mm cannula, while they were <300 mmHg at any flow rates with 18 and 16-gauge cannulae. The in-line pressure within a HOTLINE® could exceed 300 mmHg, depending on the flow rate and size and length of cannula. It is important to pay attention to the size and length of cannulae and flow rate to keep the maximum in-line pressure<300 mmHg when a roller pump type infusion device is used.

Numerical simulation of blood flow in femoral perfusion: comparison between side-armed femoral artery perfusion and direct femoral artery perfusion.

PubMed

Kitamura, Shingo; Shirota, Minori; Fukuda, Wakako; Inamura, Takao; Fukuda, Ikuo

2016-12-01

Computational numerical analysis was performed to elucidate the flow dynamics of femoral artery perfusion. Numerical simulation of blood flow was performed from the right femoral artery in an aortic model. An incompressible Navier-Stokes equation and continuity equation were solved using computed flow dynamics software. Three different perfusion models were analyzed: a 4.0-mm cannula (outer diameter 15 French size), a 5.2-mm cannula (18 French size) and an 8-mm prosthetic graft. The cannula was inserted parallel to the femoral artery, while the graft was anastomosed perpendicular to the femoral artery. Shear stress was highest with the 4-mm cannula (172 Pa) followed by the graft (127 Pa) and the 5.2-mm cannula (99 Pa). The cannula exit velocity was high, even when the 5.2-mm cannula was used. Although side-armed perfusion with an 8-mm graft generated a high shear stress area near the point of anastomosis, flow velocity at the external iliac artery was decreased. The jet speed decreased due to the Coanda effect caused by the recirculation behind sudden expansion of diameter, and the flow velocity maintains a constant speed after the reattachment length of the flow. This study showed that iliac artery shear stress was lower with the 5.2-mm cannula than with the 4-mm cannula when used for femoral perfusion. Side-armed graft perfusion generates a high shear stress area around the anastomotic site, but flow velocity in the iliac artery is slower in the graft model than in the 5.2-mm cannula model.

Effects of Cone-Shaped Bend Inlet Cannulas of an Axial Blood Pump on Thrombus Formation: An Experiment and Simulation Study.

PubMed

Liu, Guangmao; Zhou, Jianye; Sun, Hansong; Zhang, Yan; Chen, Haibo; Hu, Shengshou

2017-04-05

BACKGROUND Cannula shape and connection style influence the risk of thrombus formation in the blood pump by varying the blood flow characteristics inside the pump. Inlet cannulas should be designed based on the need for anatomical fit and reducing the risk of thrombus generation in the blood pump. The effects on thrombus formation of the cone-shaped bend inlet cannulas of axial blood pumps should be studied. MATERIAL AND METHODS The cannulas were designed as cone-shaped, with 1 bent section connecting 2 straight sections. Both the silicone tube and novel cone-shaped cannula were simulated for comparison. The flow fields of a blood pump with inlet cannula were simulated by computational fluid dynamics (CFD) at flows of 2.0, 2.5, and 3.0 liters per minute (lpm), with pump rotational speeds of 7500, 8000, and 8500 rpm, respectively. Then, 6 two-dimensional (2D) particle image velocimetry (PIV) tests were conducted and the velocity distributions were analyzed. RESULTS A low-velocity region was located inside the pump entrance when a soft silicone tube was used. At 8500 rpm and 3.0 lpm working condition, the minimum velocity inside the pump with cone-shaped cannulas was 2.5×10^-1 m/s. The cone-shaped cannulas eliminated the low-velocity region inside the pump. Both CFD and PIV results showed that the low-velocity region did not spread to the entrance of the blood pump within the flow range from 2.0 lpm to 7.0 lpm. CONCLUSIONS The designed cone-shaped bent cannulas can eliminate the low-velocity region inside the blood pump and reduce the risk of thrombus formation in the blood pump.

Impact of High-flow Nasal Cannula Therapy in Quality Improvement and Clinical Outcomes in a Non-invasive Ventilation Device-free Pediatric Intensive Care Unit.

PubMed

Can, Fulva Kamit; Anil, Ayse Berna; Anil, Murat; Zengin, Neslihan; Bal, Alkan; Bicilioglu, Yuksel; Gokalp, Gamze; Durak, Fatih; Ince, Gulberat

2017-10-15

To analyze the change in quality indicators due to the use of high-flow nasal cannula therapy as a non-invasive ventilation method in children with respiratory distress/failure in a non-invasive ventilation device-free pediatric intensive care unit. Retrospective chart review of children with respiratory distress/failure admitted 1 year before (period before high-flow nasal cannula therapy) and 1 year after (period after high-flow nasal cannula therapy) the introduction of high-flow nasal cannula therapy. We compared quality indicators as rate of mechanical ventilation, total duration of mechanical ventilation, rate of re-intubation, pediatric intensive care unit length of stay, and mortality rate between these periods. Between November 2012 and November 2014, 272 patients: 141 before and 131 after high-flow nasal cannula therapy were reviewed (median age was 20.5 mo). Of the patients in the severe respiratory distress/failure subgroup, the rate of intubation was significantly lower in period after than in period before high-flow nasal cannula therapy group (58.1% vs. 76.1%; P <0.05). The median pediatric intensive care unit length of stay was significantly shorter in patients who did not require mechanical ventilation in the period after than in the period before high-flow nasal cannula therapy group (3d vs. 4d; P<0,05). Implementation of high-flow nasal cannula therapy in pediatric intensive care unit significantly improves the quality of therapy and its outcomes.

Increased risk of cardiovascular perforation during ECMO with a bicaval, wire-reinforced cannula.

PubMed

Johnson, Sidney M; Itoga, Nathan; Garnett, Gwendolyn M; Kilcommons, Melody; Puapong, Devin P; Woo, Russell K

2014-01-01

Cardiac or major vascular perforation is a rare but serious risk of ECMO. We sought to determine if perforation rates are related to cannula design. We utilized three methods to evaluate perforation on ECMO. 1. The ELSO registry was queried to establish the historical rate of hemorrhagic pericardial tamponade. 2. ELSO centers were surveyed regarding cannula related perforation events and brands of cannulas used over a four year time period (January 2008-March 2012). 3. The FDA's MAUDE database was reviewed looking for adverse events related to ECMO cannulas. The historical rate of hemorrhagic pericardial tamponade in the ELSO registry was 0.53% (~1985-2010, ELSO registry). In the survey there were eleven reports of cannula-related perforation, 0.74% (11/1482 p-value=0.29) at 7 different ELSO centers with 23 ELSO centers responding (17% response rate). The incidence of perforation was much higher for the wire-reinforced bicaval design 3.6% (10/279) as compared to catheters designed for the atrial position, 0.1% (1/1203, p-value<0.0001). Review of the FDA's MAUDE database revealed 19 adverse events related to the bicaval cannula design, 16 of which were hemorrhagic pericardial effusions or tamponade. These findings suggest a relatively high rate of cardiac perforation associated with the dual lumen bicaval cannula. This may be related to inherent differences in cannula design or the IVC positioning required by the design. © 2014.

Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves.

PubMed

Adam, Stewart I; Srinet, Prateek; Aronberg, Ryan M; Rosenberg, Graeme; Leder, Steven B

2015-01-01

To investigate physiologic parameters, voice production abilities, and functional verbal communication ratings of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves. Case series with planned data collection. Large, urban, tertiary care teaching hospital. Referred sample of 30 consecutively enrolled adults requiring a tracheotomy tube and tested with Blom and Passy-Muir valves. Physiologic parameters recorded were oxygen saturation, respiration rate, and heart rate. Voice production abilities included maximum voice intensity in relation to ambient room noise and maximum phonation duration of the vowel/a/. Functional verbal communication was determined from randomized and blinded listener ratings of counting 1-10, saying the days of the week, and reading aloud the sentence, "There is according to legend a boiling pot of gold at one end." There were no significant differences (p>0.05) between the Blom and Passy-Muir valves for the physiologic parameters of oxygen saturation, respiration rate, and heart rate; voice production abilities of both maximum intensity and duration of/a/; and functional verbal communication ratings. Both valves allowed for significantly greater maximum voice intensity over ambient room noise (p<0.001). The Blom low profile voice inner cannula and Passy-Muir one-way speaking valves exhibited equipoise regarding patient physiologic parameters, voice production abilities, and functional verbal communication ratings. Readers will understand the importance of verbal communication for patients who require a tracheotomy tube; will be able to determine the differences between the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves; and will be confident in knowing that both the Blom and Passy-Muir one-way tracheotomy tube speaking valves are equivalent regarding physiological functioning and speech production abilities. Copyright © 2015 Elsevier Inc. All rights reserved.

Hemodynamics on abrupt stoppage of centrifugal pumps during left ventricular assist.

PubMed

Kono, S; Nishimura, K; Nishina, T; Akamatsu, T; Komeda, M

2000-01-01

A magnetically suspended centrifugal pump (MSCP), developed for long-term ventricular assist, is reliable and durable because it has no shaft or seal. However, with nonvalve pumps such as a MSCP, regurgitation occurs when they accidentally stop without cannula clamping. We investigated the hemodynamics during temporary stoppage of a MSCP being used as a left ventricular assist system (LVAS), comparing two inflow cannulation sites. In four sheep (weight, 35-45 kg), microspheres were injected into the left main coronary artery to induce heart failure. An outflow cannula was sutured onto the descending aorta, and two inflow cannulae were inserted into the left atrium and the left ventricle. The MSCP was stopped with both the left ventricular cannula and left atrial cannula clamped, and the hemodynamics and P-V loops were recorded. Each cannula was then unclamped in order, and similar parameters were recorded. LVEDP increased at unclamping of the left ventricular cannula (ULVC), and rose further at unclamping of the left atrial cannula (ULAC). Aortic pressure did not change at ULVC, but decreased at ULAC. The effective systemic flow that subtracted the regurgitant flow through the MSCP from left ventricular output was half at ULVC and almost 0 at ULAC. When stopping centrifugal pumps without circuit clamping, hemodynamic deterioration is less at ULVC than at ULAC. This finding suggests that left ventricular inflow cannulation is recommended to allow more time in emergency situations.

[Application of right jugular vessels to build extracorporeal membrane oxygenation for treating the critically ill children].

PubMed

Yan, X G; Lu, Z J; Zheng, J C; Zhang, W W; Lu, G P; Jia, B

2016-07-01

To summarize the experience in applying a technique of inserting a cannula through right internal jugular vein and common carotid artery to build extracorporeal membrane oxygenation (ECMO) for critically ill children. The data of critically ill patients received ECMO support through right internal jugular vein and common carotid artery between December 2011 and December 2015 from Children's Hospital of Fudan University were analyzed retrospectively.The data included diagnosis, age, body weight, time of cannula and ECMO running, complication and prognosis. In total 28 patients received ECMO support, 3 patients of post-cardiac surgery with transthoracic cannula were excluded.Twenty-five patients inserted cannula through neck vessels were enrolled, 15 boys and 10 girls, the median age was 1.8 years (range, 1 d-13 years), the median weight was 12.0 (2.8-50.0) kg.All the cannula sites were right internal jugular vein and right common carotid artery, before cannula use 5 patients had been inserted central vein tube and 3 patients with blood filter tube in right internal jugular vein, in one case cannula was applied during cardiopulmonary resuscitation.V-A ECMO had been built for all the cases successfully, the median operation time was (45±26) min.The pump flow was 80-150 ml/(kg·min), the median duration of ECMO support was 153(14-567) h. Sixteen (64%) patients weaned off ECMO successfully, 15(60%) survived to hospital discharge.About the complication of cannula, six patients developed cannula site bleeding, and two patients required re-fixation of cannula, one patient's external jugular vein had been hurt and sutured for bleeding. Application of right jugular vessels to build ECMO is easy and safe for treating the sick children. The skill should be proficient to assure ECMO run and reduce the complications.

Measuring Intracranial Pressure and Correlation with Severity of Blast Traumatic Brain Injury

DTIC Science & Technology

2011-10-01

cannula was then filled with a sterile saline solution. The cannula cap was filled with petroleum jelly and a fiber optic pressure sensor (FOP-MIV, FISO...petroleum jelly and the fiber optic pressure sensor (FOP-MIV, Fiso Inc.) was inserted into the cannula and threaded onto the cannula pedestal. Figure 1b...neurological consequences of explosives. J. Neurol. Sci. 249:63–67, 2006. 9Henshall, B. Shock tube–versatile tool of aerodynamic research. J. Royal

21 CFR 882.4060 - Ventricular cannula.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ventricular cannula. 882.4060 Section 882.4060 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4060 Ventricular cannula. (a...

21 CFR 882.4060 - Ventricular cannula.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Ventricular cannula. 882.4060 Section 882.4060 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES NEUROLOGICAL DEVICES Neurological Surgical Devices § 882.4060 Ventricular cannula. (a...

21 CFR 870.1300 - Catheter cannula.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Catheter cannula. 870.1300 Section 870.1300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1300 Catheter cannula. (a...

21 CFR 870.1300 - Catheter cannula.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Catheter cannula. 870.1300 Section 870.1300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1300 Catheter cannula. (a...

Arterial cannula shape optimization by means of the rotational firefly algorithm

NASA Astrophysics Data System (ADS)

Tesch, K.; Kaczorowska, K.

2016-03-01

This article presents global optimization results of arterial cannula shapes by means of the newly modified firefly algorithm. The search for the optimal arterial cannula shape is necessary in order to minimize losses and prepare the flow that leaves the circulatory support system of a ventricle (i.e. blood pump) before it reaches the heart. A modification of the standard firefly algorithm, the so-called rotational firefly algorithm, is introduced. It is shown that the rotational firefly algorithm allows for better exploration of search spaces which results in faster convergence and better solutions in comparison with its standard version. This is particularly pronounced for smaller population sizes. Furthermore, it maintains greater diversity of populations for a longer time. A small population size and a low number of iterations are necessary to keep to a minimum the computational cost of the objective function of the problem, which comes from numerical solution of the nonlinear partial differential equations. Moreover, both versions of the firefly algorithm are compared to the state of the art, namely the differential evolution and covariance matrix adaptation evolution strategies.

Microinjector for blasocysts

DOEpatents

Remenyik, Carl J.; Woychik, Richard P.; Patek, David R.; Hawk, James A.; Turner, John C.

1999-01-01

An electromechanical device for driving the tip of a microinjection cannula, or needle, through the outer barrier of a blastocyst, cell, or cell nucleus for the injection of cells or other bioactive materials. Either a flexible frame or a ram moving within a base member is employed. Cannula motion is achieved by means of a piezoelectric stack and spring return system. The thrust motion over a predetermined microscopic distance is achieved without cannula setback prior to the thrust movement. Instead of specially prepared beveled and tipped needles, standard unimproved cannulas or needles can be used.

Microinjector for blasocysts

DOEpatents

Remenyik, C.J.; Woychik, R.P.; Patek, D.R.; Hawk, J.A.; Turner, J.C.

1999-03-02

An electromechanical device is disclosed for driving the tip of a microinjection cannula, or needle, through the outer barrier of a blastocyst, cell, or cell nucleus for the injection of cells or other bioactive materials. Either a flexible frame or a ram moving within a base member is employed. Cannula motion is achieved by means of a piezoelectric stack and spring return system. The thrust motion over a predetermined microscopic distance is achieved without cannula setback prior to the thrust movement. Instead of specially prepared beveled and tipped needles, standard unimproved cannulas or needles can be used. 6 figs.

Comparison of Olive Tipped and Conventional Steven's Cannula for Sub-Tenon Ophthalmic Anesthesia

PubMed Central

Al-Motowa, Saeed; Ahmad, Nauman; Khandekar, Rajiv; Zahoor, Abdul

2016-01-01

PURPOSE: To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery. METHODS: This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant. RESULTS: There were sixty patients in each group. The age between groups was not statistically different (P = 0.4). The body mass index was higher in the ST group compared to the OT group (P < 0.001). The akinesia score at 5 and 10 min did not differ between groups (P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups (P = 0.1 and P = 0.06, respectively). There were six patients with mild chemosis and redness in the OT group and 15 patients in the ST group. CONCLUSION: An OT cannula is equally effective as the conventional Steven's cannula for delivering STB anesthesia before cataract surgery. PMID:27994394

Comparison of Olive Tipped and Conventional Steven's Cannula for Sub-Tenon Ophthalmic Anesthesia.

PubMed

Al-Motowa, Saeed; Ahmad, Nauman; Khandekar, Rajiv; Zahoor, Abdul

2016-01-01

To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery. This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant. There were sixty patients in each group. The age between groups was not statistically different ( P = 0.4). The body mass index was higher in the ST group compared to the OT group ( P < 0.001). The akinesia score at 5 and 10 min did not differ between groups ( P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups ( P = 0.1 and P = 0.06, respectively). There were six patients with mild chemosis and redness in the OT group and 15 patients in the ST group. An OT cannula is equally effective as the conventional Steven's cannula for delivering STB anesthesia before cataract surgery.

Omasal sampling technique for assessing fermentative digestion in the forestomach of dairy cows.

PubMed

Huhtanen, P; Brotz, P G; Satter, L D

1997-05-01

A procedure allowing digesta sampling from the omasum via a ruminal cannula without repeated entry into the omasum was developed. The sampling system consisted of a device inserted into the omasum via the ruminal cannula, a tube connecting the device to the ruminal cannula, and a single compressor/vacuum pump. Eight cows given ad libitum access to a total mixed diet were used in a crossover design to evaluate the effects of the sampling system on digestive activity, animal performance, and animal behavior. Results indicated that the omasal sampling system has minimal effect on normal digestive and productive functions of high-producing dairy cows. Dry matter intake was reduced (24.0 vs 21.8 kg/d; P < .02) and seemed related more to the sampling procedures than to the device in the omasum. Observations of animal behavior indicated that cows with the sampling device were similar to control cows, although rumination and total chewing times were reduced slightly. The composition of digesta samples was biased toward an over-abundance of the liquid phase, but using a double-marker system to calculate digesta flow resulted in fairly small coefficients of variation for measurements of ruminal digestion variables. This technique may prove useful for partitioning digestion between the fermentative portion of the forestomach and the lower gastrointestinal tract. The omasal sampling procedure requires less surgical intervention than the traditional methods using abomasal or duodenal cannulas as sampling sites to study forestomach digestion and avoids potentially confounding endogenous secretions of the abomasum.

PaCO2 measurement in cerebral haemodynamics: face mask or nasal cannulae?

PubMed

Minhas, J S; Robinson, T; Panerai, R

2017-06-22

PaCO 2 affects cerebral blood flow (CBF) and its regulatory mechanisms, but the effects of CO 2 measurement technique on cerebrovascular parameters are unknown. In order to determine if the two most commonly used approaches, face mask (FM) or nasal cannulae (NC), are interchangeable or not, we tested the hypothesis that the use of FM versus NC does not lead to significant differences in CO 2 -related systemic and cerebrovascular parameters. Recordings of CBF velocity (CBFV), blood pressure (BP), heart rate, and end-tidal CO 2 (EtCO 2 ) were performed in 42 subjects during normocapnia (FM or NC) and 5% CO 2 inhalation (FM) or hyperventilation (NC). Dynamic cerebral autoregulation was assessed with the autoregulation index (ARI), derived by transfer function analysis from the CBFV response to a hypothetical step change in BP. Significant differences in physiological parameters were seen between FM and NC: EtCO 2 (37.40 versus 35.26 mmHg, p  =  0.001) and heart rate (69.6 versus 66.7 bpm, p  =  0.001) respectively. No differences were observed for mean BP, CBFV or the ARI index. Use of FM or NC for measurement of EtCO 2 leads to physiological changes and differences in parameter values that need to be taken into consideration when interpreting and/or comparing results in studies of cerebral haemodynamics.

Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up.

PubMed

Hirche, C; Senghaas, A; Fischer, S; Hollenbeck, S T; Kremer, T; Kneser, U

2016-02-01

Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis. In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire. No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14. The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

High flow through a nasal cannula and CPAP effect in a simulated infant model.

PubMed

Volsko, Teresa A; Fedor, Kathy; Amadei, Jason; Chatburn, Robert L

2011-12-01

Limited data are available to describe the CPAP effects that can be expected when using high flow with a traditional nasal cannula. To describe the relationship between the pressure generated at the airway opening and flow through a nasal cannula using a simulated infant model. We hypothesized that positive pressure generated by a standard cannula at flows > 2 L/min would be minimal and clinically unimportant. Nares were simulated with holes drilled in a plastic fixture. A nares template for CPAP prongs served as a sizing template for the holes. Small, medium, and large nares fixtures were constructed and connected to a lung simulator that simulated spontaneous breathing. Respiratory muscle pressure was simulated by setting a waveform and adjusting the amplitude to deliver a range of tidal volumes (V(T)) from 3 mL to 12 mL. Lung compliance and resistance were set at 0.5 mL/cm H(2)O and 125 cm H(2)O/L/s, respectively. Nasal cannulas were inserted in the model nares. We assured that the prong occlusion of the nares did not exceed 50%. Cannula flow was adjusted from 2-6 L/min in 1-L/min increments. Data were averaged over 20 breaths. Mean airway pressure and percent change in V(T) were recorded. The greatest effect on V(T) (mean ± SD 0.16 ± 0.10 mL) and pressure change (mean ± SD 0.7 ± 0.5 cm H(2)O) occurred with the premature cannula. The least effect on pressure (mean ± SD 0.3 ± 0.22 cm H(2)O) and V(T) change (mean ± SD 0.01 ± 0.02 mL) occurred with the infant cannula. Clinically important pressures were not generated by high flows with a standard nasal cannula. The differences in spontaneous V(T) across all flows were negligible.

[Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients].

PubMed

Castañeda Pascual, M; Batllori Gastón, M; Unzué Rico, P; Murillo Jaso, E; Dorronsoro Auzmendi, M; Martín Vizcaíno, M P

2013-03-01

In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Computational Fluid Dynamics Analysis of Thrombosis Potential In Left Ventricular Assist Device Drainage Cannulae

PubMed Central

Fraser, Katharine H; Zhang, Tao; Taskin, M Ertan; Griffith, Bartley P; Wu, Zhongjun J

2010-01-01

Cannulation is necessary when blood is removed from the body, for example in hemodialysis, cardiopulmonary bypass, blood oxygenators, and ventricular assist devices. Artificial blood contacting surfaces are prone to thrombosis, especially in the presence of stagnant or recirculating flow. In this work, computational fluid dynamics was used to investigate the blood flow fields in three clinically available cannulae (Medtronic DLP 12, 16 and 24 F), used as drainage for pediatric circulatory support, and to calculate parameters which may be indicative of thrombosis potential. The results show that using the 24 F cannula below flow rates of about 0.75 l/min produces hemodynamic conditions which may increase the risk of blood clotting within the cannula. No reasons are indicated for not using the 12 or 16 F cannulae with flow rates between 0.25 and 3.0 l/min. PMID:20400890

Endoscopic Evacuation of Basal Ganglia Hemorrhage via Keyhole Approach Using an Adjustable Cannula in Comparison with Craniotomy

PubMed Central

Zhang, Heng-Zhu; Li, Yu-Ping; Yan, Zheng-cun; Wang, Xing-dong; She, Lei; Wang, Xiao-dong; Dong, Lun

2014-01-01

Neuroendoscopic (NE) surgery as a minimal invasive treatment for basal ganglia hemorrhage is a promising approach. The present study aims to evaluate the efficacy and safety of NE approach using an adjustable cannula to treat basal ganglia hemorrhage. In this study, we analysed the clinical and radiographic outcomes between NE group (21 cases) and craniotomy group (30 cases). The results indicated that NE surgery might be an effective and safe approach for basal ganglia haemorrhage, and it is also suggested that NE approach may improve good functional recovery. However, NE approach only suits the selected patient, and the usefulness of NE approach needs further randomized controlled trials (RCTs) to evaluate. PMID:24949476

A Phase 1 Study of a Novel Bidirectional Perfusion Cannula in Patients Undergoing Femoral Cannulation for Cardiac Surgery.

PubMed

Marasco, Silvana F; Tutungi, Elli; Vallance, Shirley A; Udy, Andrew A; Negri, Justin C; Zimmet, Adam D; McGiffin, David C; Pellegrino, Vincent A; Moshinsky, Randall A

Leg ischemia is a serious complication of femoral artery cannulation. The primary aim of this study was to assess the safety and efficacy of a novel bidirectional femoral arterial cannula (Sorin Group USA, a wholly owned subsidiary of LivaNova PLC, Arvada, CO USA) that provides both antegrade and retrograde flow, in patients undergoing peripheral cannulation for cardiopulmonary bypass during cardiac surgery. Patients undergoing routine cardiac surgery requiring femoral artery cannulation for cardiopulmonary bypass were identified preoperatively. Informed written consent was obtained in all cases. Bidirectional cannula insertion used either a surgical cut-down and wire through needle approach or a percutaneous technique. Flow in the superficial femoral artery was assessed using Doppler ultrasound after commencement of cardiopulmonary bypass. Lower limb perfusion was assessed using reflectance near-infrared spectroscopy to measure regional oxygen saturations in the cannulated limb during cardiopulmonary bypass. Fifteen patients (median age = 61.3 years, range = 26-79 years, 10 males, 5 females) underwent femoral arterial cannulation using the novel bidirectional femoral cannula between August 2016 and May 2017. Fourteen cannulae were inserted directly into the femoral artery via a surgical cut-down and wire through needle technique. One bidirectional cannula was inserted using a percutaneous insertion technique. Indications included minimally invasive mitral and aortic valve surgery, thoracic aortic aneurysm repair, and redo cardiac surgery. The median duration of cardiopulmonary bypass was 129 minutes (range = 53-228 minutes). The cannula was inserted and positioned without difficulty in 14 of 15 patients. Incorrect sizing and arterial spasm prevented correct cannula positioning in one patient. Antegrade flow in the superficial femoral artery was observed on Doppler ultrasound in 12 of 12 patients in which this was performed. Continuous stable distal perfusion was demonstrated in the cannulated limb in 14 of 15 patients. No procedural complications occurred in the immediate or convalescent postoperative period. This study demonstrates that in patients undergoing femoral arterial cannulation for cardiopulmonary bypass during cardiac surgery, the use of a novel bidirectional cannula is safe and easy to insert and provides stable distal perfusion of the cannulated limb. Use of the device should largely obviate the need to insert a separate downstream perfusion cannula or use other techniques to protect against lower limb ischemia. Further research on a larger scale and in different patient populations is now warranted.

Fourth ventricular thyrotropin induces satiety and increases body temperature in rats.

PubMed

Smedh, Ulrika; Scott, Karen A; Moran, Timothy H

2018-05-01

Besides its well-known action to stimulate thyroid hormone release, thyrotropin mRNA is expressed within the brain, and thyrotropin and its receptor have been shown to be present in brain areas that control feeding and gastrointestinal function. Here, the hypothesis that thyrotropin acts on receptors in the hindbrain to alter food intake and/or gastric function was tested. Fourth ventricular injections of thyrotropin (0.06, 0.60, and 6.00 µg) were given to rats with chronic intracerebroventricular cannulas aimed at the fourth ventricle. Thyrotropin produced an acute reduction of sucrose intake (30 min). The highest dose of thyrotropin caused inhibition of overnight solid food intake (22 h). In contrast, subcutaneous administration of corresponding thyrotropin doses had no effect on nutrient intake. The highest effective dose of fourth ventricular thyrotropin (6 µg) did not produce a conditioned flavor avoidance in a standardized two-bottle test, nor did it affect water intake or gastric emptying of glucose. Thyrotropin injected in the fourth ventricle produced a small but significant increase in rectal temperature and lowered plasma levels of tri-iodothyronin but did not affect plasma levels of thyroxine. In addition, there was a tendency toward a reduction in blood glucose 2 h after fourth ventricular thyrotropin injection ( P = 0.056). In conclusion, fourth ventricular thyrotropin specifically inhibits food intake, increases core temperature, and lowers plasma levels of tri-iodothyronin but does not affect gastromotor function.

Effect of Vacuum on Venous Drainage: an Experimental Evaluation on Pediatric Venous Cannulas and Tubing Systems.

PubMed

Vida, V L; Bhattarai, A; Speggiorin, S; Zanella, F; Stellin, G

2014-01-01

To observe how vacuum assisted venous drainage (VAVD) may influence the flow in a cardiopulmonary bypass circuit with different size of venous lines and cannulas. The experimental circuit was assembled to represent the cardiopulmonary bypass circuit routinely used during cardiac surgery. Wall suction was applied directly, modulated and measured into the venous reservoir. The blood flow was measured with a flow-meter positioned on the venous line. The circuit prime volume was replaced with group O date expired re-suspended red cells and Plasmalyte 148 to a hematocrit of 28% to 30%. In an open circuit with gravity siphon venous drain, angled cannulae drain more than straight ones regardless the amount of suction applied to the venous line (16 Fr straight cannula (S) drains 90 ml/min less than a 16 Fr angled (A) with a siphon gravity). The same flow can be obtained with lower cannula size and higher suction (i.e. 12 A with and -30 mmHg). Tables have been created to list how the flow varies according to the size of the cannulas, the size of the venous tubes, and the amount of suction applied to the system. Vacuum assisted venous drainage allows the use of smaller cannulae and venous lines to maintain a good venous return, which is very useful during minimally invasive approaches. The present study should be considered as a preliminary attempt to create a scientific-based starting point for a uniform the use of VAVD.

Novel Technique for Rebubbling DMEK Grafts at the Slit Lamp Using Intravenous Extension Tubing.

PubMed

Sáles, Christopher S; Straiko, Michael D; Terry, Mark A

2016-04-01

To describe a novel technique for rebubbling DMEK grafts at the slit lamp using a cannula coupled to a syringe with intravenous (IV) extension tubing. We present a retrospective case series of eyes that underwent rebubbling using a novel technique at the slit lamp. The rebubbling apparatus is assembled using a standard 43-inch IV extension tube, a 5-cc luer lock syringe, and a 27-gauge cannula. The cannula is screwed onto one end of the extension tubing, and a 5-cc syringe that has been filled with air is screwed onto the opposite end. With the patient seated at the slit lamp, the cannula is positioned in the anterior chamber by the surgeon with one hand while the other hand operates the syringe and the joystick. We performed 5 rebubbling procedures at the slit lamp using a standard syringe and cannula. Despite suboptimal ergonomics with this approach, all of these cases achieved sufficient air fills without any complications. Four rebubbling procedures were subsequently performed at the slit lamp using our novel rebubbling technique. All of these cases also attained sufficient air fills without complications, but they were noted to be much easier to perform by the surgeon. Using IV extension tubing to couple a syringe to a cannula for rebubbling DMEK grafts at the slit lamp is ergonomically superior to the conventional alternative of using a standard cannula on a syringe. The technique is also simple and inexpensive to adopt.

Influence of Ileo-Caecal Cannulation and Oxytetracycline on Ileo-Caecal and Rectal Coliform Populations in Pigs

PubMed Central

Högberg, A; Lindberg, JE; Wallgren, P

2001-01-01

The effect of surgery (insertion of an ileo-caecal cannula) and a subsequent parenteral treatment with oxytetracycline on the ileo-caecal and rectal coliform populations in 7 Swedish Yorkshire castrates were studied. Samples were collected during surgery as well as 3, 7, 14 and 20 days post surgery. The diversity of the enteric coliform flora was initially high both in the ileo-caecal ostium and in rectum. No alteration in the diversity of the enteric coliform flora was observed following surgery and treatment with oxytetracycline. As the insertion of ileo-caecal cannulas did not affect the intestinal coliform flora this study gives support to the use of this technique to mirror processes in the small intestine of pigs. Further, the diversity of the enteric coliform flora was unaffected by the parenteral treatment with oxytetracycline. PMID:11957371

Vitreoretinal surgery without schisis cavity excision for the management of juvenile X linked retinoschisis.

PubMed

García-Arumí, J; Corcóstegui, I A; Navarro, R; Zapata, M A; Berrocal, M H

2008-11-01

Juvenile X linked retinoschisis (XLRS) is a congenital X linked recessive retinal disorder characterised by cystic maculopathy and peripheral schisis. This study presents the case of an 8-month-old boy with a documented positive family history of XLRS, with a large retinoschisis cavity affecting the macula, first in the left eye and 1 year later in the right eye. The patient underwent pars plana vitrectomy in both eyes using 23-G instruments, posterior hyaloid dissection, a small retinotomy, fluid drainage with a 42-G cannula, infrared diode laser and silicone oil as internal tamponade. The anatomical and functional outcomes at 3 years following the first surgery are described. To the authors' knowledge, there is no previously reported experience with this technique in patients with XLRS.

Spectral analysis of airflow sounds in patent versus occluded tracheostomy tubes: a pilot study in tracheostomized adult patients.

PubMed

Rao, A J; Niwa, H; Watanabe, Y; Fukuta, S; Yanagita, N

1990-05-01

Cannula occlusion is a life-threatening postoperative complication of tracheostomy. Current management largely relies on nursing care for prevention of fatalities because no proven mechanical, machine-based support monitoring exists. The objective of this paper was to address the problem of monitoring the state of cannula patency, based on analysis of airflow acoustic spectral patterns in tracheostomized adult patients in the patent and partially occluded cannula. Tracheal airflow sounds were picked up via a condenser microphone air-coupled to the skin just below the tracheal stoma. Signal output from Mic was amplified, high-pass filtered, digital tape-recorded, and analyzed on a mainframe computer. Although airflow frequencies for patient cannulae were predominantly low-pitched (0.1 to 0.3 kHz), occluded tubes had discrete high-pitched spectral peaks (1.3 to 1.6 kHz). These results suggest that frequency analysis of airflow sounds can identify a change in the status of cannula patency.

Removal of ruminal contents followed by restricted feeding does not affect the frequency of luteinizing-hormone pulses in steers

USDA-ARS?s Scientific Manuscript database

The objective of this study was to determine the effects of removal of ruminal contents and reduced nutrient intake on concentrations of LH in serum of beef cattle. Gonadectomized, male, Angus x Hereford cattle (steers, 402 ± 17 kg) with rumen cannulae were randomly assigned to treatment. Control (C...

Performance increase in venous drainage for mini-invasive heart surgery: superiority of self-expanding cannulas.

PubMed

Belkoniene, Mhedi; Abdel-Sayed, Saad; Favre, Julien; von Segesser, Ludwig-Karl

2014-01-01

Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices. To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used. Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, -5.4, -15.9, -45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula. Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.

Cyclodialysis cleft with late hypotony maculopathy after inadvertent cannula detachment during cataract surgery.

PubMed

Kahawita, Shyalle; Cugati, Sudha; Casson, Robert

2015-05-01

We present the case of a 69-year-old woman who presented with hypotony several years after an inadvertent cannula detachment presumably formed a cyclodialysis cleft during phacoemulsification cataract extraction and posterior chamber intraocular lens implantation in her right eye. To our knowledge, this is the first report of late hypotony maculopathy as a result of inadvertent cannula release. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Factors influencing delivered mean airway pressure during nasal CPAP with the RAM cannula.

PubMed

Gerdes, Jeffrey S; Sivieri, Emidio M; Abbasi, Soraya

2016-01-01

To measure mean airway pressure (MAP) delivered through the RAM Cannula® when used with a ventilator in CPAP mode as a function of percent nares occlusion in a simulated nasal interface/test lung model and to compare the results to MAPs using a nasal continuous positive airway pressure (NCPAP) interface with nares fully occluded. An artificial airway model was connected to a spontaneous breathing lung model in which MAP was measured at set NCPAP levels between 4 and 8 cmH2 O provided by a Dräger Evita XL® ventilator and delivered through three sizes of RAM cannulae. Measurements were performed with varying leakage at the nasal interface by decreasing occlusion from 100% to 29%, half-way prong insertion, and simulated mouth leakage. Comparison measurements were made using the Dräger BabyFlow® NCPAP interface with a full nasal seal. With simulated mouth closed, the Dräger interface delivered MAPs within 0.5 cmH2 O of set CPAP levels. For the RAM cannula, with 60-80% nares occlusion, overall delivered MAPs were 60 ± 17% less than set CPAP levels (P < 0.001). Further, MAP decreased progressively with decreasing percent nares occlusion. The simulated open mouth condition resulted in significantly lower MAPs to <1.7 cmH2 O. The one-half prong insertion depth condition, with closed mouth, yielded MAPs approximately 35 ± 9% less than full insertion pressures (P < 0.001). In our bench tests, the RAM interface connected to a ventilator in NCPAP mode failed to deliver set CPAP levels when applied using the manufacturer recommended 60-80% nares occlusion, even with closed mouth and full nasal prong insertion conditions. © 2015 Wiley Periodicals, Inc.

A compliant, banded outflow cannula for decreased afterload sensitivity of rotary right ventricular assist devices.

PubMed

Gregory, Shaun D; Schummy, Emma; Pearcy, Mark; Pauls, Jo P; Tansley, Geoff; Fraser, John F; Timms, Daniel

2015-02-01

Biventricular support with dual rotary ventricular assist devices (VADs) has been implemented clinically with restriction of the right VAD (RVAD) outflow cannula to artificially increase afterload and, therefore, operate within recommended design speed ranges. However, the low preload and high afterload sensitivity of these devices increase the susceptibility of suction events. Active control systems are prone to sensor drift or inaccurate inferred (sensor-less) data, therefore an alternative solution may be of benefit. This study presents the in vitro evaluation of a compliant outflow cannula designed to passively decrease the afterload sensitivity of rotary RVADs and minimize left-sided suction events. A one-way fluid-structure interaction model was initially used to produce a design with suitable flow dynamics and radial deformation. The resultant geometry was cast with different initial cross-sectional restrictions and concentrations of a softening diluent before evaluation in a mock circulation loop. Pulmonary vascular resistance (PVR) was increased from 50 dyne s/cm(5) until left-sided suction events occurred with each compliant cannula and a rigid, 4.5 mm diameter outflow cannula for comparison. Early suction events (PVR ∼ 300 dyne s/cm(5) ) were observed with the rigid outflow cannula. Addition of the compliant section with an initial 3 mm diameter restriction and 10% diluent expanded the outflow restriction as PVR increased, thus increasing RVAD flow rate and preventing left-sided suction events at PVR levels beyond 1000 dyne s/cm(5) . Therefore, the compliant, restricted outflow cannula provided a passive control system to assist in the prevention of suction events with rotary biventricular support while maintaining pump speeds within normal ranges of operation. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Tracheostomy Tube Type and Inner Cannula Selection Impact Pressure and Resistance to Air Flow.

PubMed

Pryor, Lee N; Baldwin, Claire E; Ward, Elizabeth C; Cornwell, Petrea L; O'Connor, Stephanie N; Chapman, Marianne J; Bersten, Andrew D

2016-05-01

Advancements in tracheostomy tube design now provide clinicians with a range of options to facilitate communication for individuals receiving ventilator assistance through a cuffed tube. Little is known about the impact of these modern design features on resistance to air flow. We undertook a bench model test to measure pressure-flow characteristics and resistance of a range of tubes of similar outer diameter, including those enabling subglottic suction and speech. A constant inspiratory ± expiratory air flow was generated at increasing flows up to 150 L/min through each tube (with or without optional, mandatory, or interchangeable inner cannula). Driving pressures were measured, and resistance was calculated (cm H2O/L/s). Pressures changed with increasing flow (P < .001) and tube type (P < .001), with differing patterns of pressure change according to the type of tube (P < .001) and direction of air flow. The single-lumen reference tube encountered the lowest inspiratory and expiratory pressures compared with all double-lumen tubes (P < .001); placement of an optional inner cannula increased bidirectional tube resistance by a factor of 3. For a tube with interchangeable inner cannulas, the type of cannula altered pressure and resistance differently (P < .001); the speech cannula in particular amplified pressure-flow changes and increased tube resistance by more than a factor of 4. Tracheostomy tube type and inner cannula selection imposed differing pressures and resistance to air flow during inspiration and expiration. These differences may be important when selecting airway equipment or when setting parameters for monitoring, particularly for patients receiving supported ventilation or during the weaning process. Copyright © 2016 by Daedalus Enterprises.

Subdermal liposuction.

PubMed

Gasperoni, C; Salgarello, M; Emiliozzi, P; Gargani, G

1990-01-01

Liposuction is a widely used technique today and indications are that it is becoming even more popular due to new technical refinements. The use of cannulae with a smaller diameter allows suction of the fat immediately under the dermis. The cannula we use to perform this new kind of fat suction is straight and has an external diameter of less than 2 mm. This cannula, the so-called Mercedes cannula, has a bullet tip and a three-hole head. Moreover, the holes are not round but are slit-shaped and oriented in the same plane at 120 degrees. This cannula is specifically designed to produce less trauma. The cannula with one downward-facing orifice is not suitable for suction of the subdermal layer and an upward-facing orifice would be too traumatic. The advantage of this new technique, apart from the possibility of treating patients with very slight adiposity, is to allow an effective skin retraction. When a large amount of fat has already been aspirated, residual deformities can occur. These skin irregularities represent the lack of an effective cutaneous retraction mostly due to the permanence of the subdermal fat. In fact, the presence of a thick subdermal adipose layer decreases the possibility of skin retraction. Therefore, indications for liposuction of the subdermal fat are mainly the slight adiposities and the remnant deformities of a previous liposuction operation. Moreover, this technique is applied to every lipoplasty whenever better skin retraction is needed.

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the female genital organs. This generic type of device may include trocar and cannula, instruments... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula...

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the female genital organs. This generic type of device may include trocar and cannula, instruments... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula...

The effect of a cannula milk sampling technique on the microbiological diagnosis of bovine mastitis.

PubMed

Friman, M; Hiitiö, H; Niemi, M; Holopainen, J; Pyörälä, S; Simojoki, H

2017-08-01

Two methods of collecting milk samples from mastitic bovine mammary quarters were compared. Samples were taken in a consistent order in which standard aseptic technique sampling was done first, followed by insertion of a sterile cannula through the teat canal and collection of a second sample. Microbiological results of those two sampling techniques were compared. Milk samples were analysed using multiplex real-time polymerase chain reaction (PCR). The cannula technique produced a reduced number of microbial species or groups of species per sample compared with conventional sampling. Staphylococcus spp. were the most common species identified and were detected more often during conventional sampling than with cannula sampling. Staphylococcus spp. identified in milk samples could also have originated from the teat canal without being present in the milk. The number of samples positive for Trueperella pyogenes or yeasts in the conventional samples was twice as high as in the cannula samples, indicating that the presence of Trueperella pyogenes and yeast species should not necessarily be interpreted as being the causative agents of bovine intra-mammary infections (IMI). Copyright © 2017 Elsevier Ltd. All rights reserved.

Clostridium perfringens gas gangrene at a wrist intravenous line insertion.

PubMed

Determann, Catherine; Walker, Craig Andrew

2013-10-09

A patient admitted to the intensive care unit for management of hypotension following a multiple medications overdose subsequently deteriorated rapidly with sepsis. A cannula site was noted to be bruised, swollen and erythematous and the X-ray demonstrated gas sitting within the tissues surrounding the metacarpal bones. The patient was referred to the orthopaedic surgeons and quickly taken for debridement of the affected area and fasciotomies of the forearm. Microbiological investigation confirmed Clostridium perfringens to be present in multiple fluid samples taken from the affected site.

Differential impact of flow and mouth leak on oropharyngeal humidification during high-flow nasal cannula: a neonatal bench study.

PubMed

Ullrich, Tim Leon; Czernik, Christoph; Bührer, Christoph; Schmalisch, Gerd; Fischer, Hendrik Stefan

2018-06-01

Heated humidification is paramount during neonatal high-flow nasal cannula (HFNC) therapy. However, there is little knowledge about the influence of flow rate and mouth leak on oropharyngeal humidification and temperature. The effect of the Optiflow HFNC on oropharyngeal gas conditioning was investigated at flow rates of 4, 6 and 8 L min -1 with and without mouth leak in a bench model simulating physiological oropharyngeal air conditions during spontaneous breathing. Temperature and absolute humidity (AH) were measured using a digital thermo-hygrosensor. Without mouth leak, oropharyngeal temperature and AH increased significantly with increasing flow (P < 0.001). Mouth leak did not affect this increase up to 6 L min -1 , but at 8 L min -1 , temperature and AH plateaued, and the effect of mouth leak became statistically significant (P < 0.001). Mouth leak during HFNC had a negative impact on oropharyngeal gas conditioning when high flows were applied. However, temperature and AH always remained clinically acceptable.

Improving practice using action research: resolving the problem of kinking with non-metal cannulae.

PubMed

Griffith, Sue

2011-11-01

In one UK hospice, inpatient unit records showed that over 8 years 12 needlestick injuries related to continuous subcutaneous infusion of medication occurred. Following a change-over to Teflon cannulae no further incidents were reported. However, when the more sensitive and accurate McKinley T34 syringe drivers were introduced in 2007 a new problem of recurrent occlusion alarm sounding manifested. Investigation revealed that the Teflon cannulae were often kinking, delaying medication delivery and necessitating re-siting of the cannula. The action research approach was used to find an alternative device to improve practice and ensure that both staff and patients were safeguarded. This paper explains how that process was followed until a satisfactory alternative was sourced and evidenced, including an account of the problems that were experienced along the way.

Strategies for preventing peripheral intravenous cannula infection.

PubMed

Morris, Wendy; Heong Tay, Mooi

Peripheral intravenous (IV) cannulation is a procedure that involves breaching the integrity of the skin, exposing patients to the risk of infection. Acquisition of infection has associated costs both for patients and the NHS. The high number of peripheral IV cannulae (PICs) inserted annually has resulted in serious infection and significant morbidity (O'Grady et al, 2002). Risks associated with PIC infection must be addressed to reduce patient morbidity and increased cost of prolonged hospital admission and treatment. This article discusses the sources and routes of infection associated with peripheral IV cannulation, and examines healthcare management strategies for preventing infection when performing peripheral cannulation. These comprise: the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation skills and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, designed to promote infection prevention strategies directly related to cannula care and aimed at all levels of Trust staff; and the Peripheral Cannula Care Plan, which ensures accurate documentation of cannulation procedures. This last strategy is simple to use and provides a route for improving cannula-related documentation. A high standard of documentation will also assist audit, which is crucial to reducing PIC infection.

Trypan blue staining of the anterior capsule under an air bubble with a modified cannula.

PubMed

Toprak, Ahmet Baris; Erkin, Esin Fatma; Guler, Cenap

2003-01-01

To attain good visibility of the anterior capsule in the advanced or white cataract, trypan blue 0.1% is used to stain the anterior capsule. The dye is usually injected under an air bubble. However, it is difficult to inject the dye properly due to capillary forces. An ordinary anterior chamber cannula was modified and its coverage area increased to facilitate the staining of the anterior capsule under an air bubble. The anterior capsule was stained properly by using the modified cannula in all of the cases.

An evaluation of 2 new devices for nasal high-flow gas therapy.

PubMed

Waugh, Jonathan B; Granger, Wesley M

2004-08-01

The traditional nasal cannula with bubble humidifier is limited to a maximum flow of 6 L/min to minimize the risk of complications. We conducted a bench study of 2 new Food and Drug Administration-approved nasal cannula/humidifier products designed to deliver at flows> 6 L/min. Using a digital psychrometer we measured the relative humidity and temperature of delivered gas from each device, at 5 L/min increments over the specified functional high-flow range. The Salter Labs unit achieved 72.5-78.7% relative humidity (5-15 L/min range) at ambient temperature (21-23 degrees C). The Vapotherm device achieved 99.9% relative humidity at a temperature setting of 37 degrees C (5-40 L/min). Both devices meet minimum humidification standards and offer practical new treatment options. The patient-selection criteria are primarily the severity of the patient's condition and cost.

Cannula Implantation into the Cisterna Magna of Rodents.

PubMed

Xavier, Anna L R; Hauglund, Natalie Linea; von Holstein-Rathlou, Stephanie; Li, Qianliang; Sanggaard, Simon; Lou, Nanhong; Lundgaard, Iben; Nedergaard, Maiken

2018-05-23

Cisterna magna cannulation (CMc) is a straightforward procedure that enables direct access to the cerebrospinal fluid (CSF) without operative damage to the skull or the brain parenchyma. In anesthetized rodents, the exposure of the dura mater by blunt dissection of the neck muscles allows the insertion of a cannula into the cisterna magna (CM). The cannula, composed either by a fine beveled needle or borosilicate capillary, is attached via a polyethylene (PE) tube to a syringe. Using a syringe pump, molecules can then be injected at controlled rates directly into the CM, which is continuous with the subarachnoid space. From the subarachnoid space, we can trace CSF fluxes by convective flow into the perivascular space around penetrating arterioles, where solute exchange with the interstitial fluid (ISF) occurs. CMc can be performed for acute injections immediately following the surgery, or for chronic implantation, with later injection in anesthetized or awake, freely moving rodents. Quantitation of tracer distribution in the brain parenchyma can be performed by epifluorescence, 2-photon microscopy, and magnetic resonance imaging (MRI), depending on the physico-chemical properties of the injected molecules. Thus, CMc in conjunction with various imaging techniques offers a powerful tool for assessment of the glymphatic system and CSF dynamics and function. Furthermore, CMc can be utilized as a conduit for fast, brain-wide delivery of signaling molecules and metabolic substrates that could not otherwise cross the blood brain barrier (BBB).

Allergic contact dermatitis to epoxy resin in a hemodialysis cannula.

PubMed

Ng, P P; Leow, Y H; Ng, S K; Goh, C L

1998-03-01

A patient with chronic renal failure on hemodialysis presented with dermatitis, particularly over the arteriovenous fistulae sites on the forearm. Patch testing revealed a positive reaction to epoxy resin present in the glue that fixed the needle of the hemodialysis cannula.

Aspiration and methylprednisolone injection to the cavity with IV cannula needle in the treatment of volar wrist ganglia: New technique

PubMed Central

Korkmaz, Murat; Ozturk, Hayati; Amanvermez Senarslan, Dilsad; Erdogan, Yalcin

2013-01-01

Objective: There are several types of treatment modalities for wrist ganglions. The aim of the study was to assess the effectiveness of cyst aspiration and methyl prednisolone acetate injection with double IV cannula rather than sharp pointed needle, as a new technique in the treatment of volar ganglia. Methodology: The study involves total of 19 patients who received treatment by aspiration and methyl prednisolone injection into the cavity. Two IV cannulas are pricked to the cystic cavity. Cyst fluid is drained by the distally placed IV cannula meanwhile injecting methyl prednisolone by proximally placed IV cannula. The patient records and follow-up reports are retrospectively investigated. The patient age, sex, site of the cyst, the treatment that was applied, adjacency to the artery and the nerves and recurrence are recorded. Mean follow up time was 2.1±0.5 years. Results: The study involved 19 patients that received aspiration treatment for volar ganglion cysts between January 2004 and December 2009. There were 12 (63.2%) female and 7 (36.8%) male subject with volar wrist ganglion cyst. The mean age of patients was 27.63±6.6 years. Fourteen (73.7%) patients of total had cysts close to the artery. We didn’t observe any complication related to methyl prednisolone injection and arterial ischemia. Recurrence was observed in three (15.8%) patients. Conclusion: This method has lower recurrence rate than other aspiration therapy with sharp pointed needle. We prefer to use IV cannula needle for cyst aspiration and steroid injection in treatment of volar ganglia before any surgical intervention. PMID:24353517

Frameless multimodal image guidance of localized convection-enhanced delivery of therapeutics in the brain

PubMed Central

van der Bom, Imramsjah M J; Moser, Richard P; Gao, Guanping; Sena-Esteves, Miguel; Aronin, Neil

2013-01-01

Introduction Convection-enhanced delivery (CED) has been shown to be an effective method of administering macromolecular compounds into the brain that are unable to cross the blood-brain barrier. Because the administration is highly localized, accurate cannula placement by minimally invasive surgery is an important requisite. This paper reports on the use of an angiographic c-arm system which enables truly frameless multimodal image guidance during CED surgery. Methods A microcannula was placed into the striatum of five sheep under real-time fluoroscopic guidance using imaging data previously acquired by cone beam computed tomography (CBCT) and MRI, enabling three-dimensional navigation. After introduction of the cannula, high resolution CBCT was performed and registered with MRI to confirm the position of the cannula tip and to make adjustments as necessary. Adeno-associated viral vector-10, designed to deliver small-hairpin micro RNA (shRNAmir), was mixed with 2.0 mM gadolinium (Gd) and infused at a rate of 3 μl/min for a total of 100 μl. Upon completion, the animals were transferred to an MR scanner to assess the approximate distribution by measuring the volume of spread of Gd. Results The cannula was successfully introduced under multimodal image guidance. High resolution CBCT enabled validation of the cannula position and Gd-enhanced MRI after CED confirmed localized administration of the therapy. Conclusion A microcannula for CED was introduced into the striatum of five sheep under multimodal image guidance. The non-alloy 300 μm diameter cannula tip was well visualized using CBCT, enabling confirmation of the position of the end of the tip in the area of interest. PMID:22193239

Humidification of inspired oxygen is increased with pre-nasal cannula, compared to intranasal cannula.

PubMed

Dellweg, Dominic; Wenze, Markus; Hoehn, Ekkehard; Bourgund, Olaf; Haidl, Peter

2013-08-01

Oxygen therapy is usually combined with a humidification device, to prevent mucosal dryness. Depending on the cannula design, oxygen can be administered pre- or intra-nasally (administration of oxygen in front of the nasal ostia vs cannula system inside the nasal vestibulum). The impact of cannula design on intra-nasal humidity, however, has not been investigated to date. First, to develop a system, that samples air from the nasal cavity and analyzes the humidity of these samples. Second, to investigate nasal humidity during pre-nasal and intra-nasal oxygen application, with and without humidification. We first developed and validated a sampling and analysis system to measure humidity from air samples. By means of this system we measured inspiratory air samples from 12 subjects who received nasal oxygen with an intra-nasal and pre-nasal cannula at different flows, with and without humidification. The sampling and analysis system showed good correlation to a standard hygrometer within the tested humidity range (r = 0.99, P < .001). In our subjects intranasal humidity dropped significantly, from 40.3 ± 8.7% to 35.3 ± 5.8%, 32 ± 5.6%, and 29.0 ± 6.8% at flows of 1, 2, and 3 L, respectively, when oxygen was given intra-nasally without humidification (P = .001, P < .001, and P < .001, respectively). We observed no significant change in airway humidity when oxygen was given pre-nasally without humidification. With the addition of humidification we observed no significant change in humidity at any flow, and independent of pre- or intranasal oxygen administration. Pre-nasal administration of dry oxygen achieves levels of intranasal humidity similar to those achieved by intranasal administration in combination with a bubble through humidifier. Pre-nasal oxygen simplifies application and may reduce therapy cost.

Postprandial lymphatic pump function after a high-fat meal: a characterization of contractility, flow, and viscosity

PubMed Central

Kassis, Timothy; Yarlagadda, Sri Charan; Kohan, Alison B.; Tso, Patrick; Breedveld, Victor

2016-01-01

Dietary lipids are transported from the intestine through contractile lymphatics. Chronic lipid loads can adversely affect lymphatic function. However, the acute lymphatic pump response in the mesentery to a postprandial lipid meal has gone unexplored. In this study, we used the rat mesenteric collecting vessel as an in vivo model to quantify the effect of lipoproteins on vessel function. Lipid load was continuously monitored by using the intensity of a fluorescent fatty-acid analog, which we infused along with a fat emulsion through a duodenal cannula. The vessel contractility was simultaneously quantified. We demonstrated for the first time that collecting lymphatic vessels respond to an acute lipid load by reducing pump function. High lipid levels decreased contraction frequency and amplitude. We also showed a strong tonic response through a reduction in the end-diastolic and systolic diameters. We further characterized the changes in flow rate and viscosity and showed that both increase postprandially. In addition, shear-mediated Ca2+ signaling in lymphatic endothelial cells differed when cultured with lipoproteins. Together these results show that the in vivo response could be both shear and lipid mediated and provide the first evidence that high postprandial lipid has an immediate negative effect on lymphatic function even in the acute setting. PMID:26968208

Liposuction cannula device and method

DOEpatents

Weber, Paul J.; Visuri, Steven R.; Everett, Matthew J.; Da Silva, Luiz B.; Kolster, Alwin H.

2003-10-28

A liposuction apparatus and method optionally having a sonic or ultrasonic source with an axial lumen passage in which the shaft can be made to reciprocate (oscillate) in a non-rectilinear fashion. The apparatus may also contain the concomitant use of rectilinear reciprocation motion in addition to ultrasonic motion or energy along the shaft of the apparatus. The advantages of the liposuction apparatus are as follows: 1) non-rectilinear single shaft reciprocating cannula, 2) sonic or ultrasonic energy delivered to the distal tip, 3) rectilinear reciprocating cannula with ultrasonic energy along the shaft from the handle, and 4) any of the above reciprocating components powered by excess unused vacuum capacity in the liposuction aspirator (suction engine) apparatus. There are three (3) primary sources of energy applied to the cannula shaft: the first is the oscillating surgeon's arm motion (approximately 1-2 hertz); the reciprocating motion (of about 100 Hz); and the optional concomitant motion as delivered by the ultrasonic energy (e.g. 25 KHz).

Liposuction Cannula Device And Method

DOEpatents

Weber, Paul J.; Visuri, Steven R.; Everett, Matthew J.; Da Silva, Luiz B.; Kolster, Alwin H.

2005-04-05

A liposuction apparatus and method optionally having a sonic or ultrasonic source with an axial lumen passage in which the shaft can be made to reciprocate (oscillate) in a non-rectilinear fashion. The apparatus may also contain the concomitant use of rectilinear reciprocation motion in addition to ultrasonic motion or energy along the shaft of the apparatus. The advantages of the liposuction apparatus are as follows: 1) non-rectilinear single shaft reciprocating cannula, 2) sonic or ultrasonic energy delivered to the distal tip, 3) rectilinear reciprocating cannula with ultrasonic energy along the shaft from the handle, and 4) any of the above reciprocating components powered by excess unused vacuum capacity in the liposuction aspirator (suction engine) apparatus. There are three (3) primary sources of energy applied to the cannula shaft: the first is the oscillating surgeon's arm motion (approximately 1-2 hertz); the reciprocating motion (of about 100 Hz); and the optional concomitant motion as delivered by the ultrasonic energy (e.g. 25 KHz).

A survey of the use of ultrasound guidance in internal jugular venous cannulation.

PubMed

McGrattan, T; Duffty, J; Green, J S; O'Donnell, N

2008-11-01

It has been that suggested the use of two dimensional (2D) ultrasound to facilitate placement of central venous cannulae in the internal jugular vein improves patient safety and reduces complications. Since the introduction of the National Institute for Clinical Excellence Technology Appraisal Guideline Number 49 in 2002, promoting the use of ultrasound in placement of internal jugular venous cannulae, utilisation of ultrasound has increased throughout the United Kingdom. We report the findings of a postal survey of 2000 senior anaesthetists in the United Kingdom which enquired about their use of ultrasound for internal jugular vein cannulae placement. Only 27% use 2D ultrasound as their first choice technique, although 35% use it as their first choice when teaching. There was no significant difference in practice between those working within a sub specialty in anaesthesia. There continues to be discrepancies between the application of the guideline and how senior anaesthetists both site and teach the placement of internal jugular vein central venous cannulae.

The impact of using different doses of progesterone on memory performance.

PubMed

Roozbehi, A; Sharafi, M T; Karimi, F; Kamali, A M

2017-01-01

Progesterone is a sex hormone and its receptors are expressed throughout the hippocampus. This study was aimed at evaluating the effects of different doses of progesterone on memory. Male rats were arbitrarily assigned to nine groups, namely Group I: control, Group II: control-cannula, Group III received 0.5 μl of saline by cannula, Groups IV , V, VI, VII and VIII received progesterone in doses of 0.5, 1, 1.5, 2, and 3 μg/ 0.5 μl by cannula, respectively. Group IX received 0.5 μl almond oil by cannula. Memory performance was tested in form of passive avoidance task. Our results indicated that progesterone at doses of 1.5 and 2 µg (p < 0.05) significantly increased the memory performance while at a dose of 3 µg (p < 0.05), it significantly decreased memory as compared to the control group. The current study revealed that the influence of progesterone on memory is related to its dose (Fig. 1, Ref. 25).

Veno-venous extracorporeal membrane oxygenation using a double-lumen bi-caval cannula for severe respiratory failure post total artificial heart implantation.

PubMed

Miessau, J; Yang, Q; Unai, S; Entwistle, J W C; Cavarocchi, N C; Hirose, H

2015-07-01

We report a unique utilization of a double-lumen, bi-caval Avalon cannula for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during placement of a total artificial heart (TAH, SynCardia, Tucson, AZ). A 22-year-old female with post-partum cardiomyopathy was rescued on veno-arterial (VA) ECMO because of cardiogenic shock. The inability to wean ECMO necessitated implantation of the TAH as a bridge to transplant. In addition, the patient continued to have respiratory failure and concomitant VV ECMO was planned with the implant. During TAH implantation, the Avalon cannula was placed percutaneously from the right internal jugular vein into the inferior vena cava (IVC) under direct vision while the right atrium was open. During VV ECMO support, adequate flows on both ECMO and TAH were maintained without adverse events. VV ECMO was discontinued, without reopening the chest, once the patient's respiratory failure improved. However, the patient subsequently developed a profound respiratory acidosis and required VV ECMO for CO2 removal. The Avalon cannula was placed in the femoral vein to avoid accessing the internal jugular vein and risking damage to the TAH. The patient's oxygenation eventually improved and the cannula was removed at the bedside. The patient was supported for 22 days on VV ECMO and successfully weaned from the ventilator prior to her orthotropic heart transplantation. © The Author(s) 2014.

MSG-Evoked c-Fos Activity in the Nucleus of the Solitary Tract Is Dependent upon Fluid Delivery and Stimulation Parameters

PubMed Central

Thompson, John A.

2016-01-01

The marker of neuronal activation, c-Fos, can be used to visualize spatial patterns of neural activity in response to taste stimulation. Because animals will not voluntarily consume aversive tastes, these stimuli are infused directly into the oral cavity via intraoral cannulae, whereas appetitive stimuli are given in drinking bottles. Differences in these 2 methods make comparison of taste-evoked brain activity between results that utilize these methods problematic. Surprisingly, the intraoral cannulae experimental conditions that produce a similar pattern of c-Fos activity in response to taste stimulation remain unexplored. Stimulation pattern (e.g., constant/intermittent) and hydration state (e.g., water-restricted/hydrated) are the 2 primary differences between delivering tastes via bottles versus intraoral cannulae. Thus, we quantified monosodium glutamate (MSG)-evoked brain activity, as measured by c-Fos, in the nucleus of the solitary tract (nTS; primary taste nucleus) across several conditions. The number and pattern of c-Fos neurons in the nTS of animals that were water-restricted and received a constant infusion of MSG via intraoral cannula most closely mimicked animals that consumed MSG from a bottle. Therefore, in order to compare c-Fos activity between cannulae-stimulated and bottle-stimulated animals, cannulated animals should be water restricted prior to stimulation, and receive taste stimuli at a constant flow. PMID:26762887

[Complications of tracheostomy in patients with severe motor and intellectual disabilities and their management].

PubMed

Kotani, Haruko; Hino, Hiroyuki; Takechi, Tomoki; Shiraishi, Taisuke; Ogura, Hideo

2005-11-01

Some patient with severe motor and intellectual disabilities have a narrow mediastinum due to severe scoliosis or thoracic deformity. Complication of tracheostomy in these patients, such as granulation of the lower end of the cannula and tracheo-innominate artery fistulae, are difficult to treat. The causes of recurrent respiratory distress after tracheostomy in four patients with severe motor and intellectual disabilities were investigated, and its management was evaluated based on chest CT and bronchoscopy. In all patients, the lower end of the cannula was in contact with the site of tracheal stenosis, accompanied by granulation with arterial pulsation. In three patients, tracheomalacia as a complication of tracheostomy was also noted. In three patients, changing the cannula to fix its lower end proximally to the lesion, combined with stent placement in one patient with tracheomalacia, resulted in regression of the granulation and respiratory distress. However, one patient with severe tracheomalacia, who had been treated by stent placement alone, died of tracheo-innominate artery fistula. To prevent complications of tracheostomy in patients with severe motor and intellectual disabilities, it is important to select cannulas with a suitable length and angle. In the absence of severe tracheomalacia, use of custom-made short cannulas that can be fixed proximally to the site of stenosis and to the proximity of arteries are appropriate for this purpose.

Modeling the pharyngeal pressure during adult nasal high flow therapy.

PubMed

Kumar, Haribalan; Spence, Callum J T; Tawhai, Merryn H

2015-12-01

Subjects receiving nasal high flow (NHF) via wide-bore nasal cannula may experience different levels of positive pressure depending on the individual response to NHF. In this study, airflow in the nasal airway during NHF-assisted breathing is simulated and nasopharyngeal airway pressure numerically computed, to determine whether the relationship between NHF and pressure can be described by a simple equation. Two geometric models are used for analysis. In the first, 3D airway geometry is reconstructed from computed tomography images of an adult nasal airway. For the second, a simplified geometric model is derived that has the same cross-sectional area as the complex model, but is more readily amenable to analysis. Peak airway pressure is correlated as a function of nasal valve area, nostril area and cannula flow rate, for NHF rates of 20, 40 and 60 L/min. Results show that airway pressure is related by a power law to NHF rate, valve area, and nostril area. Copyright © 2015 Elsevier B.V. All rights reserved.

Does an Open Recirculation Line Affect the Flow Rate and Pressure in a Neonatal Extracorporeal Life Support Circuit With a Centrifugal or Roller Pump?

PubMed

Wang, Shigang; Spencer, Shannon B; Woitas, Karl; Glass, Kristen; Kunselman, Allen R; Ündar, Akif

2017-01-01

The objective of this study is to evaluate the impact of an open or closed recirculation line on flow rate, circuit pressure, and hemodynamic energy transmission in simulated neonatal extracorporeal life support (ECLS) systems. The two neonatal ECLS circuits consisted of a Maquet HL20 roller pump (RP group) or a RotaFlow centrifugal pump (CP group), Quadrox-iD Pediatric oxygenator, and Biomedicus arterial and venous cannulae (8 Fr and 10 Fr) primed with lactated Ringer's solution and packed red blood cells (hematocrit 35%). Trials were conducted at flow rates ranging from 200 to 600 mL/min (200 mL/min increments) with a closed or open recirculation line at 36°C. Real-time pressure and flow data were recorded using a custom-based data acquisition system. In the RP group, the preoxygenator flow did not change when the recirculation line was open while the prearterial cannula flow decreased by 15.7-20.0% (P < 0.01). Circuit pressure, total circuit pressure drop, and hemodynamic energy delivered to patients also decreased (P < 0.01). In the CP group, the prearterial cannula flow did not change while preoxygenator flow increased by 13.6-18.8% (P < 0.01). Circuit pressure drop and hemodynamic energy transmission remained the same. The results showed that the shunt of an open recirculation line could decrease perfusion flow in patients in the ECLS circuit using a roller pump, but did not change perfusion flow in the circuit using a centrifugal pump. An additional flow sensor is needed to monitor perfusion flow in patients if any shunts exist in the ECLS circuit. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Expediting red blood cell transfusions by syringing causes significant hemolysis.

PubMed

De Villiers, Willem Lambertus; Murray, Adriaan Albertus; Levin, Andrew Ian

2017-11-01

Techniques commonly used to expedite blood transfusions include pneumatically pressurizing red blood cell (RBC) bags or manual syringing its contents. We compared these techniques on RBC hemolysis using a simulated transfusion model. Fifteen warmed RBC units that were 12.3 ± 4.3 (95% confidence interval [CI], 10.1-14.5) days old were each subjected to two experimental rapid transfusion techniques. RBCs from each technique were directed through 18- and 22-gauge cannulas attached to blood administration sets. One technique involved RBC bag pressurization to 300 mmHg. The other employed a 20-mL syringe to effect forceful, manual aspiration from the RBC bag followed by forceful, manual RBC injection. The control group was gravity driven without cannulas. Free hemoglobin (Hb) concentrations were measured and percent hemolysis was calculated. Free Hb concentrations and percent hemolysis (median [95% CI]) were similar in the control (0.05 [0.03-0.08] g/dL and 0.13% [0.09%-0.17%], respectively) and pressurized experiments (0.06 [0.05-0.09] g/dL; 0.14% [0.12%-0.22%]), respectively. Syringing resulted in 10-fold higher free Hb concentrations (0.55 [0.38-0.92] g/dL) and percent hemolysis (1.28% [1.03%-2.15%]) than when employing the control (p < 0.0001) or pressurization (p < 0.0001) techniques. Cannula sizes studied did not affect hemolysis. Forceful manual syringing caused significant hemolysis and high free Hb concentrations. Pressurizing RBC bags induced no more hemolysis than after gravity-facilitated transfusions. Syringing to expedite RBC transfusions should be avoided in favor of pneumatic RBC bag pressurization. © 2017 AABB.

Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO - Prevalence and Risk Factors.

PubMed

Lehle, Karla; Philipp, Alois; Zeman, Florian; Lunz, Dirk; Lubnow, Matthias; Wendel, Hans-Peter; Göbölös, Laszlo; Schmid, Christof; Müller, Thomas

2015-01-01

The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO) and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009-2014) with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb) was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8), while acute oxygenator thrombosis (n = 15) did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0-4.5 L/min) through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142) mg/l] in comparison to non-survivors [148 (91, 256) mg/l, p≤0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality.

Technical-Induced Hemolysis in Patients with Respiratory Failure Supported with Veno-Venous ECMO – Prevalence and Risk Factors

PubMed Central

Lehle, Karla; Philipp, Alois; Zeman, Florian; Lunz, Dirk; Lubnow, Matthias; Wendel, Hans-Peter; Göbölös, Laszlo; Schmid, Christof; Müller, Thomas

2015-01-01

The aim of the study was to explore the prevalence and risk factors for technical-induced hemolysis in adults supported with veno-venous extracorporeal membrane oxygenation (vvECMO) and to analyze the effect of hemolytic episodes on outcome. This was a retrospective, single-center study that included 318 adult patients (Regensburg ECMO Registry, 2009–2014) with acute respiratory failure treated with different modern miniaturized ECMO systems. Free plasma hemoglobin (fHb) was used as indicator for hemolysis. Throughout a cumulative support duration of 4,142 days on ECMO only 1.7% of the fHb levels were above a critical value of 500 mg/l. A grave rise in fHb indicated pumphead thrombosis (n = 8), while acute oxygenator thrombosis (n = 15) did not affect fHb. Replacement of the pumphead normalized fHb within two days. Neither pump or cannula type nor duration on the first system was associated with hemolysis. Multiple trauma, need for kidney replacement therapy, increased daily red blood cell transfusion requirements, and high blood flow (3.0–4.5 L/min) through small-sized cannulas significantly resulted in augmented blood cell trauma. Survivors were characterized by lower peak levels of fHb [90 (60, 142) mg/l] in comparison to non-survivors [148 (91, 256) mg/l, p≤0.001]. In conclusion, marked hemolysis is not common in vvECMO with modern devices. Clinically obvious hemolysis often is caused by pumphead thrombosis. High flow velocity through small cannulas may also cause technical-induced hemolysis. In patients who developed lung failure due to trauma, fHb was elevated independantly of ECMO. In our cohort, the occurance of hemolysis was associated with increased mortality. PMID:26606144

Liposuction: more curettage than aspiration.

PubMed

Mottura, A A

1991-01-01

After infiltration with epinephrine solution in each adipose area, an 8- or 10-mm cannula, without the suction tube connected, was introduced. With a curettage maneuver and by directing the cannula upward, the fat began to come out spontaneously. After obtaining a considerable amount of fat, the suction tube was connected and the remaining fat tissue aspirated at low suction power (250 mm Hg). With this curettage maneuver adiposity of the abdomen, knees, and trochanteric areas can be reduced. However, in the back, buttocks, or thighs, where adiposity is more fibrous, aspiration is needed from the start in almost every case, but always at low-power suction. This procedure is indicated in particular for the face and neck and for secondary liposuction. The fact that fat comes out easily through the cannula (without suction) demonstrates that the curettage maneuver is more important than the aspiration. Only with curettage can a considerable amount of fat be removed. No fat is removed when aspiration of 1 atm without a curettage maneuver is used. Suction only helps to remove fat already mobilized and free in the cannula. Our experience includes 34 patients.

MSG-Evoked c-Fos Activity in the Nucleus of the Solitary Tract Is Dependent upon Fluid Delivery and Stimulation Parameters.

PubMed

Stratford, Jennifer M; Thompson, John A

2016-03-01

The marker of neuronal activation, c-Fos, can be used to visualize spatial patterns of neural activity in response to taste stimulation. Because animals will not voluntarily consume aversive tastes, these stimuli are infused directly into the oral cavity via intraoral cannulae, whereas appetitive stimuli are given in drinking bottles. Differences in these 2 methods make comparison of taste-evoked brain activity between results that utilize these methods problematic. Surprisingly, the intraoral cannulae experimental conditions that produce a similar pattern of c-Fos activity in response to taste stimulation remain unexplored. Stimulation pattern (e.g., constant/intermittent) and hydration state (e.g., water-restricted/hydrated) are the 2 primary differences between delivering tastes via bottles versus intraoral cannulae. Thus, we quantified monosodium glutamate (MSG)-evoked brain activity, as measured by c-Fos, in the nucleus of the solitary tract (nTS; primary taste nucleus) across several conditions. The number and pattern of c-Fos neurons in the nTS of animals that were water-restricted and received a constant infusion of MSG via intraoral cannula most closely mimicked animals that consumed MSG from a bottle. Therefore, in order to compare c-Fos activity between cannulae-stimulated and bottle-stimulated animals, cannulated animals should be water restricted prior to stimulation, and receive taste stimuli at a constant flow. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effect of stress on hepatic 11beta-hydroxysteroid dehydrogenase activity and its influence on carbohydrate metabolism.

PubMed

Altuna, María Eugenia; Lelli, Sandra Marcela; San Martín de Viale, Leonor C; Damasco, María Cristina

2006-10-01

Stress activates the synthesis and secretion of catecholamines and adrenal glucocorticoids, increasing their circulating levels. In vivo, hepatic 11beta-hydroxysteroid dehydrogenase 1 (HSD1) stimulates the shift of 11-dehydrocorticosterone to corticosterone, enhancing active glucocorticoids at tissue level. We studied the effect of 3 types of stress, 1 induced by bucogastric overload with 200 mmol/L HCl causing metabolic acidosis (HCl), the second induced by bucogastric overload with 0.45% NaCl (NaCl), and the third induced by simulated overload (cannula), on the kinetics of hepatic HSD1 of rats and their influence on the activity of the gluconeogenic enzyme phosphoenolpyruvate carboxykinase, glycemia, and glycogen deposition. Compared with unstressed controls, all types of stress significantly increased HSD1 activity (146% cannula, 130% NaCl, and 253% HCl), phosphoenolpyruvate carboxykinase activity (51% cannula, 48% NaCl, and 86% HCl), and glycemia (29% cannula, 30% NaCl, and 41% HCl), but decreased hepatic glycogen (68% cannula, 68% NaCl, and 78% HCl). Owing to these results, we suggest the following events occur when stress is induced: an increase in hepatic HSD1 activity, augmented active glucocorticoid levels, increased gluconeogenesis, and glycemia. Also involved are the multiple events indirectly related to glucocorticoids, which lead to the depletion of hepatic glycogen deposits, thereby contributing to increased glycemia. This new approach shows that stress increments the activity of hepatic HSD1 and suggests that this enzyme could be involved in the development of the Metabolic Syndrome.

A Novel Rat Model to Study the Role of Intracranial Pressure Modulation on Optic Neuropathies

PubMed Central

Roy Chowdhury, Uttio; Holman, Bradley H.; Fautsch, Michael P.

2013-01-01

Reduced intracranial pressure is considered a risk factor for glaucomatous optic neuropathies. All current data supporting intracranial pressure as a glaucoma risk factor comes from retrospective and prospective studies. Unfortunately, there are no relevant animal models for investigating this link experimentally. Here we report a novel rat model that can be used to study the role of intracranial pressure modulation on optic neuropathies. Stainless steel cannulae were inserted into the cisterna magna or the lateral ventricle of Sprague-Dawley and Brown Norway rats. The cannula was attached to a pressure transducer connected to a computer that recorded intracranial pressure in real-time. Intracranial pressure was modulated manually by adjusting the height of a column filled with artificial cerebrospinal fluid in relation to the animal’s head. After data collection the morphological appearance of the brain tissue was analyzed. Based on ease of surgery and ability to retain the cannula, Brown Norway rats with the cannula implanted in the lateral ventricle were selected for further studies. Baseline intracranial pressure for rats was 5.5±1.5 cm water (n=5). Lowering of the artificial cerebrospinal fluid column by 2 cm and 4 cm below head level reduced ICP to 3.7±1.0 cm water (n=5) and 1.5±0.6 cm water (n=4), a reduction of 33.0% and 72.7% below baseline. Raising the cerebrospinal fluid column by 4 cm increased ICP to 7.5±1.4 cm water (n=2) corresponding to a 38.3% increase in intracranial pressure. Histological studies confirmed correct cannula placement and indicated minimal invasive damage to brain tissues. Our data suggests that the intraventricular cannula model is a unique and viable model that can be used to study the effect of altered intracranial pressure on glaucomatous optic neuropathies. PMID:24367501

Aerosol Delivery with Two Nebulizers Through High-Flow Nasal Cannula: A Randomized Cross-Over Single-Photon Emission Computed Tomography-Computed Tomography Study.

PubMed

Dugernier, Jonathan; Hesse, Michel; Jumetz, Thibaud; Bialais, Emilie; Roeseler, Jean; Depoortere, Virginie; Michotte, Jean-Bernard; Wittebole, Xavier; Ehrmann, Stephan; Laterre, Pierre-François; Jamar, François; Reychler, Gregory

2017-10-01

High-flow nasal cannula use is developing in ICUs. The aim of this study was to compare aerosol efficiency by using two nebulizers through a high-flow nasal cannula: the most commonly used jet nebulizer (JN) and a more efficient vibrating-mesh nebulizer (VN). Aerosol delivery of diethylenetriaminepentaacetic acid labeled with technetium-99m (4 mCi/4 mL) to the lungs by using a VN (Aerogen Solo ® ; Aerogen Ltd., Galway, Ireland) and a constant-output JN (Opti-Mist Plus Nebulizer ® ; ConvaTec, Bridgewater, NJ) through a high-flow nasal cannula (Optiflow ® ; Fisher & Paykel, New Zealand) was compared in six healthy subjects. Flow rate was set at 30 L/min through the heated humidified circuit. Pulmonary and extrapulmonary deposition was measured by single-photon emission computed tomography combined with a low-dose computed tomographic scan and by planar scintigraphy. Lung deposition was only 3.6 (2.1-4.4) and 1 (0.7-2)% of the nominal dose with the VN and the JN, respectively (p < 0.05). The JN showed higher retained doses than the VN. However, both nebulizers were associated with substantial deposition in the single limb circuit, the humidification chamber, and the nasal cannula [58.2 (51.6-61.6)% of the nominal dose with the VN versus 19.2 (15.8-22.9)% of the nominal dose with the JN, p < 0.05] and in the upper respiratory tract [17.6 (13.4-27.9)% of the nominal dose with the VN and 8.6 (6.0-11.0)% of the nominal dose with the JN, p < 0.05], especially in the nasal cavity. In the specific conditions of the study, pulmonary drug delivery through the high-flow nasal cannula is about 1%-4% of the initial amount of drugs placed in the nebulizer, despite the higher efficiency of the VN as compared with the JN.

New, Virtually Wall-less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery.

PubMed

von Segesser, Ludwig Karl; Berdajs, Denis; Abdel-Sayed, Saad; Tozzi, Piergiorgio; Ferrari, Enrico; Maisano, Francesco

2016-01-01

Inadequate venous drainage during minimally invasive cardiac surgery becomes most evident when the blood trapped in the pulmonary circulation floods the surgical field. The present study was designed to assess the in vivo performance of new, thinner, virtually wall-less, venous cannulas designed for augmented venous drainage in comparison to traditional thin-wall cannulas. Remote cannulation was realized in 5 bovine experiments (74.0 ± 2.4 kg) with percutaneous venous access over the wire, serial dilation up to 18 F and insertion of either traditional 19 F thin wall, wire-wound cannulas, or through the same access channel, new, thinner, virtually wall-less, braided cannulas designed for augmented venous drainage. A standard minimal extracorporeal circuit set with a centrifugal pump and a hollow fiber membrane oxygenator, but no in-line reservoir was used. One hundred fifty pairs of pump-flow and required pump inlet pressure values were recorded with calibrated pressure transducers and a flowmeter calibrated by a volumetric tank and timer at increasing pump speed from 1500 RPM to 3500 RPM (500-RPM increments). Pump flow accounted for 1.73 ± 0.85 l/min for wall-less versus 1.17 ± 0.45 l/min for thin wall at 1500 RPM, 3.91 ± 0.86 versus 3.23 ± 0.66 at 2500 RPM, 5.82 ± 1.05 versus 4.96 ± 0.81 at 3500 RPM. Pump inlet pressure accounted for 9.6 ± 9.7 mm Hg versus 4.2 ± 18.8 mm Hg for 1500 RPM, -42.4 ± 26.7 versus -123 ± 51.1 at 2500 RPM, and -126.7 ± 55.3 versus -313 ± 116.7 for 3500 RPM. At the well-accepted pump inlet pressure of -80 mm Hg, the new, thinner, virtually wall-less, braided cannulas provide unmatched venous drainage in vivo. Early clinical analyses have confirmed these findings.

A scanning electron microscope study and statistical analysis of adipocyte morphology in lipofilling: comparing the effects of harvesting and purification procedures with 2 different techniques.

PubMed

Rubino, Corrado; Mazzarello, Vittorio; Faenza, Mario; Montella, Andrea; Santanelli, Fabio; Farace, Francesco

2015-06-01

The aim of this study was to evaluate the effects on adipocyte morphology of 2 techniques of fat harvesting and of fat purification in lipofilling, considering that the number of viable healthy adipocytes is important in fat survival in recipient areas of lipofilling. Fat harvesting was performed in 10 female patients from flanks, on one side with a 2-mm Coleman cannula and on the other side with a 3-mm Mercedes cannula. Thirty milliliter of fat tissue from each side was collected and divided into three 10 mL syringes: A, B, and C. The fat inside syringe A was left untreated, the fat in syringe B underwent simple sedimentation, and the fat inside syringe C underwent centrifugation at 3000 rpm for 3 minutes. Each fat graft specimen was processed for examination under low-vacuum scanning electron microscope. Diameter (μ) and number of adipocytes per square millimeter and number of altered adipocytes per square millimeter were evaluated. Untreated specimens harvested with the 2 different techniques were first compared, then sedimented versus centrifuged specimens harvested with the same technique were compared. Statistical analysis was performed using Wilcoxon signed rank test. The number of adipocytes per square millimeter was statistically higher in specimens harvested with the 3-mm Mercedes cannula (P = 0.0310). The number of altered cells was statistically higher in centrifuged specimens than in sedimented ones using both methods of fat harvesting (P = 0.0080) with a 2-mm Coleman cannula and (P = 0.0050) with a 3-mm Mercedes cannula. Alterations in adipocyte morphology consisted in wrinkling of the membrane, opening of pore with leakage of oily material, reduction of cellular diameter, and total collapse of the cellular membrane. Fat harvesting by a 3-mm cannula results in a higher number of adipocytes and centrifugation of the harvested fat results in a higher number of morphologic altered cells than sedimentation.

Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?

PubMed

Kubicka, Zuzanna J; Limauro, Joseph; Darnall, Robert A

2008-01-01

The goal was to estimate the level of delivered continuous positive airway pressure by measuring oral cavity pressure with the mouth closed in infants of various weights and ages treated with heated, humidified high-flow nasal cannula at flow rates of 1-5 L/minute. We hypothesized that clinically relevant levels of continuous positive airway pressure would not be achieved if a nasal leak is maintained. After performing bench measurements and demonstrating that oral cavity pressure closely approximated levels of traditionally applied nasal continuous positive airway pressure, we successfully measured oral cavity pressure during heated, humidified, high-flow nasal cannula treatment in 27 infants. Small (outer diameter: 0.2 cm) cannulae were used for all infants, and flow rates were left as ordered by providers. Bench measurements showed that, for any given leak size, there was a nearly linear relationship between flow rate and pressure. The highest pressure achieved was 4.5 cmH2O (flow rate: 8 L/minute; leak: 3 mm). In our study infants (postmenstrual age: 29.1-44.7 weeks; weight: 835-3735 g; flow rate: 1-5 L/minute), no pressure was generated with the mouth open at any flow rate. With the mouth closed, the oral cavity pressure was related to both flow rate and weight. For infants of < or = 1500 g, there was a linear relationship between flow rate and oral cavity pressure. Oral cavity pressure can estimate the level of continuous positive airway pressure. Continuous positive airway pressure generated with heated, humidified, high-flow nasal cannula treatment depends on the flow rate and weight. Only in the smallest infants with the highest flow rates, with the mouth fully closed, can clinically significant but unpredictable levels of continuous positive airway pressure be achieved. We conclude that heated, humidified high-flow nasal cannula should not be used as a replacement for delivering continuous positive airway pressure.

Impact of tubing length on hemodynamics in a simulated neonatal extracorporeal life support circuit.

PubMed

Qiu, Feng; Uluer, Mehmet C; Kunselman, Allen; Clark, J Brian; Myers, John L; Undar, Akif

2010-11-01

During extracorporeal life support (ECLS), a large portion of the hemodynamic energy is lost to various components of the circuit. Minimization of this loss in the circuit leads to better vital organ perfusion and decreases the risk of systemic inflammation. In this study, we evaluated the hemodynamic properties of differing lengths of tubing in a simulated neonatal ECLS circuit. The neonatal ECLS circuit used in this study included a Capiox Baby RX05 oxygenator (Terumo Corporation, Tokyo, Japan), a Rotaflow centrifugal pump (MAQUET Cardiopulmonary AG, Hirrlingen, Germany), and a heater and cooler unit. An 8Fr Biomedicus arterial and a 10Fr Biomedicus venous cannula were connected to the pseudopatient. One-fourth inch tubing was used for both the arterial and the venous line. A Hoffman clamp was located upstream from the pseudopatient to maintain a certain patient pressure. Three pressure transducers were placed at different sites: postoxygenator, prearterial cannula, and postarterial cannula. The system was primed with Lactated Ringer's solution; human blood was then added to maintain a hematocrit of 40%. The volume of the pseudopatient was 500mL. We hemodynamically evaluated three circuits with different lengths of tubing: 6, 4, and 2 feet (182.88, 121.92, and 60.96 cm, respectively) for both arterial and venous lines; the priming volumes including all of the components of the circuits were 195, 155, and 115mL, respectively. In each circuit, we measured the pressure drops of the arterial tubing and the arterial cannula, as well as the flow rates at different rpm (1750-3000, 250 intervals) under three patient pressures (40, 60, and 80mm Hg). All the experiments were conducted at 37°C. The pressure drop across the arterial cannula is much larger than that of arterial tubing in all set-ups, especially under high flow rates. Upon cutting the tubing from 6 to 2 feet, the pressure drop of the arterial tubing decreased by half, while the pressure drop of the arterial cannula increased due to the slightly higher flow rates. These results suggest that compared to the arterial tubing, the arterial cannula has a larger impact on the hemodynamics of the circuit. There is a little influence of tubing length on the circuit flow rate. © 2010, Copyright the Authors. Artificial Organs © 2010, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Ovariohysterectomy in a dog by a hybrid NOTES technique

PubMed Central

Brun, Maurício V.; Silva, Marco A.M.; Mariano, Mirandolino B.; Motta, Adriana C.; Colomé, Lucas M.; Feranti, João P.S.; Pohl, Virgínia L.; Ataide, Michelli W.; Guedes, Rogério L.; Santos, Fabiane R.

2011-01-01

This report demonstrates the feasibility of an elective ovariosalpingohysterectomy by natural transluminal endoscopic surgery (NOTES) hybrid technique in a dog. A 5-mm abdominal cannula was used in combination with a 10-mm cannula (vaginal access). The patient’s quick recovery and the absence of complications are indicative of the effectiveness of this surgery. PMID:22131580

[An atraumatic needle for the puncture of ports and pumps].

PubMed

Haindl, H; Müller, H

1988-10-17

Huber-point needles have been found to induce substantial coring during puncture of ports or pumps, which may lead to leakage or obturation of these devices. Therefore, different types of cannulas were tested in order to evaluate their applicability for this purpose. Pencil-point needles led to increased pain during puncture and thus seemed unsuitable. A newly developed port-cannula bent inwards within the length of the bevel ("protected bevel") and proved to be definitely noncoring during electron microscopy. Consequently the force required to introduce this needle was reduced by 50% in comparison with the Huber-type needle. In addition, this cannula allowed up to 3000 punctures of one port without leakage and, thus, correspondingly therefore relevantly increased the durability of this device.

Lesion of medial prefrontal dopamine terminals abolishes habituation of accumbens shell dopamine responsiveness to taste stimuli.

PubMed

Bimpisidis, Zisis; De Luca, Maria Antonietta; Pisanu, Augusta; Di Chiara, Gaetano

2013-02-01

Taste stimuli increase extracellular dopamine (DA) in the nucleus accumbens (NAc) and in the medial prefrontal cortex (mPFC). This effect shows single-trial habituation in NAc shell but not in core or in mPFC. Morphine sensitization abolishes habituation of DA responsiveness in NAc shell but induces it in mPFC. These observations support the hypothesis of an inhibitory influence of mPFC DA on NAc DA. To test this hypothesis, we used in vivo microdialysis to investigate the effect of mPFC 6-hydroxy-dopamine (6-OHDA) lesions on the NAc DA responsiveness to taste stimuli. 6-OHDA was infused bilaterally in the mPFC of rats implanted with guide cannulae. After 1 week, rats were implanted with an intraoral catheter, microdialysis probes were inserted into the guide cannulae, and dialysate DA was monitored in NAc shell/core after intraoral chocolate. 6-OHDA infusion reduced tissue DA in the mPFC by 75%. Tyrosine hydroxylase immunohistochemistry showed that lesions were confined to the mPFC. mPFC 6-OHDA lesion did not affect the NAc shell DA responsiveness to chocolate in naive rats but abolished habituation in rats pre-exposed to the taste. In the NAc core, mPFC lesion potentiated, delayed and prolonged the stimulatory DA response to taste but failed to affect DA in pre-exposed rats. Behavioural taste reactions and motor activity were not affected. The results indicate a top-down control of NAc DA by mPFC and a reciprocal relationship between DA transmission in these two areas. Moreover, habituation of DA responsiveness in the NAc shell is dependent upon an intact DA input to the mPFC. © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

The effects of gas humidification with high-flow nasal cannula on cultured human airway epithelial cells.

PubMed

Chidekel, Aaron; Zhu, Yan; Wang, Jordan; Mosko, John J; Rodriguez, Elena; Shaffer, Thomas H

2012-01-01

Humidification of inspired gas is important for patients receiving respiratory support. High-flow nasal cannula (HFNC) effectively provides temperature and humidity-controlled gas to the airway. We hypothesized that various levels of gas humidification would have differential effects on airway epithelial monolayers. Calu-3 monolayers were placed in environmental chambers at 37°C with relative humidity (RH) < 20% (dry), 69% (noninterventional comparator), and >90% (HFNC) for 4 and 8 hours with 10 L/min of room air. At 4 and 8 hours, cell viability and transepithelial resistance measurements were performed, apical surface fluid was collected and assayed for indices of cell inflammation and function, and cells were harvested for histology (n = 6/condition). Transepithelial resistance and cell viability decreased over time (P < 0.001) between HFNC and dry groups (P < 0.001). Total protein secretion increased at 8 hours in the dry group (P < 0.001). Secretion of interleukin (IL)-6 and IL-8 in the dry group was greater than the other groups at 8 hours (P < 0.001). Histological analysis showed increasing injury over time for the dry group. These data demonstrate that exposure to low humidity results in reduced epithelial cell function and increased inflammation.

The Effects of Gas Humidification with High-Flow Nasal Cannula on Cultured Human Airway Epithelial Cells

PubMed Central

Chidekel, Aaron; Zhu, Yan; Wang, Jordan; Mosko, John J.; Rodriguez, Elena; Shaffer, Thomas H.

2012-01-01

Humidification of inspired gas is important for patients receiving respiratory support. High-flow nasal cannula (HFNC) effectively provides temperature and humidity-controlled gas to the airway. We hypothesized that various levels of gas humidification would have differential effects on airway epithelial monolayers. Calu-3 monolayers were placed in environmental chambers at 37°C with relative humidity (RH) < 20% (dry), 69% (noninterventional comparator), and >90% (HFNC) for 4 and 8 hours with 10 L/min of room air. At 4 and 8 hours, cell viability and transepithelial resistance measurements were performed, apical surface fluid was collected and assayed for indices of cell inflammation and function, and cells were harvested for histology (n = 6/condition). Transepithelial resistance and cell viability decreased over time (P < 0.001) between HFNC and dry groups (P < 0.001). Total protein secretion increased at 8 hours in the dry group (P < 0.001). Secretion of interleukin (IL)-6 and IL-8 in the dry group was greater than the other groups at 8 hours (P < 0.001). Histological analysis showed increasing injury over time for the dry group. These data demonstrate that exposure to low humidity results in reduced epithelial cell function and increased inflammation. PMID:22988501

Prokinetic effects of large-dose lubiprostone on gastrointestinal transit in dogs and its mechanisms.

PubMed

Song, Jun; Yin, Jieyun; Xu, Xiaohong; Chen, Jiande

2015-01-01

To systemically explore effects of large dose of lubiprostone on gastrointestinal (GI) transit and contractions and its safety in dogs. 12 healthy dogs were studied. 6 dogs were operated to receive duodenal cannula and colon cannula and the other 6 dogs received gastric cannula. Lubiprostone was orally administrated at a dose of 24 µg or 48 µg 1 hr prior to the experiments. Gastric emptying (GE) of solids and small bowel transit were evaluated by collecting the effluents from the duodenal cannula and from the colon cannula. Gastric accommodation was measured by barostat. Gastric and intestinal contractions were by manometry. Colon transit was by X-ray pictures. 1) Lubiprostone 48 µg not 24 µg accelerated GE. Atropine could block the effect; 2) Average motility index (MI) of gastric antrum in lubiprostone 48 µg session was significantly higher in both fasting state (P = 0.01) and fed state (P = 0.03). Gastric accommodation was not significantly different; 3) Lubiprostone 48 µg accelerated small bowel and colon transit. Atropine could block the effect on small bowel transit; 4) Lubiprostone 48 µg increased postprandial small bowel MI (P = 0.0008) and colon MI (P = 0.002). 5) No other adverse effects except for diarrhea were observed. Acute administration of lubiprostone at a dose of 48 µg accelerates GI motility and enhances GI contractions in the postprandial state. The findings suggest that lubiprostone may have an indirect prokinetic effects on the GI tract and vagal activity may be involved. Lubiprostone may be safely used.

Prokinetic effects of large-dose lubiprostone on gastrointestinal transit in dogs and its mechanisms

PubMed Central

Song, Jun; Yin, Jieyun; Xu, Xiaohong; Chen, Jiande

2015-01-01

Objective: To systemically explore effects of large dose of lubiprostone on gastrointestinal (GI) transit and contractions and its safety in dogs. Methods: 12 healthy dogs were studied. 6 dogs were operated to receive duodenal cannula and colon cannula and the other 6 dogs received gastric cannula. Lubiprostone was orally administrated at a dose of 24 µg or 48 µg 1 hr prior to the experiments. Gastric emptying (GE) of solids and small bowel transit were evaluated by collecting the effluents from the duodenal cannula and from the colon cannula. Gastric accommodation was measured by barostat. Gastric and intestinal contractions were by manometry. Colon transit was by X-ray pictures. Results: 1) Lubiprostone 48 µg not 24 µg accelerated GE. Atropine could block the effect; 2) Average motility index (MI) of gastric antrum in lubiprostone 48 µg session was significantly higher in both fasting state (P = 0.01) and fed state (P = 0.03). Gastric accommodation was not significantly different; 3) Lubiprostone 48 µg accelerated small bowel and colon transit. Atropine could block the effect on small bowel transit; 4) Lubiprostone 48 µg increased postprandial small bowel MI (P = 0.0008) and colon MI (P = 0.002). 5) No other adverse effects except for diarrhea were observed. Conclusion: Acute administration of lubiprostone at a dose of 48 µg accelerates GI motility and enhances GI contractions in the postprandial state. The findings suggest that lubiprostone may have an indirect prokinetic effects on the GI tract and vagal activity may be involved. Lubiprostone may be safely used. PMID:26045891

Improving the frequency of visual infusion phlebitis (VIP) scoring on an oncology ward

PubMed Central

Tzolos, Evangelos; Salawu, Abdulazeez

2014-01-01

Phlebitis from peripheral intravenous infusions is an important potential source of oncology patient morbidity. Important factors found to determine phlebitis incidence include the kind of infusion and dwell time of intravenous cannula. Early studies showed incidence rates of between 25–70% worldwide, and association with up to 10% of S. aureus bacteraemia. The introduction of the visual infusion phlebitis (VIP) score tool for assessment of the early signs of phlebitis, along with prompt removal of peripheral intravenous cannulas, has been very successful in reducing the incidence below the acceptable rate of 5%. However, achieving this goal depends on strict compliance with guidelines for cannula insertion, documentation, and assessment using the VIP tool. This study aimed to increase the use of VIP scoring tool to 100% on an oncology ward during a four to six month period in order to maximise its utility in phlebitis prevention. Three plan-do-study-act (PDSA) cycles were carried out, during which two major interventions were introduced. The first cycle aimed to improve junior doctors’ awareness of VIP scoring using presentations in induction meetings and posters. The second cycle ensured that ready access to the VIP tool was provided in the form of bedside intentional rounding charts. Proportions of intravenous cannulas with proper documentation and VIP assessment were measured before intervention and at nine subsequent bi-weekly time points. Pre-intervention, under 30% of cannulas were properly documented and assessed. This proportion rose to around 80% by the end of the second PDSA cycle and achieved 100% by the end of the third cycle. PMID:26734282

[Axillary blockade of the brachial plexus. A prospective evaluation of 1133 cases of plexus catheter anesthesia].

PubMed

Büttner, J; Kemmer, A; Argo, A; Klose, R; Forst, R

1988-01-01

The results of 1133 axillary catheter brachial blocks are reported. Effectiveness and side-effects were monitored in a prospective manner over a period of 1 year. The puncture was performed with an 18-gauge plastic cannula fitted with a solid steel stylet. The stylet has a 45 degrees, short bevel with rounded edges. When puncturing the axillary neurovascular sheath, no attempt was made to elicit paresthesias with the needle. A distinct "click" and very easy advancement of the plastic cannula were signs of being well inside the neurovascular sheath. To confirm the correct positioning, 0.5-3 ml refrigerated saline solution were injected. If no paresthesias could be produced, a new puncture was performed using a nerve stimulator. The plastic cannula was fixed to the skin. For long-lasting operations or if postoperative analgesia or sympatholysis was required, a more flexible catheter was introduced through the plastic cannula. As an initial dose 40 ml 1% mepivacaine was injected via the cannula. If there was an insufficient block after 20 min, another 20 ml 1% mepivacaine was given. For long-lasting operations, 40 ml 1% mepivacaine was injected every 2 h. Surgery was completed in 72% of patients; 24% required some form of supplementation including 17.2% of patients who received a "top-up" after 20 min (Table 1). In 3.8% of cases the technique was considered to be a complete failure, meaning that patients needed some type of general anesthesia including the use of i.v. ketamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary inulin supplementation does not promote colonic iron absorption in a porcine model

USDA-ARS?s Scientific Manuscript database

Prebiotics may enhance iron bioavailability by increasing iron absorption in the colon. Anemic pigs fitted with cecal cannulas were fed a low-iron diet with or without 4% inulin. Over 7 days, pigs were administered 1 mg 54 Fe in the morning feed followed by cannula infusion of 0.5 mg 58 Fe to measu...

Cannula Tip With Integrated Volume Sensor for Rotary Blood Pump Control: Early-Stage Development.

PubMed

Cysyk, Joshua; Newswanger, Ray; Popjes, Eric; Pae, Walter; Jhun, Choon-Sik; Izer, Jenelle; Weiss, William; Rosenberg, Gerson

2018-05-10

The lack of direct measurement of left ventricular unloading is a significant impediment to the development of an automatic speed control system for continuous-flow left ventricular assist devices (cf-LVADs). We have developed an inlet cannula tip for cf-LVADs with integrated electrodes for volume sensing based on conductance. Four platinum-iridium ring electrodes were installed into grooves on a cannula body constructed from polyetheretherketone (PEEK). A sinusoidal current excitation waveform (250 μA pk-pk, 50 kHz) was applied across one pair of electrodes, and the conductance-dependent voltage was sensed across the second pair of electrodes. The conductance catheter was tested in an acute ovine model (n = 3) in conjunction with the HeartMate II rotary blood pump to provide circulatory support and unload the ventricle. Echocardiography was used to measure ventricular size during pump support for verification for the conductance measurements. The conductance measurements correlated linearly with the echocardiography dimension measurements more than the full range of pump support from minimum support to suction. This cannula tip will enable the development of automatic control systems to optimize pump support based on a real-time measurement of ventricular size.

Repeated subretinal surgery and removal of subretinal decalin is well tolerated - evidence from a porcine model.

PubMed

Sørensen, Nina Buus; Klemp, Kristian; Kjær, Troels Wesenberg; Heegaard, Steffen; la Cour, Morten; Kiilgaard, Jens Folke

2017-09-01

Subretinal perfluorocarbon liquid (PFCL) is a serious complication that can occur after retinal detachment repair. It is possible to remove the PFCL surgically, but retinal damage related to the procedure is unknown. Also, increasing interest in subretinal treatment makes it relevant to examine the functional and morphological consequences of repeated subretinal manipulation. We hypothesized that PFCL in a porcine model can be injected in the subretinal space and removed with minimal effect on retinal structure and function. The left eyes of ten healthy three-month-old female domestic pigs were included. Multifocal electroretinograms (mfERG) were recorded before surgery. Following vitrectomy, a PFCL bleb (decalin) was injected subretinally using a 41G cannula. After 14 days the decalin was removed through a 41G cannula in combination with a 2 ml syringe and an intermediate flexible tube. Two weeks after removal, a control mfERG was recorded, the pigs were enucleated and sacrificed and eyes were examined histologically. All statistics were carried out with a paired t-test in SAS Enterprise Guide 7.1® (SAS Institute Inc., Cary, NC, USA). There was no significant difference in mfERG amplitude ratio (left/right eye) between baseline and recordings two weeks after removal of decalin (P1 (M = 0.26, SD = 0.80, p = 0.39), second order kernel (M = -0.18, SD = 0.86, p = 0.57), Direct Response (M = 0.39, SD = 0.61, p = 0.12) or Induced Component (M = -0.03, SD = 0.40, p = 0.80)). Histologically, the photoreceptor outer segments were minimally affected. Otherwise the retina was normal 14 days after removal of decalin. In four pigs the subretinal decalin displaced inferiorly and was no longer accessible for removal. Subretinal decalin can be removed within 14 days without lasting retinal damage. Decalin is a heavy liquid where the risk of displacement is high. Future studies using PFCLs to control duration of an experimental retinal separation should focus on PFCLs that are isodense to the vitreus body.

Veno-venous extracorporeal membrane oxygenation using an innovative dual-lumen cannula following implantation of a total artificial heart.

PubMed

Youdle, Jemma; Penn, Sarah; Maunz, Olaf; Simon, Andre

2017-01-01

We report our first clinical use of the new Protek Duo TM cannula for peripheral veno-venous extra-corporeal life support (ECLS). A 53-year-old male patient underwent implantation of a total artificial heart (TAH) for biventricular failure. However, due to the development of post-operative respiratory dysfunction, the patient required ECLS for six days.

In-Line Filtration Reduces Postoperative Venous Peripheral Phlebitis Associated With Cannulation: A Randomized Clinical Trial.

PubMed

Villa, Gianluca; Chelazzi, Cosimo; Giua, Rosa; Tofani, Lorenzo; Zagli, Giovanni; Boninsegni, Paolo; Pinelli, Fulvio; De Gaudio, A Raffaele; Romagnoli, Stefano

2018-04-23

Peripheral venous cannulation is an everyday practice of care for patients undergoing anesthesia and surgery. Particles infused with intravenous fluids (eg, plastic/glass/drugs particulate) contribute to the pathogenesis of peripheral phlebitis. The aim of this study is to demonstrate the efficacy of in-line filtration in reducing the incidence of postoperative phlebitis associated with peripheral short-term vascular access. In this controlled trial, 268 surgical patients were randomly assigned to in-line filtration and standard care (NCT03193827). The incidence of phlebitis (defined as visual infusion phlebitis [VIP] score, ≥2) within 48 hours was compared between the 2 groups, as well as the onset and severity of phlebitis and the reasons for removal of the cannula. The lifespan of venous cannulae was compared for the in-line filter and no-filter groups through a Kaplan-Meier curve. The incidence of phlebitis within 48 hours postoperatively was 2.2% and 26.9% (difference, 25% [95% confidence interval {CI}, 12%-36%]; odds ratio, 0.05 [0.01-0.15]), respectively, for the in-line filter and no-filter groups (P < .001). From 24 to 96 hours postoperatively, patients in the no-filter group had higher VIP scores than those in in-line filter group (P < .001). Venous cannulae in the in-line filter group exhibited prolonged lifespan compared to those in the no-filter group (P = .01). In particular, 64 (47.8%) of cannulae in the in-line filter group and 56 (41.8%) of those in the no-filter group were still in place at 96 hours postoperatively. At the same time point, patients with a VIP score <3 were 100% in the in-line filter group and only 50% for the no-filter group. In-line filtration was a protective factor for postoperative phlebitis (hazard ratio, 0.05 [95% CI, 0.014-0.15]; P < .0001) and cannula removal (hazard ratio, 0.7 [95% CI, 0.52-0.96]; P = .02). In-line filtration has a protective effect for postoperative phlebitis and prolongs cannula lifespan during peripheral venous cannulation in surgical patients.

Using side-opening injection cannulas to prevent cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures, does it really work?

PubMed

Li, Jigang; Li, Tao; Ma, Qiuhong; Li, Jianmin

2017-09-01

Percutaneous vertebroplasty has been widely applied in the treatment of osteoporotic vertebral compression fractures over the past two decades. However as one of the major complications, the rate of cement leakage seems not to be decreased significantly. In this study, the rate of cement leakage was compared between two groups using two different cement injection cannulas. The purpose was to determine the efficacy of side-opening cannula on preventing cement leakage in vertebroplasty for the treatment of osteoporotic vertebral compression fractures. A retrospective study was conducted from January 2013 to December 2015. Totally 225 patients who received bilateral vertebroplasty due to osteoporotic vertebral compression fractures were included in the study. The patients were divided into test group who received vertebroplasty with side-opening cannulas and control group who received vertebroplasty with front-opening cannulas. The patients' medical records were reviewed to determine the bone marrow density, preoperative vertebral compression ratio, preoperative and postoperative VAS, operation time, volume of injected bone cement, rate of cement leakage. Post-operative X-rays and CT scans were utilized to assess the degree of Cement leakage. Comparisons between groups and clinical results on VAS in each group were analyzed with appropriate test. All the patients were performed successfully without symptomatic complications. The back pain was significantly relieved after operation in both groups (P < 0.05). At 6 days and 6 months follow-up, there was no significant difference in the mean VAS score between the two groups (P > 0.05). The rate of cement leakage in the test group was significantly lower than that in the control group (P < 0.05). Percutaneous vertebroplasty with side-opening cannula is a safe and effective minimally invasive method in the treatment of osteoporotic vertebral compression fractures, the rate of cement leakage can be significantly reduced by redirecting the cement flow. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Lung physiology during ECS resuscitation of DCD donors followed by in situ assessment of lung function.

PubMed

Reoma, Junewai L; Rojas, Alvaro; Krause, Eric M; Obeid, Nabeel R; Lafayette, Nathan G; Pohlmann, Joshua R; Padiyar, Niru P; Punch, Jeffery D; Cook, Keith E; Bartlett, Robert H

2009-01-01

Extracorporeal cardiopulmonary support (ECS) of donors after cardiac death (DCD) has been shown to improve abdominal organs for transplantation. This study assesses whether pulmonary congestion occurs during ECS with the heart arrested and describes an in vivo method to assess if lungs are suitable for transplantation from DCD donors after ECS resuscitation. Cardiac arrest was induced in 30 kg pigs, followed by 10 min of warm ischemia. Cannulae were placed into the right atrium (RA) and iliac artery, and veno-arterial ECS was initiated for 90 min with lungs inflated, group 1 (n = 5) or deflated, group 2 (n = 3). Left atrial pressures were measured as a marker for pulmonary congestion. After 90 min of ECS, lung function was evaluated. Cannulae were placed into the pulmonary artery (PA) and left ventricle (LV). A second pump was included, and ECS was converted to a bi-ventricular (bi-VAD) system. The RVAD drained from the RA and pumped into the PA, and the LVAD drained the LV and pumped into the iliac. This brought the lungs back into circulation for a 1-hr assessment period. The oxygenator was turned off, and ventilation was restarted. Flows, blood gases, PA and left atrial pressures, and compliance were recorded. In both the groups, LA pressure was <15 mm Hg during ECS. During the lung assessment period, PA flows were 1.4-2.2 L/min. PO2 was >300 mm Hg, with normal PCO2. Extracorporeal cardiopulmonary support resuscitation of DCD donors is feasible and allows for assessment of function before procurement. Extracorporeal cardiopulmonary support does not cause pulmonary congestion, and the lungs retain adequate function for transplantation. Compliance correlated with lung function.

LUNG PHYSIOLOGY DURING ECS RESUSCITATION OF DCD DONORS FOLLOWED BY IN-SITU ASSESSMENT OF LUNG FUNCTION

PubMed Central

Reoma, Junewai L.; Rojas, Alvaro; Krause, Eric M.; Obeid, Nabeel R.; Lafayette, Nathan G.; Pohlmann, Joshua R.; Padiyar, Niru P.; Punch, Jeffery D; Cook, Keith E.; Bartlett, Robert H

2009-01-01

Extracorporeal cardiopulmonary support(ECS) of donors following cardiac death(DCD) has been shown to improve abdominal organs for transplantation. This study assesses whether pulmonary congestion occurs during ECS with the heart arrested and describes an in-vivo method to assess if lungs are suitable for transplantation from DCD donors following ECS resuscitation. Cardiac arrest was induced in 30 kg pigs, followed by 10min. of warm ischemia. Cannulas were placed into right atrium (RA) and iliac artery, and veno-arterial ECS was initiated for 90min with lungs inflated, Group 1 (n=5) or deflated Group 2 (n=3). Left atrial pressures were measured as a marker for pulmonary congestion. After 90 min of ECS, lung function was evaluated. Cannulae were placed into the pulmonary artery (PA) and left ventricle (LV). A second pump was included, and ECS was converted to a bi-VAD system. The RVAD drained from the RA and pumped into the PA, and the LVAD drained the LV and pumped into the iliac. This brought the lungs back into circulation for a 1hr assessment period. The oxygenator was turned off, and ventilation restarted. Flows, blood gases, pulmonary artery and left atrial pressures, and compliance were recorded. In both groups: LA pressure was <15mmHg during ECS. During the lung assessment period, PA flows were 1.4−2.2 liter/min. PO2 was >300mmHg, with normal PCO2. ECS resuscitation of DCD donors is feasible and allows for assessment of function prior to procurement. ECS does not cause pulmonary congestion, and lungs retain adequate function for transplantation. Compliance correlated with lung function. PMID:19506464

Prevalence of skeletal muscle mass loss and its association with swallowing function after cardiovascular surgery.

PubMed

Wakabayashi, Hidetaka; Takahashi, Rimiko; Watanabe, Naoko; Oritsu, Hideyuki; Shimizu, Yoshitaka

2017-06-01

The aim of this study was to assess the prevalence of skeletal muscle mass loss and its association with swallowing function in patients with dysphagia after cardiovascular surgery. A retrospective cohort study was performed in 65 consecutive patients with dysphagia after cardiovascular surgery who were prescribed speech therapy. Skeletal muscle index (SMI) was calculated as total psoas muscle area assessed via abdominal computed tomography divided by height squared. Cutoff values were 6.36 cm 2 /m 2 for men and 3.92 cm 2 /m 2 for women. The Food Intake Level Scale (FILS) was used to assess the swallowing function. Univariate and ordered logistic regression analyses were applied to examine the associations between skeletal muscle mass loss and dysphagia. The study included 50 men and 15 women (mean age 73 ± 8 y). The mean SMI was 4.72 ± 1.37 cm 2 /m 2 in men and 3.33 ± 1.42 cm 2 /m 2 in women. Skeletal muscle mass loss was found in 53 (82%) patients. Twelve had tracheostomy cannula. Thirteen were non-oral feeding (FILS levels 1-3), 5 were oral food intake and alternative nutrition (levels 4-6), and 47 were oral food intake alone (levels 7-9) at discharge. The FILS at discharge was significantly lower in patients with skeletal muscle mass loss. Ordered logistic regression analysis of swallowing function showed that skeletal muscle mass loss and tracheostomy cannula were associated independently with the FILS at discharge. The prevalence of skeletal muscle mass loss is very high, and skeletal muscle mass loss is associated with swallowing function. Copyright © 2017 Elsevier Inc. All rights reserved.

[Interest and feasibility of local anesthesia in the management of massive extravasation of contrast medium].

PubMed

Ho Quoc, C; Chaput, B; Grolleau, J-L

2013-04-01

Radiographic contrast medium extravasation in the upper extremity is not rare. It can be responsible for functional (compartment syndrome) and cosmetic sequelae. It is very difficult to predict the degree of final tissue injury in emergency. Currently, there is no consensus of emergency treatment. However, liposuction and saline washout as described by Gault is the usual treatment. We report the case of 42 year-old woman with radiographic contrast medium extravasation in the arm (120 cm(3)) with neurologic complications involving median nerve and medial cutaneous nerves of arm and forearm. Emergency conservative surgical washout with saline solution was performed under local anaesthesia. Drainage was realised by lipoaspiration cannula and arm massages. Clinical and radiological results were estimated. Ultimately, the patient has retained no sequela. Contrast medium extravasation in the arm with tissue complications is exceptional. We think that saline washout and lipoaspiration cannula drainage are an emergency useful treatment for radiographic contrast medium extravasation with tissue complications. Tolerance of the management was quite good. Postoperative X-rays are useful to assess treatment efficacy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Single jugular vein cannulated rats may not be suitable for intravenous pharmacokinetic screening of high logP compounds.

PubMed

Gaud, Nilesh; Kumar, Anoop; Matta, Muralikrishna; Kole, Prashant; Sridhar, Srikanth; Mandlekar, Sandhya; Holenarsipur, Vinay K

2017-03-01

Rat is commonly used for pharmacokinetic screening during pharmaceutical lead optimization. To handle the large number of compounds, rats with a single jugular vein cannulation are commonly utilized for intravenous pharmacokinetic studies, where the same cannula is used both for dose administration and blood sampling. We demonstrate that the single cannula method is not suitable for all compounds, especially for high logP compounds. We propose an alternative dual cannulation technique in which two cannulas are placed in the same jugular vein, thus avoiding an additional surgery. Compounds were administered orally or via intravenous infusion to compare PK parameters, including bioavailability, using both procedures. For itraconazole and amiodarone, known to bind to the cannula, the measured plasma exposures were substantially higher in the single cannulated rats than those from dual cannulated rats. Area under the plasma concentration time curve differed by 79% and 74% for itraconazole and amiodarone, respectively. When compared to the single cannulation approach, clearance, volume of distribution and bioavailability determined by dual cannulation were 39%, 60% and 38% higher for itraconazole, and 46%, 34% and 42% higher for amiodarone, respectively. In contrast, all pharmacokinetic parameters were similar between single and dual-cannulated rats for the hydrophilic compound atenolol. Based on these results, we recommend the use of dual cannulated rats for intravenous pharmacokinetic studies when testing a series of hydrophobic compounds that may be prone to non-specific binding to the cannula. If single cannulated model is selected for pharmacokinetic screening, we recommend a bridging study with dual cannulated rats with representative compounds of a given chemical series. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of Nasal Continuous Positive Airway Pressure and Cannula Use in the Neonatal Intensive Care Unit Setting

PubMed Central

Jatana, Kris R.; Oplatek, Agnes; Stein, Melanie; Phillips, Gary; Kang, D. Richard; Elmaraghy, Charles A.

2013-01-01

Objective To investigate the effects of nasal continuous positive airway pressure (CPAP) and cannula use in the neonatal intensive care unit. Design Cross-sectional study. Setting Tertiary care children’s hospital. Patients One hundred patients (200 nasal cavities), younger than 1 year, who received at least 7 days of nasal CPAP (n = 91) or cannula supplementation (n = 9) in the neonatal intensive care unit. Interventions External nasal examination and anterior nasal endoscopy with photographic documentation. Main Outcome Measures The incidence and characteristics of internal and external nasal findings of patients with nasal CPAP or cannula use. Results Nasal complications were seen in 12 of the 91 patients (13.2%) with at least 7 days of nasal CPAP exposure, while no complications were seen in the 9 patients with nasal cannula use alone. The external nasal finding of columellar necrosis, seen in 5 patients (5.5%), occurred as early as 10 days after nasal CPAP use. Incidence of intranasal findings attributed to CPAP use, in the 182 nostrils examined, included ulceration in 6 nasal cavities (3.3%), granulation in 3 nasal cavities (1.6%), and vestibular stenosis in 4 nasal cavities (2.2%). Intranasal complications were seen as early as 8 to 9 days after nasal CPAP administration. Nasal complications from CPAP were associated with lower Apgar scores at 1 (P = .02) and 5 (P = .06) minutes. Conclusions External or internal complications of nasal CPAP can be relatively frequent (13.2%) and can occur early, and patients with lower Apgar scores may be at higher risk. Close surveillance for potential complications should be considered during nasal CPAP use. PMID:20231649

Cannula Versus Sharp Needle for Placement of Soft Tissue Fillers: An Observational Cadaver Study.

PubMed

van Loghem, Jani A J; Humzah, Dalvi; Kerscher, Martina

2017-12-13

Soft-tissue fillers have become important products for facial rejuvenation. Deep fat compartments and facial bones lose volume during the natural aging process. For the most natural-looking results, deep volumetric injections at strategic sites are therefore preferred. Supraperiosteal placement is performed with a sharp needle or a non-traumatic cannula. The primary objective was to determine whether there is a difference in precision between supraperiosteal placement with a sharp needle compared with a non-traumatic cannula in cadaver specimens. A secondary objective was to analyze the safety profiles of both injection techniques. Cadaver heads were injected with dye material and soft-tissue fillers at multiple aesthetic facial sites on the supraperiosteum and subsequently dissected for observation of dye and filler placement. The non-traumatic cannula technique resulted in product being confined to the deep anatomic layers. In contrast, with the sharp needle technique, material was placed in multiple anatomic layers, from the periosteum to more superficial skin layers. For both techniques results were consistent for all facial sites. Although direct extrapolation from cadavers to the in vivo situation cannot be made, cannulae showed more precision in placement of product. With the sharp needle, the material was injected on the periosteum, and then migrated in a retrograde direction along the trajectory of the needle path, ending up in multiple anatomic layers. The sharp needle technique also showed a higher complication risk with intra-arterial injection occurring, even though the needle tip was positioned on the periosteum and the product was injected with the needle in constant contact with the periosteum. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Separation of opioid from nonopioid mediation of affect in neonatal rats: nonopioid mechanisms mediate maternal contact influences.

PubMed

Blass, E M; Fillion, T J; Weller, A; Brunson, L

1990-08-01

A causal distinction is established in infant Norway rats between opioid- and nonopioid-mediated determinants of behavior. Contact influences are shown to be mediated by nonopioid pathways, whereas gustatory influences are shown to be opioid mediated. Specifically, naltrexone (0.5 and 1.0 mg/kg) did not at all diminish quieting exerted by contact with an anesthetized dam but completely reversed the quieting effects of morphine in isolated rats. Naloxone (5 mg/kg) did not affect the latencies with which nondeprived or 8-hr deprived rats 9, 12, 15, and 18 days of age attached to the nipples of anesthetized dams, nor did naloxone (5 and 10 mg/kg) cause any systematic change in nipple attachment in 10- and 18-day-old rats that had been deprived of their dam for either 0, 8, or 24 hr. In a 3rd experiment, naloxone (5 mg/kg) did not significantly reduce milk intake by 9-, 12-, 15-, or 18-day-old rats from the nipple when milk letdown was induced by oxytocin. Moreover, naloxone (5 and 10 mg/kg) did not reduce milk intake in Day-10 rats that, while suckling, received milk via a cannula placed in the posterior portion of the tongue at the level of the intermolar eminence or in rats that obtained milk directly from their awake mother. In contrast, milk intake was significantly reduced by naltrexone (0.25-1.0 mg/kg) in Day-10 rats that obtained milk (a) by licking it off a saturated substrate or (b) through an indwelling cannula located in the anterior portion of the lower jaw. (Milk delivered at this placement is thought to engage feeding systems by its taste and texture.) In a final set of experiments in Day-10 rats, intake of milk delivered via anterior jaw cannulae was reduced by naloxone (5 and 10 mg/kg) in rats that were either isolated, in contact with an anesthetized dam, or attached to her nipples. On the basis of resistance to naloxone and naltrexone administration, these experiments demonstrate that behavioral influences of the tactile (and possibly olfactory) qualities of the mother are not mediated by opioid systems. Implications for understanding the means through which mothers can influence their young and the infantile mediators of these maternal influences are discussed.

Two-Stage Rumen Cannulation Technique in Dairy Cows.

PubMed

Martineau, Roger; Proulx, Julien G; Côrtes, Cristiano; Brito, Andre F; Duffield, Todd F

2015-07-01

To describe a 2-stage rumen cannulation technique for dairy cows. Case series. 172 dairy cows from 2 research institutions. The 2-stage rumen cannulation technique first exteriorized a rumen segment within a wooden clamp, fixing the clamp to the skin with 6 mattress sutures. After 1 week, the necrotic rumen segment was removed, leaving a rumen fistula in which a 7.5 cm cannula was inserted. This was replaced by a 10 cm cannula a further 1 week later. The surgery took an average of 30 minutes. At least 1 assistant is required for the technique. The overall complication frequency was 7/172 (4%). One cow and 1 heifer aborted less than 10 days after surgery. Two late-pregnant heifers died from peritonitis after insertion of the 7.5 cm cannula because of incomplete adhesion of the rumen to the abdominal wall. The exteriorized rumen segment slipped back in the abdomen in 3 cows but was successfully re-clamped prior to insertion of the 7.5 cm cannula. A high success rate was achieved with this 2-stage cannulation technique. Postoperative complications were attributed to delayed adhesion of the rumen, perhaps because of stress-related factors (e.g., transport, mixing with other animals, transition period). © 2015 by The American College of Veterinary Surgeons.

Neuropeptides in Experimental Head Injury.

DTIC Science & Technology

1986-02-28

administered through a cannula placed in the inferior vena cava via the femoral vein. The femoral artery was cannulated (PE90) to monitor heart rate...placed in the left femoral artery for withdrawal of reference arterial samples. A PE9O cannula with a slightly flared end was placed in the left atrium ...the left atrium over approximately 30 seconds. The injection of this number of microspheres insured that tissue samples over 250 mg would contain at

Laparoscopic access with a visualizing trocar.

PubMed

Wolf, J S

1997-01-01

Although useful in most situations, there are several inherent disadvantages of the standard laparoscopic access techniques of Veress needle insertion and Hasson-type cannula placement. Veress needle placement may be hazardous in patients at high risk for intraabdominal adhesions and difficult in patients who are obese. The usual alternative, the Hasson-type cannula, often does not provide a good gas seal. As another option, the use of a visualizing trocar (OPTIVIEW) has proven to be effective in the initial experience at the University of Michigan. The inner trocar of the visualizing trocar is hollow except for a clear plastic conical tip with two external ridges. The trocar-cannula assembly is passed through tissue layers to enter the operative space under direct vision from a 10-mm zero-degree laparoscope placed into the trocar. Results suggest that this technique is an excellent alternative to Veress needle placement when laparoscopic access is likely to be hazardous or difficult.

The effects of octanol on penicillin induced epileptiform activity in rats: an in vivo study.

PubMed

Bostanci, M Omer; Bağirici, Faruk

2006-10-01

The common features of all types of epilepsy are the synchronized and uncontrolled discharges of nerve cell assemblies. The reason for the pathologically synchronized discharges of the neuron is not exactly known yet. Recent reports claim that gap junctions have a critical role in neuronal synchronization. The present study was planned to investigate the effects of octanol, a gap junction blocker, on penicillin-induced experimental epilepsy. Permanent screw electrodes allowing EEG monitoring from conscious animals and permanent cannula providing the administration of the substances to the brain ventricle were placed into the cranium of rats under general anesthesia. After the postoperative recovery period, epileptiform activity was generated by injecting 300 IU crystallized penicillin through the ventricular cannula. When epileptiform activity, monitored from a digital recording system, reached at its maximum intensity, octanol was applied in the same way as penicillin administered. Application of octanol caused an inhibition in the epileptiform activity. Vehicle solution alone did not affect the epileptiform activity. Results of this study suggest that the blockade of electrical synapses may contribute to the prevention and amelioration of epileptic activity. Production of gap junction blockers selective for connexin types is needed. Further studies on the differential roles of gap junctions on certain epileptiform activities are required.

Image-guided intracranial cannula placement for awake in vivo microdialysis in nonhuman primates

NASA Astrophysics Data System (ADS)

Chen, Antong; Bone, Ashleigh; Hines, Catherine D. G.; Dogdas, Belma; Montgomery, Tamara O.; Michener, Maria; Winkelmann, Christopher T.; Ghafurian, Soheil; Lubbers, Laura S.; Renger, John; Bagchi, Ansuman; Uslaner, Jason M.; Johnson, Colena; Zariwala, Hatim A.

2016-03-01

Intracranial microdialysis is used for sampling neurochemicals and large peptides along with their metabolites from the interstitial fluid (ISF) of the brain. The ability to perform this in nonhuman primates (NHP) e.g., rhesus could improve the prediction of pharmacokinetic (PK) and pharmacodynamics (PD) action of drugs in human. However, microdialysis in rhesus brains is not as routinely performed as in rodents. One challenge is that the precise intracranial probe placement in NHP brains is difficult due to the richness of the anatomical structure and the variability of the size and shape of brains across animals. Also, a repeatable and reproducible ISF sampling from the same animal is highly desirable when combined with cognitive behaviors or other longitudinal study end points. Toward that end, we have developed a semi-automatic flexible neurosurgical method employing MR and CT imaging to (a) derive coordinates for permanent guide cannula placement in mid-brain structures and (b) fabricate a customized recording chamber to implant above the skull for enclosing and safeguarding access to the cannula for repeated experiments. In order to place the intracranial guide cannula in each subject, the entry points in the skull and the depth in the brain were derived using co-registered images acquired from MR and CT scans. The anterior/posterior (A/P) and medial-lateral (M/L) rotation in the pose of the animal was corrected in the 3D image to appropriately represent the pose used in the stereotactic frame. An array of implanted fiducial markers was used to transform stereotactic coordinates to the images. The recording chamber was custom fabricated using computer-aided design (CAD), such that it would fit the contours of the individual skull with minimum error. The chamber also helped in guiding the cannula through the entry points down a trajectory into the depth of the brain. We have validated our method in four animals and our results indicate average placement error of cannula to be 1.20 +/- 0.68 mm of the targeted positions. The approach employed here for derivation of the coordinates, surgical implantation and post implant validation is built using traditional access to surgical and imaging methods without the necessity of intra-operative imaging. The validation of our method lends support to its wider application in most nonhuman primate laboratories with onsite MR and CT imaging capabilities.

Phlebitis: treatment, care and prevention.

PubMed

Higginson, Ray; Parry, Andrew

Peripheral venous catheter-associated phlebitis is caused by inflammation to the vein at a cannula access site. It can have a mechanical, chemical or infectious cause. Good practice when inserting a cannula, including appropriate choice of device and site, can help to prevent phlebitis. Good infection control techniques are also vital in preventing the condition. There are two phlebitis scoring systems, which should be used in routine practice to identify and treat early signs of the Peripheral venous cannulation

Aspiration of breast abscess through wide bore 14-gauge intravenous cannula.

PubMed

Afridi, Shahida Parveen; Alam, Shams Nadeem; Ainuddin, Saman

2014-10-01

To aspirate breast abscess through a wide bore (14-gauge) intravenous (I/V) cannula and determine its efficacy in terms of the number of recurrences and number of aspirations. Case series. Dow University of Health Sciences and Civil Hospital and Bantva Hospital, Karachi, Pakistan, from January 2009 to December 2011. Patients with breast abscesses confirmed on ultrasound without skin ulceration were selected. The soft area of breast abscess with positive fluctuation was marked and fixed with index finger and thumb. A 14-gauge cannula was inserted. Pus was aspirated through a 50 cc syringe, repeated till no aspirate could be obtained. All patients were followed weekly for 4 weeks, clinically for size of lump, local tenderness and temperature, while complete resolution was confirmed on ultrasound, as resolution of the lesion. A total of 55 patients were included in this study. Mean age was 29 ± 5.58 years while ranging from 20 - 40 years. Complete resolution of abscess was seen in 31 (56.4%) cases by single aspiration. Second aspiration was required in 24 (43.6%) patients and third aspiration in single setting was required in one case only. Recurrence after the second aspiration occurred in 08 (14.5%). Incision drainage was required in 7 (12.7%) patients. Percutaneous aspiration of breast abscess through a wide bore (14-gauge) I/V cannula is a simple alternative to incision and drainage.

Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin.

PubMed

Díaz-Lobato, Salvador; Folgado, Miguel Angel; Chapa, Angel; Mayoralas Alises, Sagrario

2013-12-01

The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years, high-flow oxygen therapy and active humidification devices have been introduced, and emerging evidence suggests that high-flow oxygen may be effective in various clinical settings, such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in do-not-intubate patients, in patients with chronic cough and copious secretions, pulmonary fibrosis, or cancer, in critical areas and the emergency department. We report on a patient with amyotrophic lateral sclerosis who arrived at the emergency department with acute hypercapnic respiratory failure. She did not tolerate NIV and refused intubation, but was treated successfully with heated, humidified oxygen via high-flow nasal cannula. Arterial blood analysis after an hour on high-flow nasal cannula showed improved pH, P(aCO2), and awareness. The respiratory acidosis was corrected, and she was discharged after 5 days of hospitalization. Her response to high-flow nasal cannula was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy.

Noninvasive blood-flow meter using a curved cannula with zero compensation for an axial flow blood pump.

PubMed

Kosaka, Ryo; Fukuda, Kyohei; Nishida, Masahiro; Maruyama, Osamu; Yamane, Takashi

2013-01-01

In order to monitor the condition of a patient using a left ventricular assist system (LVAS), blood flow should be measured. However, the reliable determination of blood-flow rate has not been established. The purpose of the present study is to develop a noninvasive blood-flow meter using a curved cannula with zero compensation for an axial flow blood pump. The flow meter uses the centrifugal force generated by the flow rate in the curved cannula. Two strain gauges served as sensors. The first gauges were attached to the curved area to measure static pressure and centrifugal force, and the second gauges were attached to straight area to measure static pressure. The flow rate was determined by the differences in output from the two gauges. The zero compensation was constructed based on the consideration that the flow rate could be estimated during the initial driving condition and the ventricular suction condition without using the flow meter. A mock circulation loop was constructed in order to evaluate the measurement performance of the developed flow meter with zero compensation. As a result, the zero compensation worked effectively for the initial calibration and the zero-drift of the measured flow rate. We confirmed that the developed flow meter using a curved cannula with zero compensation was able to accurately measure the flow rate continuously and noninvasively.

Evaluation of different diameter arterial tubing and arterial cannulae in simulated neonatal/pediatric cardiopulmonary bypass circuits.

PubMed

Wang, Shigang; Rosenthal, Tami; Kunselman, Allen R; Ündar, Akif

2015-01-01

The objective of this study is to evaluate three different diameters of arterial tubing and three diameters of arterial cannulae in terms of pressure drop, and hemodynamic energy delivery in simulated neonatal/pediatric cardiopulmonary bypass (CPB) circuits. The CPB circuit consisted of a Terumo Capiox Baby FX05 oxygenator (Terumo Corporation, Tokyo, Japan), arterial tubing (1/4 in, 3/16 in, or 1/8 in × 150 cm), and a Medtronic Bio-Medicus arterial cannula (8, 10, or 12 Fr; Medtronic, Inc., Minneapolis, MN, USA). The pseudo patient's pressure was maintained at 50 mm Hg. The circuit was primed using lactated Ringer's solution and heparinized packed human red blood cells (hematocrit 30%). Trials were conducted at different flow rates and temperatures (35 and 28°C). Flow and pressure data were collected using a custom-based data acquisition system. Using 8 Fr arterial cannula at 500 mL/min, small diameter arterial tubing generated higher circuit pressure (294.6 ± 0.1 mm Hg [1/8 in], 213.5 ± 0.5 mm Hg [3/16 in], 208.4 ± 0.4 mm Hg [1/4 in] at 35°C) and arterial line pressure drop (158.3 ± 0.1 mm Hg [1/8 in], 79.6 ± 0.1 mm Hg [3/16 in], 62.1 ± 0.1 mm Hg [1/4 in] at 35°C). Using 10 Fr arterial cannula at 1000 mL/min, pre-oxygenator pressures were 266.8 ± 0.2 mm Hg (3/16 in) and 248.0 ± 0.3 mm Hg (1/4 in); arterial line pressure drops were 111.6 ± 0.0 mm Hg (3/16 in) and 74.0 ± 0.1 mm Hg (1/4 in) at 35°C. When using 12 Fr arterial cannula at 1500 mL/min, preoxygenator pressures reached 324.4 ± 0.3 mm Hg (3/16 in) and 302.5 ± 0.4 mm Hg (1/4 in); arterial line pressure drops were 154.0 ± 0.1 mm Hg (3/16 in) and 92.0 ± 0.2 mm Hg (1/4 in) at 35°C. Pressure drops across arterial line tubing were main CPB circuit pressure drops. High flow rate, hypothermia, small diameter arterial tubing. and arterial cannula created more hemodynamic energy at the preoxygenator site, but energy loss across CPB circuit also increased. Although small diameter (<1/4 in ID) arterial tubing may decrease total CPB priming volume, it also led to significantly higher circuit pressure, higher pressure drop, and more hemodynamic energy loss across CPB circuit. Larger diameter arterial cannula had less pressure drop and allowed more hemodynamic energy delivery to the patient. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Neurotensin decreases pepsin output and gastrointestinal motility in chickens.

PubMed

Degolier, T F; Duke, G E; Carraway, R E

1997-10-01

Two experiments were conducted to determine the effect of neurotensin on gastric secretion and gastrointestinal motility in conscious chickens. Chickens were surgically fitted with a cannula to collect secretions from the proventriculus and strain gauge transducers sutured to the gizzard, duodenum, and ileum in order to detect contractions. Peripheral intravenous infusion of physiological levels of neurotensin inhibited pepsin output from the proventriculus, but had no effect on the volume or pH of gastric secretions. Neurotensin also inhibited both the frequency and strength of gastrointestinal contractions when compared to motility patterns following infusion of isotonic 0.9% (wt/vol) saline. The frequency of occurrence of small intestinal refluxes was not affected by neurotensin. These results coupled with our earlier work, which demonstrated that neurotensin is released by the presence of oleic acid in the duodenum, indicate that neurotensin may function as an enterogastrone released by lipids in the gastrointestinal tract of the chicken. This overall inhibitory effect of neurotensin on the avian gut indicates that it is involved in the postprandial regulation of digestion, especially lipid digestion.

LAPAROSCOPIC OVARIECTOMY IN THE ASIATIC BLACK BEAR (URSUS THIBETANUS) WITH THE USE OF THE SONICISION™ DEVICE.

PubMed

Lee, Seung Y; Jeong, Dong H; Seok, Seong H; Yang, Jeong J; Kong, Ju Y; Park, Se J; Jin, So Y; Kim, Min H; Lee, Bae K; Lee, Hee C; Yeon, Seong C

2017-03-01

Laparoscopic ovariectomy was performed in two Asiatic black bears ( Ursus thibetanus ). Bears were placed in a 20° Trendelenburg position on a surgical table. A three-portal technique was used. A camera port was established 10 cm caudal to the umbilicus with a 5-mm cannula. Two instrument ports were made 1 cm caudal to the umbilicus with a 5-mm cannula and 8 cm caudal to the camera port with a 12-mm cannula, respectively. The suspensory ligament, ovarian vasculature, and uterine horn tip were progressively dissected following coagulation with the Sonicision™ cordless ultrasonic dissection device. The resected ovary was exteriorized through the 12-mm instrument portal site but enlarged to a 2-cm incision length. The abdominal musculature, subcutaneous tissue, and skin of the portal sites were closed separately. Total surgical time was 113 min (Bear A) and 49 min (Bear B), and no postoperative complications were encountered. This is the first report of laparoscopic ovariectomy in the Asiatic black bear.

Unsteady flow in the nasal cavity with high flow therapy measured by stereoscopic PIV

NASA Astrophysics Data System (ADS)

Spence, C. J. T.; Buchmann, N. A.; Jermy, M. C.

2012-03-01

Nasal high flow (NHF) cannulae are used to deliver heated and humidified air to patients at steady flows ranging from 5 to 50 l/min. In this study, the flow velocities in the nasal cavity across the complete respiratory cycle during natural breathing and with NHF has been mapped in vitro using time-resolved stereoscopic particle image velocimetry (SPIV). An anatomically accurate silicone resin model of a complete human nasal cavity was constructed using CT scan data and rapid prototyping. Physiological breathing waveforms were reproduced in vitro using Reynolds and Womersley number matching and a piston pump driven by a ball screw and stepper motor. The flow pattern in the nasal cavity with NHF was found to differ significantly from natural breathing. Velocities of 2.4 and 3.3 ms-1 occurred in the nasal valve during natural breathing at peak expiration and inspiration, respectively; however, on expiration, the maximum velocity of 3.8 ms-1 occurred in the nasopharynx. At a cannula flow rate of 30 l/min, maximal velocities of 13.6 and 16.5 ms-1 at peak expiration and inspiration, respectively, were both located in the cannula jet within the nasal valve. Results are presented that suggest the quasi-steady flow assumption is invalid in the nasal cavity during natural breathing; however, it was valid with NHF. Cannula flow has been found to continuously flush the nasopharyngeal dead space, which may enhance carbon dioxide removal and increase oxygen fraction.

A new approach in the management of the hydrocele with a silicone catheter.

PubMed

Arslan, Mehmet; Kilinç, Mehmet; Yilmaz, Kadir; Oztürk, Ahmet

2004-01-01

To describe a new alternative technique to overcome several disadvantages of previous techniques to repair idiopathic hydrocele. Idiopathic hydrocele, which causes scrotal enlargement and discomfort for patients, is an abnormal fluid collection between the parietal and visceral layers of tunica vaginalis of the testis. Surgical and sclerotherapy treatments have previously been used to treat this problem. Forty-five patients with hydrocele (aged 19 to 67 years) underwent an alternative procedure using a silicone catheter 15 to 20 cm in length in which holes had been made to enable flow of the hydrocele fluid from the parietal layer of the tunica vaginalis to the surrounding scrotal tissue. After an incision of approximately 5 mm on the scrotal wall with a scalpel knife, a cannula was pushed through the hydrocele sac with a gentle rotation until reaching the upper scrotal wall. A silicone catheter with holes was passed through the cannula to the point of the incision by way of the cannula. At the end, both tips of the catheter were sutured. During the procedure, the hydrocele fluid was emptied using an angiocatheter before the cannula was removed. The results of this study indicate that this procedure does not require dissection, incision, or manipulation of the scrotal contents during treatment. It also resulted in a low rate of recurrence during the 1 to 3 years of follow-up. Additionally, the procedure has minimal complications and requires a short time, only about 15 minutes.

A qualitative analysis of how parents assess acute pain in young children

PubMed Central

Loopstra, Candice; Herd, David

2015-01-01

An accurate and comprehensive pain assessment is crucial for adequate pain management in pre- and early verbal children during painful medical procedures. This study used an inductive approach to explore the processes involved in parental pain assessment and to develop a new model of Parental Assessment of Acute Child Pain. Participants were 19 parents of children aged under 3 years who had previously or were potentially about to experience an intravenous cannula or nasogastric tube insertion. Parental affect regulation, while witnessing their child in acute pain/distress, appeared to be critical to the processes involved in assessing their child’s pain. PMID:28070349

Perilymph pharmacokinetics of marker applied through a cochlear implant in guinea pigs

PubMed Central

Hartsock, Jared; Gill, Ruth; Smyth, Daniel; Kirk, Jonathon; Verhoeven, Kristien

2017-01-01

Patients undergoing cochlear implantation could benefit from a simultaneous application of drugs into the ear, helping preserve residual low-frequency hearing and afferent nerve fiber populations. One way to apply drugs is to incorporate a cannula into the implant, through which drug solution is driven. For such an approach, perilymph concentrations achieved and the distribution in the ear over time have not previously been documented. We used FITC-labeled dextran as a marker, delivering it into perilymph of guinea pigs at 10 or 100 nL/min though a cannula incorporated into a cochlear implant with the outlet in the mid basal turn. After injections of varying duration (2 hours, 1 day or 7 days) perilymph was collected from the cochlear apex using a sequential sampling technique, allowing dextran levels and gradients along scala tympani to be quantified. Data were interpreted quantitatively using computer simulations of the experiments. For injections of 2 hours duration, dextran levels were critically influenced by the presence or absence of fluid leakage at the cochleostomy site. When the cochleostomy was fluid-tight, substantially higher perilymph levels were achieved at the injection site, with concentration declining along scala tympani towards the apex. Contrary to expectations, large dextran gradients along scala tympani persisted after 24 hours of sustained injection and were still present in some animals after 7 days injection. Functional changes associated with implantation and dextran delivery, and the histological state of the implant and cannula were also documented. The persistent longitudinal gradients of dextan along the ear were not readily explained by computer simulations of the experiments based on prior pharmacokinetic data. One explanation is that inner ear pharmacokinetics are altered in the period after cochlear implantation, possibly by a permeabilization of the blood-labyrinth barrier as part of the immune response to the implant. PMID:28817653

Safety and tolerability of MRI-guided infusion of AAV2-hAADC into the mid-brain of nonhuman primate

PubMed Central

Sebastian, Waldy San; Kells, Adrian P; Bringas, John; Samaranch, Lluis; Hadaczek, Piotr; Ciesielska, Agnieszka; Macayan, Michael J; Pivirotto, Phillip J; Forsayeth, John; Osborne, Sheryl; Wright, J Fraser; Green, Foad; Heller, Gregory; Bankiewicz, Krystof S

2014-01-01

Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare, autosomal-recessive neurological disorder caused by mutations in the DDC gene that leads to an inability to synthesize catecholamines and serotonin. As a result, patients suffer compromised development, particularly in motor function. A recent gene replacement clinical trial explored putaminal delivery of recombinant adeno-associated virus serotype 2 vector encoding human AADC (AAV2-hAADC) in AADC-deficient children. Unfortunately, patients presented only modest amelioration of motor symptoms, which authors acknowledged could be due to insufficient transduction of putamen. We hypothesize that, with the development of a highly accurate MRI-guided cannula placement technology, a more effective approach might be to target the affected mid-brain neurons directly. Transduction of AADC-deficient dopaminergic neurons in the substantia nigra and ventral tegmental area with locally infused AAV2-hAADC would be expected to lead to restoration of normal dopamine levels in affected children. The objective of this study was to assess the long-term safety and tolerability of bilateral AAV2-hAADC MRI-guided pressurized infusion into the mid-brain of nonhuman primates. Animals received either vehicle, low or high AAV2-hAADC vector dose and were euthanized 1, 3, or 9 months after surgery. Our data indicate that effective mid-brain transduction was achieved without untoward effects. PMID:25541617

Passive control of a biventricular assist device with compliant inflow cannulae.

PubMed

Gregory, Shaun David; Pearcy, Mark John; Timms, Daniel

2012-08-01

Rotary ventricular assist device (VAD) support of the cardiovascular system is susceptible to suction events due to the limited preload sensitivity of these devices. This may be of particular concern with rotary biventricular support (BiVAD) where the native, flow balancing Starling response is diminished in both ventricles. The reliability of sensor and sensorless-based control systems which aim to control VAD flow based on preload has limitations, and, thus, an alternative solution is desired. This study introduces a compliant inflow cannula (CIC) which could improve the preload sensitivity of a rotary VAD by passively altering VAD flow depending on preload. To evaluate the design, both the CIC and a standard rigid inflow cannula were inserted into a mock circulation loop to enable biventricular heart failure support using configurations of atrial and ventricular inflow, and arterial outflow cannulation. A range of left (LVAD) and right VAD (RVAD) rotational speeds were tested as well as step changes in systemic/pulmonary vascular resistance to alter relative preloads, with resulting flow rates recorded. Simulated suction events were observed, particularly at higher VAD speeds, during support with the rigid inflow cannula, while the CIC prevented suction events under all circumstances. The compliant section passively restricted its internal diameter as preload was reduced, which increased the VAD circuit resistance and thus reduced VAD flow. Therefore, a CIC could potentially be used as a passive control system to prevent suction events in rotary left, right, and biventricular support. © 2012, Copyright the Authors. Artificial Organs © 2012, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Arthroscopic ankle arthrodesis with intra-articular distraction.

PubMed

Kim, Hyong Nyun; Jeon, June Young; Noh, Kyu Cheol; Kim, Hong Kyun; Dong, Quanyu; Park, Yong Wook

2014-01-01

Arthroscopic ankle arthrodesis has shown high rates of union comparable to those with open arthrodesis but with substantially less postoperative morbidity, shorter operative times, less blood loss, and shorter hospital stays. To easily perform arthroscopic resection of the articular cartilage, sufficient distraction of the joint is necessary to insert the arthroscope and instruments. However, sometimes, standard noninvasive ankle distraction will not be sufficient in post-traumatic ankle arthritis, with the development of arthrofibrosis and joint contracture after severe ankle trauma. In the present report, we describe a technique to distract the ankle joint by inserting a 4.6-mm stainless steel cannula with a blunt trocar inside the joint. The cannula allowed sufficient intra-articular distraction, and, at the same time, a 4.0-mm arthroscope can be inserted through the cannula to view the joint. Screws can be inserted to fix the joint under fluoroscopic guidance without changing the patient's position or removing the noninvasive distraction device and leg holder, which are often necessary during standard arthroscopic arthrodesis with noninvasive distraction. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Interventional magnetic resonance imaging-guided cell transplantation into the brain with radially branched deployment.

PubMed

Silvestrini, Matthew T; Yin, Dali; Martin, Alastair J; Coppes, Valerie G; Mann, Preeti; Larson, Paul S; Starr, Philip A; Zeng, Xianmin; Gupta, Nalin; Panter, S S; Desai, Tejal A; Lim, Daniel A

2015-01-01

Intracerebral cell transplantation is being pursued as a treatment for many neurological diseases, and effective cell delivery is critical for clinical success. To facilitate intracerebral cell transplantation at the scale and complexity of the human brain, we developed a platform technology that enables radially branched deployment (RBD) of cells to multiple target locations at variable radial distances and depths along the initial brain penetration tract with real-time interventional magnetic resonance image (iMRI) guidance. iMRI-guided RBD functioned as an "add-on" to standard neurosurgical and imaging workflows, and procedures were performed in a commonly available clinical MRI scanner. Multiple deposits of super paramagnetic iron oxide beads were safely delivered to the striatum of live swine, and distribution to the entire putamen was achieved via a single cannula insertion in human cadaveric heads. Human embryonic stem cell-derived dopaminergic neurons were biocompatible with the iMRI-guided RBD platform and successfully delivered with iMRI guidance into the swine striatum. Thus, iMRI-guided RBD overcomes some of the technical limitations inherent to the use of straight cannulas and standard stereotactic targeting. This platform technology could have a major impact on the clinical translation of a wide range of cell therapeutics for the treatment of many neurological diseases.

Protein Synthesis Inhibition in the Peri-Infarct Cortex Slows Motor Recovery in Rats.

PubMed

Schubring-Giese, Maximilian; Leemburg, Susan; Luft, Andreas Rüdiger; Hosp, Jonas Aurel

2016-01-01

Neuroplasticity and reorganization of brain motor networks are thought to enable recovery of motor function after ischemic stroke. Especially in the cortex surrounding the ischemic scar (i.e., peri-infarct cortex), evidence for lasting reorganization has been found at the level of neurons and networks. This reorganization depends on expression of specific genes and subsequent protein synthesis. To test the functional relevance of the peri-infarct cortex for recovery we assessed the effect of protein synthesis inhibition within this region after experimental stroke. Long-Evans rats were trained to perform a skilled-reaching task (SRT) until they reached plateau performance. A photothrombotic stroke was induced in the forelimb representation of the primary motor cortex (M1) contralateral to the trained paw. The SRT was re-trained after stroke while the protein synthesis inhibitor anisomycin (ANI) or saline were injected into the peri-infarct cortex through implanted cannulas. ANI injections reduced protein synthesis within the peri-infarct cortex by 69% and significantly impaired recovery of reaching performance through re-training. Improvement of motor performance within a single training session remained intact, while improvement between training sessions was impaired. ANI injections did not affect infarct size. Thus, protein synthesis inhibition within the peri-infarct cortex impairs recovery of motor deficits after ischemic stroke by interfering with consolidation of motor memory between training sessions but not short-term improvements within one session.

[Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomized controlled trial].

PubMed

Seliem, Wael; Sultan, Amira M

2018-04-04

The aim of our study is to evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by respiratory syncytial virus. We have conducted a prospective randomized controlled study. All patients fulfilled inclusion criteria were randomized to either heliox (79:21) or air via NC at 2 L/min for a continuous 24hours. Measurements were taken at baseline, after 2hours and at the end of the 24hours. We have included 104 patients into our study. The MCA-S did not show any significant difference between the two groups after 2hours 4.3 vs. 4.1 (P =.78), or at 24hours after 4.2 vs. 4.3 (P =.89). No difference was found in the proportion of participants progressed to MV, n-CPAP or oxygen via nasal cannula (RR 1.0, 0.86 and 0.89) (P= 1.0, .77 and .73). There was no notable reduction in length of treatment in Heliox group 2.42 days vs. 2.79 days in air group P =.65. The in oxygen saturation, PaO 2 , and PaCO 2 did not to have any statistical difference between the two studied groups after 2hours and 24hours of treatment. Our data showed absence of any beneficial effect of heliox in a concentration (79:21) delivered through low flow nasal cannula in terms of respiratory distress improvement in infants with RSV acute bronchiolitis. Copyright © 2018. Publicado por Elsevier España, S.L.U.

Reduction of Serious Adverse Events Demanding Study Exclusion in Model Development: Extracorporeal Life Support Resuscitation of Ventricular Fibrillation Cardiac Arrest in Rats.

PubMed

Warenits, Alexandra-Maria; Sterz, Fritz; Schober, Andreas; Ettl, Florian; Magnet, Ingrid Anna Maria; Högler, Sandra; Teubenbacher, Ursula; Grassmann, Daniel; Wagner, Michael; Janata, Andreas; Weihs, Wolfgang

2016-12-01

Extracorporeal life support is a promising concept for selected patients in refractory cardiogenic shock and for advanced life support of persistent ventricular fibrillation cardiac arrest. Animal models of ventricular fibrillation cardiac arrest could help to investigate new treatment strategies for successful resuscitation. Associated procedural pitfalls in establishing a rat model of extracorporeal life support resuscitation need to be replaced, refined, reduced, and reported.Anesthetized male Sprague-Dawley rats (350-600 g) (n = 126) underwent cardiac arrest induced with a pacing catheter placed into the right ventricle via a jugular cannula. Rats were resuscitated with extracorporeal life support, mechanical ventilation, defibrillation, and medication. Catheter and cannula explantation was performed if restoration of spontaneous circulation was achieved. All observed serious adverse events (SAEs) occurring in each of the experimental phases were analyzed.Restoration of spontaneous circulation could be achieved in 68 of 126 rats (54%); SAEs were observed in 76 (60%) experiments. Experimental procedures related SAEs were 62 (82%) and avoidable human errors were 14 (18%). The most common serious adverse events were caused by insertion or explantation of the venous bypass cannula and resulted in lethal bleeding, cannula dislocation, or air embolism.Establishing an extracorporeal life support model in rats has confronted us with technical challenges. Even advancements in small animal critical care management over the years delivered by an experienced team and technical modifications were not able to totally avoid such serious adverse events. Replacement, refinement, and reduction reports of serious adverse events demanding study exclusions to avoid animal resources are missing and are presented hereby.

Comparison of design features and mechanical properties of commercially available Veress needles.

PubMed

Schramel, Johannes P; Kindslehner, Angelika; Bockstahler, Barbara A; Dupré, Gilles P

2017-10-01

To compare design features and mechanical properties of 13 commercially available Veress needles (VN). In vitro biomechanical study. Veress needles from 9 manufacturers (6 reusable, 6 disposable, and 1 with a reusable stylet combined with a disposable cannula) were included in the study. Veress needles are designed with a spring-loaded stylet to protect the tip of the cannula following insertion into the abdomen. Stylet forces were measured with a scale in a test jig by moving the stylet in 0.5 mm steps into the hollow cannula. Forces and spring rates were derived from force-displacement plots. Mass, mechanical dimensions, and the bevel angle and geometry were assessed. Differences between VN models were analyzed with a univariate analysis of variance. Results are reported as mean ± SD or median (range). Physical and mechanical parameters differed between models. The exposed stylet length was 3.5 mm (2-7). Three bevel geometries (bias, lancet type, and back-cut) with angles between 20° and 40° were identified. Reusable VN weigh more (24.9 ± 2.2 g) than disposable designs (6.0 ± 2.3 g). The mean values for the spring rate and the residual stylet force were 0.23 ± 0.08 Nmm -1 and 0.94 ± 0.28 N, respectively. The mean force required to move the stylet to the cannula tip was 1.81 ± 0.29 N and 2.77 ± 0.54 N to move to the proximal end of the bevel. Commercially available VN use diverse bevel geometries and have different mechanical characteristics. Studies investigating laparoscopic entry complications should explicitly report the type of VN model used. © 2017 The American College of Veterinary Surgeons.

[Treatment of acute and chronic laryngeal and tracheal stenoses in the 19th and beginning of the 20th century by tracheotomy, coniotomy, intubation and dilatation. Pictures from the history of otorhinolaryngology illustrated by instruments from the collection of the Ingolstadt Medical History Museum].

PubMed

Feldmann, H

1995-04-01

Although tracheotomy had been described in the Middle Ages and especially in the 17th century in writings (Fabricius d'Aquapendente 1620) and illustrations (Scultetus 1645), there was hardly any possibility of actually performing this operation as a life-saving intervention until the middle of the 19th century. It was only after suitable cannulae had been introduced by Trousseau in 1851 (double cannula with removeable insert) that tracheotomy became a routine procedure, and it was immediately carried out in a great many cases of diphtheria, croup, typhus, and lues, which often caused critical dispnea. Within the following 25 years, all technical modifications of cannulae were devised that are in use up to this day: the flap valve for the artificial larynx (1861), inflatable cuff (1871), and extra long flexible cannula. Beginning in 1885, O'Dwyer's method of intubation became established as an alternative to tracheotomy. Both procedures, like the underlying disease itself, frequently resulted in a permanent stenosis of the larynx or the trachea rendering decannulation impossible. Since about 1870 the treatment of these stenoses, primarily by bougienage, became an important issue in laryngology, which had just been established as a discipline in its own right. The history of this evolution and the therapeutic approaches by Schrötter in Vienna and Thost in Hamburg are described in detail, including their specially devised equipment. Apart from that, other medical aspects of historical interest around the turn of the century are mentioned, such as artificial nutrition by subcutaneous injections and tracheotomy in horses.(ABSTRACT TRUNCATED AT 250 WORDS)

Randomized pilot study to compare metal needles versus plastic cannulae in the development of complications in hemodialysis access.

PubMed

Marticorena, Rosa M; Dacouris, Niki; Donnelly, Sandra M

2018-05-01

Hemodialysis requires needle insertions every treatment. Needle injury (mechanical or hemodynamic) may cause complications (aneurysms/stenosis) that compromise dialysis delivery requiring interventions. Metal needles have a sharp slanted "V"-shaped cutting tip; plastic cannulae have a dull round tip and four side holes. Preliminary observations demonstrated a difference in intradialytic blood flow images and mean Doppler velocities at cannulation sites between the two devices. Complications from mechanical and hemodynamic trauma requiring interventions were compared in each group. In all, 33 patients (13 females and 17 new accesses) were randomized to metal group (n = 17) and plastic group (n = 16). Mechanical trauma was minimized by having five nurses performing ultrasound-guided cannulations. Complications were identified by the clinician and addressed by the interventionalists, both blinded to study participation. Patients were followed for up to 12 months. Baseline characteristics were not significant. Procedures to treat complications along cannulation segments increased from 0.41 to 1.29 per patient (metal group) and decreased from 1.25 to 0.69 per patient (plastic group; p = 0.004). The relative risks of having an intervention (relative risk = 1.5, 95% confidence interval = 0.88-2.67) and having an infiltration during hemodialysis (relative risk = 2.26, 95% confidence interval = 1.03-4.97) were higher for metal needles. Time to first intervention trended in favor of plastic cannula (p = 0.069). Cost of supplies for these interventions was approximately CAD$20,000 lower for the plastic group. Decreased burden of illness related to cannulation (less infiltrations during hemodialysis) and Qb were associated with plastic cannulae. Decreased procedure costs were suggested during the study period in the plastic group.

Efficacy of regional saturation of oxygen monitor using near-infrared spectroscopy for lower limb ischemia during minimally invasive cardiac surgery.

PubMed

Toya, Teppei; Fujita, Tomoyuki; Fukushima, Satuki; Shimahara, Yusuke; Kume, Yuta; Yamashita, Kizuku; Matsumoto, Yorihiko; Kawamoto, Naonori; Kobayashi, Junjiro

2018-06-25

Lower limb ischemia with an occlusive cannula is a potential complication of minimally invasive cardiac surgery (MICS). We evaluated intraoperative local oxygen supply-demand balance by monitoring regional saturation of oxygen (rSO 2 ) using near-infrared spectroscopy (NIRS), and analyzed the correlation between cannula size and fluctuation range of rSO 2 . Fifty-four patients undergoing MICS surgery using femoral artery cannulation from April 2015 to August 2016 were enrolled. The rSO 2 of both the cannulated and uncannulated lower limbs were measured using NIRS. The association between the decline of rSO 2 from baseline (delta-rSO 2 ) and the ratio of the cannula diameter to the femoral artery diameter (Cd/FAd) was analyzed. Of the 54 patients, 16 (30%) (Group 1) showed values over 0.65 for Cd/FAd, and the remaining 38 (70%) (Group 2) showed values under 0.65. No patient developed postoperative lower limb ischemia. No patient was treated with an ipsilateral distal perfusion cannula. There were significant differences between Group 1 and Group 2 in the decrease of rSO 2 at the point of cannulation on the cannulated limb. In the lower limb on the cannulated side, delta-rSO 2 showed a significant decrease in Group 1 compared to Group 2 (Group 1 vs Group 2: 19.9 vs 11.0%; p < 0.001). Delta-rSO 2 was significantly correlated with body surface aera (BSA), but not with gender or age. Decreasing rSO 2 correlates with the Cd/FAd index. Low BSA, Cd/Fad > 0.65 is considered as the risk factor for decline of rSO 2 in cannulated limb in MICS.

Deep inferior epigastric artery perforator flap donor-site closure with cannula-assisted, limited undermining, and progressive high-tension sutures versus standard abdominoplasty: complications, sensitivity, and cosmetic outcomes.

PubMed

Visconti, Giuseppe; Tomaselli, Federica; Monda, Anna; Barone-Adesi, Liliana; Salgarello, Marzia

2015-01-01

In deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, abdominal donor-site cosmetic and sensibility outcomes and the closure technique have drawn little attention in the literature, with many surgeons still following the principles of standard abdominoplasty. In this article, the authors report their experience with the cannula-assisted, limited undermining, and progressive high-tension suture ("CALP") technique of DIEP donor-site closure compared with standard abdominoplasty. Between December of 2008 and January of 2013, 137 consecutive women underwent DIEP flap breast reconstruction. Of these, 82 patients (between December of 2008 and November of 2011) underwent DIEP flap donor-site closure by means of standard abdominoplasty (control group) and 55 patients (from December of 2011 to January of 2013) by means of cannula-assisted, limited undermining, and progressive high-tension suture (study group). The abdominal drainage daily output, donor-site complications, abdominal skin sensitivity at 1-year follow-up, cosmetic outcomes, and patient satisfaction were recorded and analyzed statistically. Daily drainage output was significantly lower in the study group. Donor-site complications were significantly higher in the control group (37.8 percent versus 9 percent). Seroma and wound healing problems were experienced in the control group. Abdominal skin sensibility was better preserved in the study group. Overall, abdominal wall aesthetic outcomes were similar in both groups, except for scar quality (better in the study group). According to the authors' experience, cannula-assisted, limited undermining, and progressive high-tension suture should be always preferred to standard abdominoplasty for DIEP donor-site closure to reduce the complication rate to improve abdominal skin sensitivity and scar quality. Therapeutic, II.

A randomized, crossover comparison of injected buffered lidocaine, lidocaine cream, and no analgesia for peripheral intravenous cannula insertion.

PubMed

McNaughton, Candace; Zhou, Chuan; Robert, Linda; Storrow, Alan; Kennedy, Robert

2009-08-01

We compare pain and anxiety associated with peripheral intravenous (IV) cannula insertion after pretreatment with no local anesthesia, 4% lidocaine cream, or subcutaneously injected, buffered 1% lidocaine. In a randomized, crossover design, 3 peripheral IVs were inserted in each of 70 medical students or nurses. In random order, insertion sites were pretreated with nothing, lidocaine cream, or injected, buffered lidocaine. After each IV insertion, subjects recorded pain, anxiety, and preference (as patient and provider) for each technique on a 10-point numeric rating scale. Higher scores indicated greater pain, anxiety, and preference. Median pain scores (interquartile range [IQR]) were 7 (4 to 8) without local anesthesia, 3 (2 to 5) with lidocaine cream, and 1 (1 to 2) with injected, buffered lidocaine. Median anxiety scores (IQR) were 4 (2 to 7) without local anesthesia, 2 (1 to 4) with lidocaine cream, and 2 (1 to 3) with injected, buffered lidocaine. There was no detectable difference in anxiety scores between lidocaine cream and injected, buffered lidocaine. Most IV placement attempts were successful, regardless of technique. Seventy percent of subjects indicated they would "always" request buffered lidocaine for peripheral IV insertion. In adult health care providers, pain and anxiety associated with peripheral IV insertion is significantly reduced by using topical lidocaine cream or injected, buffered lidocaine. Injected, buffered lidocaine reduces IV insertion pain more than lidocaine cream, without affecting success. Adults desire the use of local anesthetic techniques for IV insertion for themselves and for their patients.

Cannulae and infection control in theatre.

PubMed

Aziz, Ann-Marie

Healthcare-associated infections (HAIs) are those that are not present or incubating when an individual enters hospital, but are acquired while in hospital. At any one time, 8% of patients have an infection acquired in hospital (Department of Health (DH), 2008). On average, an infection adds 3-10 days to the length of a patient's stay in hospital. It can cost pound4000- pound10 000 more to treat a patient with an infection than one without an infection (DH, 2008). It is not surprising, then, that attention has been focused on tackling HAIs and, in particular, in-dwelling devices such as cannulae that have a potential for causing infections.

Basal forebrain infusion of HC-3 in rats: maze learning deficits and neuropathology.

PubMed

Hurlbut, B J; Lubar, J F; Switzer, R; Dougherty, J; Eisenstadt, M L

1987-01-01

Ten adult male Sprague-Dawley rats were infused with hemicholinium (HC-3) using mini-osmotic pumps over a 14 day period through bilateral, chronically implanted cannulae in the nucleus basalis magnocellularis (nbm). Ten matched controls were infused in the same fashion with saline. HC-3 rats receiving implants demonstrated a significant deficit in maze-learning ability compared with individual and group performances before receiving the implants. In saline rats there was no significant difference in maze-learning ability before and after receiving implants. The HC-3 group receiving implants demonstrated a significant deficit in maze-learning ability compared with the saline control group. Serial sections through nbm from control and HC-3 rats indicated that all cannulae were located within infusion range of nbm. In HC-3 subjects, cholinergic cell bodies were destroyed with concurrent degeneration of terminal fields in cortex. Except for cannula insertion damage, the cholinergic neurotransmitter system appeared unharmed in controls. Stains for neuritic plaques and neurofibrillary damage were negative in both groups. The memory deficit in experimental subjects supported by the demonstrated destruction of nbm cholinergic neurons suggests that HC-3 may be useful in the development of an animal model for Alzheimer's Disease.

Miyake-Apple view of inner side of sclerotomy during microincision vitrectomy surgery.

PubMed

Inoue, Makoto; Ota, Ichiro; Taniuchi, Shutaro; Nagamoto, Toshiyuki; Miyake, Kensaku; Hirakata, Akito

2011-08-01

To examine the inner surface of the sclerotomy during microincision vitrectomy surgery by Miyake-Apple view. The anterior half of porcine eyes was attached to a transparent acrylic plate with cyanoacrylate glue. Then, either a 23-gauge or a 25-gauge trocar-cannula was inserted through the sclera obliquely. The inner surface of the entrance site was observed posteriorly by Miyake-Apple view. These images were compared with the endoscopic view of two patients who underwent vitreous surgery for an epiretinal membrane. When the trocar-cannula was inserted obliquely, the Miyake-Apple view showed that the ciliary epithelium at the sclerotomy site was stretched. When the trocar-cannula was inserted vertically, the ciliary epithelium was folded, and the folds remained even after the trocar was removed. Vitreous strands were seen incarcerated into the sclerotomy site. In human eyes, a folding of the ciliary epithelium was not clearly seen with the endoscopic view but the incarcerated vitreous was seen. The Miyake-Apple view provided a precise, in vivo, observation of the inner surface of the entry site. It disclosed the morphological stress on the ciliary epithelium by the sclerotomy. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Supplemental oxygen: ensuring its safe delivery during facial surgery.

PubMed

Reyes, R J; Smith, A A; Mascaro, J R; Windle, B H

1995-04-01

Electrosurgical coagulation in the presence of blow-by oxygen is a potential source of fire in facial surgery. A case report of a patient sustaining partial-thickness facial burns secondary to such a flash fire is presented. A fiberglass facial model is then used to study the variables involved in providing supplemental oxygen when an electrosurgical unit is employed. Oxygen flow, oxygen delivery systems, distance from the oxygen source, and coagulation current levels were varied. A nasal cannula and an adapted suction tubing provided the oxygen delivery systems on the model. Both the "displaced" nasal cannula and the adapted suction tubing ignited at a minimum coagulation level of 30 W, an oxygen flow of 2 liters/minute, and a linear distance of 5 cm from the oxygen source. The properly placed nasal cannula did not ignite at any combination of oxygen flow, coagulation current level, or distance from the oxygen source. Facial cutaneous surgery in patients provided supplemental oxygen should be practiced with caution when an electrosurgical unit is used for coagulation. The oxygen delivery systems adapted for use are hazardous and should not be used until their safety has been demonstrated.

An Amperometric Glucose Sensor Integrated into an Insulin Delivery Cannula: In Vitro and In Vivo Evaluation

PubMed Central

Heinrich, Gabriel; Breen, Matthew; Benware, Sheila; Vollum, Nicole; Morris, Kristin; Knutsen, Chad; Kowalski, Joseph D.; Campbell, Scott; Biehler, Jerry; Vreeke, Mark S.; Vanderwerf, Scott M.; Castle, Jessica R.; Cargill, Robert S.

2017-01-01

Abstract Background: Labeling prohibits delivery of insulin at the site of subcutaneous continuous glucose monitoring (CGM). Integration of the sensing and insulin delivery functions into a single device would likely increase the usage of CGM in persons with type 1 diabetes. Methods: To understand the nature of such interference, we measured glucose at the site of bolus insulin delivery in swine using a flexible electrode strip that was laminated to the outer wall of an insulin delivery cannula. In terms of sensing design, we compared H2O2-measuring sensors biased at 600 mV with redox mediator-type sensors biased at 175 mV. Results: In H2O2-measuring sensors, but not in sensors with redox-mediated chemistry, a spurious rise in current was seen after insulin lis-pro boluses. This prolonged artifact was accompanied by electrode poisoning. In redox-mediated sensors, the patterns of sensor signals acquired during delivery of saline and without any liquid delivery were similar to those acquired during insulin delivery. Conclusion: Considering in vitro and in vivo findings together, it became clear that the mechanism of interference is the oxidation, at high bias potentials, of phenolic preservatives present in insulin formulations. This effect can be avoided by the use of redox mediator chemistry using a low bias potential. PMID:28221814

Analysis of baroreflex sensitivity during undulation pump ventricular assist device support.

PubMed

Liu, Hongjian; Shiraishi, Yasuyuki; Zhang, Xiumin; Song, Hojin; Saijo, Yoshifumi; Baba, Atsushi; Yambe, Tomoyuki; Abe, Yusuke; Imachi, Kou

2009-07-01

The aim of this study was to examine the baroreflex sensitivity (BRS), which involves the autonomic nervous system, in a goat with a chronically implanted undulation pump ventricular assist device (UPVAD). The UPVAD involved transforming the rotation of a brushless DC motor into an undulating motion by a disc attached via a special linking mechanism, and a jellyfish valve in the outflow cannula to prevent diastolic backflow. The pump was implanted into the thoracic cavity of a goat by a left thoracotomy, and the inflow and outflow cannulae were sutured to the apex of the left ventricle and to the descending aorta, respectively. The driving cable was wired percutaneously to an external controller. Electrocardiogram and hemodynamic waveforms were recorded at a sampling frequency of 1 kHz. BRS was determined when awake by the slope of the linear regression of R-R interval against mean arterial pressure changes, which were induced by the administration of methoxamine hydrochloride, both with continuous driving of the UPVAD as well as without assistance. BRS values during the UPVAD support and without assistance were 1.60 +/- 0.30 msec/mm Hg and 0.98 +/- 0.22 msec/mm Hg (n = 5, P < 0.05), respectively. BRS was significantly improved during left ventricular assistance. Therefore, UPVAD support might decrease sympathetic nerve activity and increase parasympathetic nerve activity to improve both microcirculation and organ function.

Hypothalamic GABAergic influences on treadmill exercise responses in rats.

PubMed

Overton, J M; Redding, M W; Yancey, S L; Stremel, R W

1994-01-01

Microinjection of GABAergic antagonists in the posterior hypothalamus (PH) produces exercise-like adjustments in cardiovascular function. To test the hypothesis that a hypothalamic GABAergic mechanism within the PH modulates the cardiovascular adjustments to dynamic exercise in conscious animals, Sprague-Dawley rats (n = 10) were instrumented with bilateral guide cannula directed at the pH, an arterial cannula, and Doppler flow probes on the iliac and mesenteric arteries. Saline (100 nl) or the GABAA receptor agonist muscimol (125 ng.100 nl-1) was bilaterally injected into the PH during treadmill exercise (20 m.min-1). Microinjection of saline had no effect on mean arterial pressure (MAP), heart rate (HR), mesenteric vascular resistance (MR), or iliac vascular resistance (IR) during exercise. Microinjection of muscimol during exercise produced no significant changes in MAP (mean change +/- SE; +0 +/- 1 mmHg), HR (+17 +/- 12 b.min-1), or MR (+7 +/- 13%). However, microinjection of muscimol produced a significant increase in IR during exercise (16 +/- 6%). In addition, muscimol significantly decreased treadmill run time (saline = 19.6 +/- 0.4 min; muscimol = 17.8 +/- 0.6 min) and produced behavioral effects (including mild sedation) that were most evident after exercise. The results of these experiments suggest that while the posterior hypothalamic GABAergic system may modulate iliac blood flow during exercise in rats, this system does not modulate HR and MR responses to dynamic exercise.

Evaluation of dressings used with local anaesthetic cream and for peripheral venous cannulation.

PubMed

Needham, Rowan; Strehle, Eugen-Matthias

2008-10-01

To compare four polyurethane dressings manufactured by two different companies for use in children. Seventy-eight dressings were applied to secure either local anaesthetic creams (n = 62) or intravenous cannulae (n = 16). Each dressing was evaluated for ease of application, security and ease of removal, using a simple scoring system. 84 per cent of Opsite flexigrid and 90 per cent of Tegaderm local anaesthetic cream dressings were rated as easy or very easy to apply. Opsite flexigrid was felt to be more secure, whereas Tegaderm was easier to remove. The Tegaderm cannula dressing was easier to apply than the iv3000 dressing. There was little difference between the two brands, including costs.

The impact of didactic read-aloud action cards on the performance of cannula cricothyroidotomy in a simulated 'can't intubate can't oxygenate' scenario.

PubMed

Harvey, R; Foulds, L; Housden, T; Bennett, K A; Falzon, D; McNarry, A F; Graham, C

2017-03-01

Significant benefits have been demonstrated with the use of peri-operative checklists. We assessed whether a read-aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated 'can't intubate, can't oxygenate' scenario. A 17-step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into 'no-card' or 'card' groups. Scenarios were video-recorded for analysis. Fifty-three participants (27 no-card and 26 card) completed the scenario. The number of steps omitted was mean (SD) 6.7 (2.0) in the no-card group vs. 0.3 (0.5); p < 0.001 in the card group, but the no-card group was faster to oxygenation by mean (95% CI) 35.4 (6.6-64.2) s. The Kappa statistic was 0.84 (0.73-0.95). Our study demonstrated that action cards are beneficial in achieving successful front-of-neck access using a cannula cricothyroidotomy technique. Further investigation is required to determine this tool's effectiveness in other front-of-neck access situations, and its role in teaching or clinical management. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Management, clinical outcomes, and complications of acute cannula-related peripheral vein phlebitis of the upper extremity: A retrospective study.

PubMed

Dunda, S E; Demir, E; Mefful, O J; Grieb, G; Bozkurt, A; Pallua, N

2015-07-01

Acute phlebitis due to peripheral vein catheter use is frequently observed in clinical practice, and requires surgical therapy in severe cases. In this retrospective study, we aimed to increase awareness, evaluate current treatment options, and develop recommendations to optimize treatment outcomes. A total of 240 hospitalized patients with a diagnosis of upper extremity phlebitis from 2006 to 2011 were evaluated in terms of initial clinical features, parameters, co-morbidities and treatment regimes. Severity of phlebitis was graded according to the Baxter scale by assessing clinical symptoms such as pain, erythema, induration, swelling, or palpable venous cord (grade 0-5). Patients were divided in two subgroups: conservative (n = 132) and operative (n = 108) treatment. Surgical intervention rates and severity were higher for cannula insertion in the cubital fossa region than for cannula insertion in the forearm and hand region (p < 0.05). Baxter scale grades were higher in the surgical treatment group than in the conservative treatment group (4.47 vs. 2.67, respectively). The cubital fossa region is vulnerable to severe phlebitis and is not recommended as the first site of choice for cannulation. Phlebitis of Baxter scale grade 4 or 5 should be considered for early surgical intervention. © The Author(s) 2014.

Local administration of sarizotan into the subthalamic nucleus attenuates levodopa-induced dyskinesias in 6-OHDA-lesioned rats.

PubMed

Marin, C; Aguilar, E; Rodríguez-Oroz, M C; Bartoszyk, G D; Obeso, J A

2009-06-01

Dyskinesia affects the majority of levodopa-treated parkinsonian patients within 5-10 years of treatment with levodopa. Clinical and preclinical observations suggest that an increase in serotoninergic transmission can contribute to the appearance of dyskinesias. It is thus conceivable that a modulation of synaptic dopamine (DA) levels induced by the inhibition of serotonin (5-HT) release, as a consequence of 5-HT(1A) agonists administration, might alleviate dyskinesias. Since 5-HT(1A) receptors are expressed in the subthalamic nucleus (STN), the aim of the present study was to assess the effect of the intrasubthalamic administration of sarizotan, a compound with full 5-HT(1A) agonist properties, on levodopa-induced dyskinesias in the 6-hydroxydopamine (6-OHDA) model of parkinsonism. Male Sprague-Dawley rats received a unilateral 6-OHDA administration in the nigrostriatal pathway. A test of apomorphine was performed to evaluate dopamine depletion. One week later, a cannula was implanted in the STN. Animals were treated with levodopa (6 mg/kg, i.p., twice at day) for 22 consecutive days. On day 23, several doses (1 ng, 10 ng, or 1 microg) of sarizotan were administered through the cannula to the STN. The higher doses of sarizotan effectively attenuated all levodopa-induced dyskinesias including axial, limb, and orolingual subtypes. These results suggest that the STN is a target structure for the antidyskinetic action of sarizotan and indicate that drug-mediated modulation of STN activity may be an alternative option for the treatment of levodopa-induced dyskinesias in Parkinson's disease.

Study on design and cutting parameters of rotating needles for core biopsy.

PubMed

Giovannini, Marco; Ren, Huaqing; Cao, Jian; Ehmann, Kornel

2018-06-15

Core needle biopsies are widely adopted medical procedures that consist in the removal of biological tissue to better identify a lesion or an abnormality observed through a physical exam or a radiology scan. These procedures can provide significantly more information than most medical tests and they are usually performed on bone lesions, breast masses, lymph nodes and the prostate. The quality of the samples mainly depends on the forces exerted by the needle during the cutting process. The reduction of these forces is critical to extract high-quality tissue samples. The most critical factors that affect the cutting forces are the geometry of the needle tip and its motion while it is penetrating the tissue. However, optimal needle tip configurations and cutting parameters are not well established for rotating insertions. In this paper, the geometry and cutting forces of hollow needles are investigated. The fundamental goal of this study is to provide a series of guidelines for clinicians and surgeons to properly select the optimal tip geometries and speeds. Analytical models related to the cutting angles of several needle tip designs are presented and compared. Several needle tip geometries were manufactured from a 14-gauge cannula, commonly adopted during breast biopsies. The needles were then tested at different speeds and on different phantom tissues. According to these experimental measurements recommendations were formulated for rotating needle insertions. The findings of this study can be applied and extended to several biopsy procedures in which a cannula is used to extract tissue samples. Copyright © 2018 Elsevier Ltd. All rights reserved.

Side differences in cerebrovascular accidents after cardiac surgery: a statistical analysis of neurologic symptoms and possible implications for anatomic mechanisms of aortic particle embolization.

PubMed

Boivie, Patrik; Edström, Cecilia; Engström, Karl Gunnar

2005-03-01

Aortic manipulation and particle embolization have been identified to cause cerebrovascular accidents in cardiac surgery. Recent data suggest that left-hemispheric cerebrovascular accident (right-sided symptoms) is more common, and this has been interpreted as being caused by aortic cannula stream jets. Our aim was to evaluate symptoms of cerebrovascular accident and side differences from a retrospective statistical analysis. During a 2-year period, 2641 consecutive cardiac surgery cases were analyzed. Patients positive for cerebrovascular accident were extracted from a database designed to monitor clinical symptoms. A protocol was used to confirm symptom data with the correct diagnosis in patient records. Patients were subdivided into 3 groups: control, immediate cerebrovascular accident, and delayed cerebrovascular accident. Among pooled patients, immediate and delayed cerebrovascular accidents were 3.0% and 0.9%, respectively. The expected predisposing factors behind immediate cerebrovascular accidents were significant, although the type of operation affected this search. Aortic quality was a strong predictor ( P < .001). The rate of delayed cerebrovascular accident was unaffected by surgery group. Left-sided symptoms of immediate cerebrovascular accident were approximately twice as frequent ( P = .016) as on the contralateral side. This phenomenon was observed for pooled patients and for isolated coronary bypass procedures (n = 1882; P = .025). Immediate cerebrovascular accident and aortic calcifications are linked. The predominance of left-sided symptoms may suggest that aortic manipulation and anatomic mechanisms in the aortic arch are more likely to cause cerebrovascular accidents than effects from cannula stream jets.

Contemporary Outcomes of Extracorporeal Membrane Oxygenation Used as Bridge to Lung Transplantation.

PubMed

Hakim, Ali H; Ahmad, Usman; McCurry, Kenneth R; Johnston, Douglas R; Pettersson, Gosta B; Budev, Marie; Murthy, Sudish; Blackstone, Eugene H; Tong, Michael Z

2018-07-01

Extracorporeal membrane oxygenation (ECMO), when used as bridge to lung transplantation, (BTT) identifies high-risk candidates. Recent advances in cannula design and patient selection fosters "awake ambulatory ECMO" as a viable option for critically ill candidates in an attempt to retard deconditioning while awaiting allografts. From 2012 to 2015, 30 patients underwent ECMO as BTT. Candidacy for ECMO was determined before listing for transplant. A dual-lumen single cannula was used first in 13 of 30 patients (43%). Of the remaining 30 patients, 6 (20%) were supported with venoarterial ECMO and 11 (37%) with venovenous ECMO, with double-site cannulation in 11 (37%), and 6 of 11 converted to a dual-lumen single cannula. All ECMO patients were managed in a dedicated heart/lung failure intensive care unit, and early aggressive physical therapy, ambulation, and spontaneous breathing trials were emphasized. BTT was successful in 26 patients (87%). In the 19 patients with dual-lumen single cannula, 5 (26%) were successfully ambulated, and 6 (32%) achieved spontaneous ventilation. Median (25th, 75th percentile) lengths of stay in the intensive care unit and hospital were 33 days (20, 46 days) and 56 days (28, 78 days), respectively, and were 20 and 31 days, respectively, in patients successfully ambulated (intensive care unit: p = 0.5; hospital: p = 0.4). Among all patients who received a transplant, 30-day, 1-year, and 3-year survival were 92%, 85%, and 80%, respectively. Among patients undergoing primary transplants, 3-year survival was 91%. ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early use of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Bacteriology of the Buttonhole Cannulation Tract in Hemodialysis Patients: A Prospective Cohort Study.

PubMed

Christensen, Line Dahlstrøm; Skadborg, Mai-Britt; Mortensen, Agnete H; Mortensen, Carsten; Møller, Jens K; Lemming, Lars; Høgsberg, Irene; Petersen, Steffen E; Buus, Niels H

2018-03-29

The buttonhole cannulation technique for arteriovenous fistulas is widely used, but has been associated with an increased rate of vascular access-related infections. We describe the frequency and type of bacterial colonization of the buttonhole tract over time and associated clinical infections. A prospective observational cohort study with 9 months of follow-up. 84 in-center hemodialysis patients using the buttonhole cannulation technique at 2 Danish dialysis centers. Bacterial growth from the buttonhole tract and dialysis cannula tip and clinically important infections during follow-up. On 3 occasions 1 month apart, cultures before dialysis (from the skin surrounding the buttonhole before disinfection and from the cannulation tract after disinfection and scab removal) and the cannula tip after dialysis. Patients with positive cultures from the buttonhole tract or cannula tip had repeat cultures within 1 week, along with blood cultures. Growth from the cannulation tract and/or cannula tip at each of the 3 monthly sets of cultures was found in 18%, 20%, and 17% of patients, respectively. 38% of patients had at least 1 positive culture from the buttonhole tract. Sustained growth was detected in 11% of patients, whereas asymptomatic bacteremia was seen in 30% of those with positive buttonhole cultures. Staphylococci species were the most common pathogens (Staphylococcus aureus, 25%; and Staphylococcus epidermidis, 41%). Colonization-positive buttonholes had more localized redness and slightly more tenderness. During follow-up, significantly more access-related infections were diagnosed among those with positive buttonhole cultures (P<0.001). No comparison to area puncture cannulation technique. Blood cultures were obtained only from patients with positive buttonhole bacteriology. Transient or sustained colonization of the buttonhole tract by staphylococci and asymptomatic bacteremia is common in hemodialysis patients, implying a substantial risk for access-related infections among patients using a buttonhole cannulation technique. These findings suggest the possible value of surveillance of buttonhole colonization. Copyright © 2018 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Vacuum-assisted venous return reduces blood usage.

PubMed

Banbury, Michael K; White, Jennifer A; Blackstone, Eugene H; Cosgrove, Delos M

2003-09-01

To determine whether vacuum-assisted venous return has clinical advantages over conventional gravity drainage apart from allowing the use of smaller cannulas and shorter tubing. A total of 150 valve operations were performed at our institution between February and July 1999 using vacuum-assisted venous return with small venous cannulas connected to short tubing. These were compared with (1) 83 valve operations performed between April 1997 and January 1998 using the initial version of vacuum-assisted venous return, and (2) 124 valve operations performed between January and April of 1997 using conventional gravity drainage. Priming volume, hematocrit value, red blood cell usage, and total blood product usage were compared multivariably. These comparisons were covariate and propensity adjusted for dissimilarities between the groups and confirmed by propensity-matched pairs analysis. Priming volume was 1.4 +/- 0.4 L for small-cannula vacuum-assisted venous return, 1.7 +/- 0.4 L for initial vacuum-assisted venous return, and 2.0 +/- 0.4 L for gravity drainage (P <.0001). Smaller priming resulted in higher hematocrit values both at the beginning of cardiopulmonary bypass (27% +/- 5% compared with 26% +/- 4% and 25% +/- 4%, respectively, P <.0001) and at the end (30% +/- 4% compared with 28% +/- 4% and 27% +/- 4%, respectively, P <.0001). Red cell transfusions were used in 17% of the patients having small-cannula vacuum-assisted venous return, 27% of the initial patients having vacuum-assisted venous return, and 37% of the patients having gravity drainage (P =.001); total blood product usage was 19%, 27%, and 39%, respectively (P =.002). Although ministernotomy also was associated with reduced blood product usage (P <.004), propensity matching on type of sternotomy confirmed the association of vacuum-assisted venous return with lowered blood product usage. Vacuum-assisted venous return results in (1) higher hematocrit values during cardiopulmonary bypass and (2) decreased red cell and total blood product usage.

Design changes in continuous-flow left ventricular assist devices and life-threatening pump malfunctions.

PubMed

Soltani, Sajjad; Kaufmann, Friedrich; Vierecke, Juliane; Kretzschmar, Alexandra; Hennig, Ewald; Stein, Julia; Hetzer, Roland; Krabatsch, Thomas; Potapov, Evgenij V

2015-06-01

The implantable continuous-flow left ventricular assist devices (LVADs) HeartMate II (HM II) and HeartWare HVAD (HW) underwent design modifications. The impact of these changes on life-threatening pump malfunctions was evaluated. We retrospectively analysed pump malfunctions due to thrombosis or cable damage in patients supported with primarily implanted HM II (n = 191) and HW (n = 347), separated into patients supported with the old and new pump designs. In 2010, the cable strain relief of the HM II device was improved (132 patients with old and 79 with new) and sealed grafts were introduced (68 patients with sealed inflow connector and outflow graft and 125 without). In 2011, titanium sintering of the inflow cannula of HW pumps was introduced (137 patients with a non-sintered and 210 with a sintered inflow cannula). The median support time was 1.12 (0-6.1) years for all HM II and 0.59 (0-4.2) years for all HW patients. The cumulative rate of events per patient-year (EPPY) was 0.11 in HM II patients, compared with 0.09 EPPY in HW patients (P = 0.32). After introduction of the new cable design, incidence of cable damage in HM II patients dropped from 0.06 to 0 EPPY (P = 0.03), whereas pump thrombosis increased from 0.02 to 0.14 EPPY (P < 0.001) after the sealed graft was introduced. Pump thrombosis occurred in 4% of patients supported with HW with a sintered inflow cannula vs 15% with a non-sintered pump; the incidence changed from 0.10 to 0.07 EPPY in sintered pumps (P = 0.45). Kaplan-Meier analysis showed no differences over a period of 2.5 years for events when the HM II cohort with sealed graft and new cable design (n = 68) was compared with the HW group with a sintered cannula (P = 0.14). The modified cable strain relief of the HM II pump and the sintering of the inflow cannula of the HW pump demonstrated a significant reduction in the incidence of life-threatening pump-related complications, whereas the sealed inflow connector and outflow graft seem to be associated with a higher incidence of pump thrombosis. However, the overall incidence of pump-related complications after the latest design changes was similar for both pumps over a 2.5-year period. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula... (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable) scissors, and suction/irrigation...

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula... (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable) scissors, and suction/irrigation...

21 CFR 884.1640 - Culdoscope and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... instruments include: lens cleaning brush, biopsy brush, clip applier (without clips), applicator, cannula... (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable) scissors, and suction/irrigation...

Complications of unsafe abortion: case reports and the need for curriculum review in Nigeria.

PubMed

Umoh, A V; Umoiyoho, A J

2009-09-01

Unsafe abortion remains a major reproductive health problem in Nigeria. These are 2 case reports of unsafe abortion, one performed by a patent medicine dealer where a false passage was created in the substance of the cervix to evacuate the uterus using a cannula. A piece of the cannula was left in situ for five years leading to chronic infection and infertility. The second case was performed by a medical practitioner for a second trimester abortion. He deliberately created a false passage in the substance of the cervix to evacuate the uterus leading to severe haemorrhage. We conclude that there is a need to review and improve the training of medical practitioners in termination of pregnancies to avoid unsafe abortion.

Reversal of androgen inhibition of estrogen-activated sexual behavior by cholinergic agents.

PubMed

Dohanich, G P; Cada, D A

1989-12-01

Androgens have been found to inhibit lordosis activated by estrogen treatment of ovariectomized female rats. In the present experiments, dihydrotestosterone propionate (200 micrograms for 3 days) inhibited the incidence of lordosis in ovariectomized females treated with estradiol benzoate (1 microgram for 3 days). This inhibition of lordosis was reversed 15 min after bilateral intraventricular infusion of physostigmine (10 micrograms/cannula), an acetylcholinesterase inhibitor, or carbachol (0.5 microgram/cannula), a cholinergic receptor agonist. This reversal of inhibition appears to be mediated by cholinergic muscarinic receptors since pretreatment with scopolamine (4 mg/kg, ip), a muscarinic receptor blocker, prevented the reversal of androgen inhibition by physostigmine. These results indicate that androgens may inhibit estrogen-activated lordosis through interference with central cholinergic muscarinic mechanisms.

[Study and development of a new automatic suction system (SS) of intratracheal sputum in order to improve QOL of many patients with tracheostomy mechanical ventilation (TMV) and their family members by this new autonomic SS].

PubMed

Hokezu, Youichi; Yamamoto, Makoto; Tokunaga, Syuichi; Niikura, Makoto; Nagamatsu, Keiji; Kira, Jun-ichi; Fukunaga, Toshihide; Shima, Kouji; Kikuchi, Seiji; Kimura, Itaru; Kondo, Kiyohiko; Mori, Teruhiko; Goto, Katumasa; Takigami, Shigeru; Shioya, Keiichi; Uehara, Minako

2009-11-01

In Japan, many patients equipped with TMV are under medical treatment at home after 1990. These patients can't put out sputa in trachea, so that these patient's family members must suck these patient's intratracheal sputa all days. Mr Yamamoto and Mr Tokunaga, main researchers of this study, began the study on the automatic SS of itratracheal sputa from 1999. In first stage, They developed the intermittent SS in detaining the suction tube within tracheal cannula, monitering the intratracheal pressure, but this system takes the ventilation away from the patient. Hypoventilation caused by this SS may cause the serious accident in patient. Therefore, we remodel the SS from intermittent SS to rollerpomp-type SS continuing to suck the itratracheal sputa with low volume from 2004, and thereafter we made up the SS of piston pomp type-SS finally at 2007. We developed the tracheal cannula with double suction holes of inner and lower hole in the lower part of its cannula together with the suction machine. We think that the practical use of this automatic SS will bring these patients with TMV and their family members great benefits. We desire that the practical use of this SS will be realized as soon as possible.

Reservoir Cannulas for Pediatric Oxygen Therapy: A Proof-of-Concept Study

PubMed Central

Wu, Grace; DiBlasi, Robert M.; Saxon, Eugene; Austin, Glenn; Ginsburg, Amy Sarah

2016-01-01

Hypoxemia is a complication of pneumonia—the leading infectious cause of death in children worldwide. Treatment generally requires oxygen-enriched air, but access in low-resource settings is expensive and unreliable. We explored use of reservoir cannulas (RCs), which yield oxygen savings in adults but have not been examined in children. Toddler, small child, and adolescent breathing profiles were simulated with artificial lung and airway models. An oxygen concentrator provided flow rates of 0 to 5 L/min via a standard nasal cannula (NC) or RC, and delivered oxygen fraction (FdO2) was measured. The oxygen savings ratio (SR) and absolute flow savings (AFS) were calculated, comparing NC and RC. We demonstrated proof-of-concept that pendant RCs could conserve oxygen during pediatric therapy. SR mean and standard deviation were 1.1 ± 0.2 to 1.4 ± 0.4, 1.1 ± 0.1 to 1.7 ± 0.3, and 1.3 ± 0.1 to 2.4 ± 0.3 for toddler, small child, and adolescent models, respectively. Maximum AFS observed were 0.3 ± 0.3, 0.2 ± 0.1, and 1.4 ± 0.3 L/min for the same models. RCs have the potential to reduce oxygen consumption during treatment of hypoxemia in children; however, further evaluation of products is needed, followed by clinical analysis in patients. PMID:27999601

CPAP and High-Flow Nasal Cannula Oxygen in Bronchiolitis.

PubMed

Sinha, Ian P; McBride, Antonia K S; Smith, Rachel; Fernandes, Ricardo M

2015-09-01

Severe respiratory failure develops in some infants with bronchiolitis because of a complex pathophysiologic process involving increased airways resistance, alveolar atelectasis, muscle fatigue, and hypoxemia due to mismatch between ventilation and perfusion. Nasal CPAP and high-flow nasal cannula (HFNC) oxygen may improve the work of breathing and oxygenation. Although the mechanisms behind these noninvasive modalities of respiratory support are not well understood, they may help infants by way of distending pressure and delivery of high concentrations of warmed and humidified oxygen. Observational studies of varying quality have suggested that CPAP and HFNC may confer direct physiologic benefits to infants with bronchiolitis and that their use has reduced the need for intubation. No trials to our knowledge, however, have compared CPAP with HFNC in bronchiolitis. Two randomized trials compared CPAP with oxygen delivered by low-flow nasal cannula or face mask and found some improvements in blood gas results and some physiologic parameters, but these trials were unable to demonstrate a reduction in the need for intubation. Two trials evaluated HFNC in bronchiolitis (one comparing it with headbox oxygen, the other with nebulized hypertonic saline), with the results not seeming to suggest important clinical or physiologic benefits. In this article, we review the pathophysiology of respiratory failure in bronchiolitis, discuss these trials in detail, and consider how future research studies may be designed to best evaluate CPAP and HFNC in bronchiolitis.

Temporomandibular joint arthroscopy technique using a single working cannula.

PubMed

Srouji, S; Oren, D; Zoabi, A; Ronen, O; Zraik, H

2016-11-01

The traditional arthroscopy technique includes the creation of three ports in order to enable visualization, operation, and arthrocentesis. The aim of this study was to assess an advanced temporomandibular joint (TMJ) arthroscopy technique that requires only a single cannula, through which a one-piece instrument containing a visualization canal, irrigation canal, and a working canal is inserted, as an alternative to the traditional double-puncture technique. This retrospective study assessed eight patients (13 TMJs) with pain and/or limited range of movement that was refractory to conservative therapy, who were treated between June 2015 and December 2015. The temporomandibular joint disorder (TMD) was diagnosed by physical examination and mouth opening measurements. The duration of surgery was recorded and compared to that documented for traditional arthroscopies performed by the same surgeon. Operative single-cannula arthroscopy (OSCA) was performed using a holmium YAG (Ho:YAG) 230μm fibre laser for ablation. The OSCA technique proved effective in improving mouth opening in all patients (mean increase 9.12±1.96mm) and in reducing pain (mean visual analogue scale decrease of 3.25±1.28). The operation time was approximately half that of the traditional technique. The OSCA technique is as efficient as the traditional technique, is simple to learn, and is simpler to execute. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[When the heart and/or the lung fails: the ECMO].

PubMed

Giraud, R; Siegenthaler, N; Tassaux, D; Richard, J C M; Reverdin, S; Cikirikcioglu, M; Licker, M J; Bendjelid, K; Brochard, L

2011-12-14

The Extra corporeal membrane oxygenation (ECMO) was initially proposed as a technique of respiratory support using an external membrane oxygenator. With time, it has also become a technique of cardiorespiratory support to ensure both gas exchange and organ perfusion until the restoration of organs function. This technical assistance can be central or peripheral and provides a partial or total circulatory support. The circuit includes a non occlusive centrifugal pump, an oxygenator for an enrichment of O2 and elimination of CO2 and cannulas for drainage and re-injection. Recently, the establishment of such assistance became possible percutaneously, allowing it to be initiated at the intensive care bedside or even before in-hospital admission.

Trocar anterior chamber maintainer: Improvised infusion technique.

PubMed

Agarwal, Amar; Narang, Priya; Kumar, Dhivya A; Agarwal, Ashvin

2016-02-01

We present an improvised technique of infusion that uses a trocar cannula as an anterior chamber maintainer (ACM). Although routinely used in posterior segment surgery, the trocar cannula has been infrequently used in complex anterior segment procedures. The trocar ACM creates a transconjunctival biplanar wound of appropriate size that is self-sealing and overcomes the shortcomings of an ACM, such as spontaneous extrusion and forced introduction into the eye from variability in the size of the corneal paracentesis incision. Constant infusion inflow through the trocar ACM is used to maintain positive intraocular pressure through a self-sealing sclerotomy incision at the limbus. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Inspiratory Tube Condensation During High-Flow Nasal Cannula Therapy: A Bench Study.

PubMed

Chikata, Yusuke; Unai, Kazuaki; Izawa, Masayo; Okuda, Nao; Oto, Jun; Nishimura, Masaji

2016-03-01

High-flow nasal cannula (HFNC) therapy provides better humidification than conventional oxygen therapy. To allay loss of vapor as condensation, a servo-controlled heating wire is incorporated in the inspiratory tube, but condensation is not completely avoidable. We investigated factors that might affect condensation: thermal characteristics of the inspiratory tube, HFNC flow, and ambient temperature. We evaluated 2 types of HFNC tubes, SLH Flex 22-mm single tube and RT202. Both tubes were connected to a heated humidifier with water reservoir. HFNC flow was set at 20, 40, and 60 L/min, and FIO2 was set at 0.21. Air conditioning was used maintain ambient temperature at close to either 20 or 25°C. We weighed the tubes on a digital scale before (0 h) and at 3, 6, and 24 h after, turning on the heated humidifier, and calculated the amount of condensation by simple subtraction. The amount of distilled water used during 24 h was also recorded. At 25°C, there was little condensation, but at 20°C and HFNC flow of 20, 40, and 60 L/min for 24 h, the amount of condensation with the SLH was 50.2 ± 10.7, 44.3 ± 17.7, and 56.6 ± 13.9 mg, and the amount with the RT202 was 96.0 ± 35.1, 72.8 ± 8.2, and 64.9 ± 0.8 mg. When ambient temperature was set to 20°C, condensation with the RT202 was statistically significantly greater than with the SLH at all flow settings (P < .001). Ambient temperature statistically significantly influenced the amount of condensation in the tubes. Copyright © 2016 by Daedalus Enterprises.

Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.

PubMed

Palese, A; Ambrosi, E; Fabris, F; Guarnier, A; Barelli, P; Zambiasi, P; Allegrini, E; Bazoli, L; Casson, P; Marin, M; Padovan, M; Picogna, M; Taddia, P; Salmaso, D; Chiari, P; Marognolli, O; Canzan, F; Saiani, L

2016-03-01

To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED). To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors. A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed. The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Effect of paddock vs. stall housing on 24 hour gastric pH within the proximal and ventral equine stomach.

PubMed

Husted, L; Sanchez, L C; Olsen, S N; Baptiste, K E; Merritt, A M

2008-06-01

Stall housing has been suggested as a risk factor for ulcer development in the equine stomach; however, the exact pathogenesis for this has not been established. To investigate the effect of 3 environmental situations (grass paddock, stall alone or stall with adjacent companion) on pH in the proximal and the ventral stomach. Six horses with permanently implanted gastric cannulae were used in a randomised, cross-over, block design. Each horse rotated through each of three 24 h environmental situations. Horses remained on their normal diet (grass hay ad libitum and grain b.i.d.) throughout the study. Intragastric pH was measured continuously for 72 h just inside the lower oesophageal sphincter (proximal stomach) and via a pH probe in the gastric cannula (ventral stomach). Neither proximal nor ventral 24 h gastric pH changed significantly between the 3 environmental situations. Mean hourly proximal gastric pH decreased significantly in the interval from 01.00-09.00 h compared to the interval from 13.00-20.00 h, regardless of environmental situation. Median hourly proximal pH only differed in the interval from 06.00-07.00 h compared to the interval 14.00-19.00 h. Neither mean nor median hourly ventral gastric pH varied significantly with the time of day. The change in housing status used in the current study did not affect acid exposure within either region of the equine stomach. The pH in the ventral stomach was uniformly stable throughout the study, while the proximal pH demonstrated a 24 h circadian pattern.

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... genital organs. This generic type of device may include: Trocar and cannula, instruments used through an... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... genital organs. This generic type of device may include: Trocar and cannula, instruments used through an... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...

Humidity and Inspired Oxygen Concentration During High-Flow Nasal Cannula Therapy in Neonatal and Infant Lung Models.

PubMed

Chikata, Yusuke; Ohnishi, Saki; Nishimura, Masaji

2017-05-01

High-flow nasal cannula therapy (HFNC) for neonate/infants can deliver up to 10 L/min of heated and humidified gas, and F IO 2 can be adjusted to between 0.21 and 1.0. With adults, humidification and actual F IO 2 are known to vary according to inspiratory and HFNC gas flow, tidal volume (V T ), and ambient temperature. There have been few studies focused on humidification and F IO 2 in HFNC settings for neonates/infants, so we performed a bench study to investigate the influence of gas flow, ambient temperature, and respiratory parameters on humidification and actual F IO 2 in a neonate/infant simulation. HFNC gas flow was set at 3, 5, and 7 L/min, and F IO 2 was set at 0.3, 0.5, and 0.7. Spontaneous breathing was simulated using a 2-bellows-in-a-box model of a neonate lung. Tests were conducted with V T settings of 20, 30, and 40 mL and breathing frequencies of 20 and 30 breaths/min. Inspiratory time was 0.8 s with decelerating flow waveform. The HFNC tube was placed in an incubator, which was either set at 37°C or turned off. Absolute humidity (AH) and actual F IO 2 were measured for 1 min using a hygrometer and an oxygen analyzer, and data for the final 3 breaths were extracted. At all settings, when the incubator was turned on, AH was greater than when it was turned off ( P < .001). When the incubator was turned off, as gas flow increased, AH increased ( P < .001); however, V T did not affect AH ( P = .16). As gas flow increased, actual F IO 2 more closely corresponded to set F IO 2 . When gas flow was 3 L/min, measured F IO 2 decreased proportionally more at each F IO 2 setting increment ( P < .001). AH was affected by ambient temperature and HFNC gas flow. Actual F IO 2 depended on V T when gas flow was 3 L/min. Copyright © 2017 by Daedalus Enterprises.

A combinatorial optogenetic approach to medial habenula function

NASA Astrophysics Data System (ADS)

Turner, Eric E.; Hsu, Yun-Wei; Wang, Si; Morton, Glenn; Zeng, Hongkui

2013-03-01

The habenula is a brain region found in all vertebrate species. It consists of medial and lateral subnuclei which make complex descending connections to the brainstem. Although the medial habenula (MHb) and its projection, the fasciculus retroflexus (FR), have been recognized for decades, their function remains obscure. The small size of the MHb in rodents, and the cellular and molecular complexity of this region, have made it difficult to study the function of this region with high specificity. Here we describe a Cre-mediated genetic system for expressing the microbial opsin channelrhodopsin (ChR2) specifically in the dorsal (dMHb) and ventral (vMHb) medial habenula. Genetically targeted expression of ChR2 allows MHb neurons to be selectively activated with light in acute brain slices with electrophysiological readouts, and in vivo by means of custom-built fiber optic cannulas. These tools will allow highly specific studies of MHb circuitry and the role of the MHb in behaviors related to addiction and mood regulation.

Use of the Blom Tracheotomy Tube with Suction Inner Cannula to Decontaminate Microorganisms from the Subglottic Space. A Proof of Concept.

PubMed

Rabach, Lesley; Siegel, Mark D; Puchalski, Jonathan T; Towle, Dana; Follert, Michelle; Johnson, Kelsey M; Rademaker, Alfred W; Leder, Steven B

2015-06-01

Preventing pulmonary complications during mechanical ventilation via tracheotomy is a high priority. To investigate if the Blom tracheotomy tube with suction-above-the-cuff inner cannula reduced the quantity of normal flora and pathogens in supra- versus subglottic spaces. We enrolled 20 consecutive medical ICU adults requiring tracheostomy for mechanical ventilation in this proof-of-concept, prospective, single-center study. All participants received a Blom tracheotomy tube with suction-above-the-cuff inner cannula to decontaminate microorganisms from the supra- and subglottic spaces. Supra- and subglottic sputum samples were obtained for microbiologic analysis while an endotracheal tube was in place before tracheotomy and once per week for up to 4 weeks of mechanical ventilation after tracheotomy. Demographics, duration of endotracheal tube intubation, and duration of mechanical ventilation post-tracheotomy were recorded. There was a significant reduction for supraglottic (2.86 ± 1.11 [mean ± SD]) versus subglottic suction samples (2.48 ± 1.07) (paired t test, P = 0.048; Wilcoxon test, P = 0.045) when all data pairs for normal flora and pathogens were combined across times. There was a significant reduction of normal flora pooled across times in 19 data pairs for supraglottic (3.00 ± 1.05) versus subglottic suction samples (2.00 ± 0.94) (paired t test, P = 0.0004; Wilcoxon test, P = 0.0007). There was no significant reduction of pathogens pooled across times in 25 data pairs for supraglottic (2.76 ± 1.16) versus subglottic suction samples (2.84 ± 1.03) (paired t test, P = 0.75; Wilcoxon test, P = 0.83). Proof-of-concept was confirmed. The Blom tracheotomy tube with disposable suction-above-the-cuff inner cannula decontaminated microorganisms from the subglottic space when normal flora and pathogens were combined. Future research should investigate if decreased quantity of normal flora and pathogens in the subglottic space reduces the incidence of ventilator-associated pulmonary complications in critically ill patients requiring ongoing mechanical ventilation via tracheotomy.

Characterization of Carbon Dioxide Washout Measurement Techniques in the Mark-III Space Suit

NASA Technical Reports Server (NTRS)

Meginnis, I; Norcross, J.; Bekdash, O.

2016-01-01

It is essential to provide adequate carbon dioxide (CO2) washout in a space suit to reduce the risks associated with manned operations in space suits. Symptoms of elevated CO2 levels range from reduced cognitive performance and headache to unconsciousness and death at high levels of CO2. Because of this, NASA imposes limits on inspired CO2 levels for space suits when they are used in space and for ground testing. Testing and/or analysis must be performed to verify that a space suit meets CO2 washout requirements. Testing for developmental space suits has traditionally used an oronasal mask that collects CO2 samples at the left and rights sides of the mouth. Testing with this mask resulted in artificially elevated CO2 concentration measurements, which is most likely due to the dead space volume at the front of the mask. The mask also extends outward and into the supply gas stream, which may disrupt the washout effect of the suit supply gas. To mitigate these problems, a nasal cannula was investigated as a method for measuring inspired CO2 based on the assumptions that it is low profile and would not interfere with the designed suit gas flow path, and it has reduced dead space. This test series compared the performance of a nasal cannula to the oronasal mask in the Mark III space suit. Inspired CO2 levels were measured with subjects at rest and at metabolic workloads of 1000, 2000, and 3000 BTU/hr. Workloads were achieved by use of an arm ergometer or treadmill. Test points were conducted at air flow rates of 2, 4, and 6 actual cubic feet per minute, with a suit pressure of 4.3 psid. Results from this test series will evaluate the accuracy and repeatability across subjects of the nasal cannula collection method, which will provide rationale for using a nasal cannula as the new method for measuring inspired CO2 in a space suit. Proper characterization of sampling methods and of suit CO2 washout capability will better inform requirements definition and verification techniques for future CO2 washout limits in space suits

In Vitro Evaluation of an Alternative Neonatal Extracorporeal Life Support Circuit on Hemodynamic Performance and Bubble Trap.

PubMed

Spencer, Shannon B; Wang, Shigang; Woitas, Karl; Glass, Kristen; Kunselman, Allen R; Ündar, Akif

2017-01-01

The objective of this study was to evaluate an alternative neonatal extracorporeal life support (ECLS) circuit with a RotaFlow centrifugal pump and Better-Bladder (BB) for hemodynamic performance and gaseous microemboli (GME) capture in a simulated neonatal ECLS system. The circuit consisted of a Maquet RotaFlow centrifugal pump, a Quadrox-iD Pediatric diffusion membrane oxygenator, 8 Fr arterial cannula, and 10 Fr venous cannula. A "Y" connector was inserted into the venous line to allow for comparison between BB and no BB. The circuit and pseudopatient were primed with lactated Ringer's solution and packed human red blood cells (hematocrit 35%). All hemodynamic trials were conducted at flow rates ranging from 100 to 600 mL/min at 36°C. Real-time pressure and flow data were recorded using a data acquisition system. For GME testing, 0.5 cc of air was injected via syringe into the venous line. GME were detected and characterized with or without the BB using the Emboli Detection and Classification Quantifier (EDAC) System. Trials were conducted at flow rates ranging from 200 to 500 mL/min. The hemodynamic energy data showed that up to 75.2% of the total hemodynamic energy was lost from the circuit. The greatest pressure drops occurred across the arterial cannula and increased with increasing flow rate from 10.1 mm Hg at 100 mL/min to 114.3 mm Hg at 600 mL/min. The EDAC results showed that the BB trapped a significant amount of the GME in the circuit. When the bladder was removed, GME passed through the pump head and the oxygenator to the arterial line. This study showed that a RotaFlow centrifugal pump combined with a BB can help to significantly decrease the number of GME in a neonatal ECLS circuit. Even with this optimized alternative circuit, a large percentage of the total hemodynamic energy was lost. The arterial cannula was the main source of resistance in the circuit. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Using oxygen at home

MedlinePlus

... One item is called a nasal cannula. This plastic tubing wraps over your ears, like eyeglasses, with 2 prongs that fit into your nostrils. Wash the plastic tubing once or twice a week with soap ...

Intraosseous samples can be used for creatinine measurements--an experimental study in the anaesthetised pig.

PubMed

Strandberg, Gunnar; Lipcsey, Miklós; Eriksson, Mats; Larsson, Anders

2014-01-01

Intraosseous (IO) access is a valuable tool in prehospital locations and in emergency departments when other forms of vascular access are unavailable. Creatinine is often used for dose adjustment of drugs that may be administered through intraosseous cannulae. We aimed to study the possibility of analysing creatinine in intraosseous samples and study the accuracy and precision of such measurements. Eight pigs with endotoxin induced septic shock were sampled hourly for six hours and analysed for plasma creatinine. Samples were collected from arterial, venous, and IO cannulae. There was an increase in creatinine values during the later part of the experiment. The coefficients of variation between the three sampling sites were less than 10% at all sampling times. Based on our findings intraosseous samples can be used for creatinine determination in emergency settings.

[Clinical analysis of 41 children's urinary calculus and acute renal failure].

PubMed

Li, Lu-Ping; Fan, Ying-Zhong; Zhang, Qian; Zhang, Sheng-Li

2013-04-01

To analyze the treatment of acute renal failure caused by irrational drug use. Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement. In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later. Irrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.

[Postspinal headache. A comparison of the 24G Sprotte syringe and a 29G Quincke needle].

PubMed

Lim, M; Cross, G D; Sold, M

1992-09-01

A randomised study was performed to compare the frequency of postdural puncture headache in 56 patients who underwent spinal anaesthesia for extra-corporeal shockwave lithotripsy using either a Sprotte 24 G (n = 28) or Vygon 29 G or Quincke type needle (n = 28). Frequency of headache was recorded in a similar group of 28 patients who received general anaesthesia. Dural puncture was easier with the Sprotte 24 G cannula than with the less stable Quincke needle, as documented by a significantly shortened time for insertion of the cannula (4.6 +/- 2.6 vs 8.6 +/- 6.3 min, P less than 0.005). The total frequency of post-operative headache was 57% in the Vygon 29 G group and 25% in the Sprotte 24 G group; 21% of patients in the general anaesthesia group complained of headache. Frequency of postdural puncture headache, classified as being posture-related, was 25% in the 29 G Vygon group, compared with 11% in the 24 G Sprotte group (P = 0.148). When only moderate and severe postdural puncture headache was considered, there was a significant difference (25% vs. 4%; P = 0.026) in favour of the Sprotte cannula. Thus, the 24 G Sprotte needle was at least as effective as the 29 G Vygon needle, and there is a suggestion that the former is more effective in minimising the incidence of moderate or severe postdural puncture headache.

Active screening of multi-drug resistant bacteria effectively prevent and control the potential infections.

PubMed

Ren, Yuguo; Ma, Guoliang; Peng, Lin; Ren, Yufeng; Zhang, Fengmei

2015-03-01

Our objective is to determine if actively screen the multi-drug resistant bacteria (MDRB) infection in intensive care unit (ICU) to prevent, control, and decrease the infection rate and transmission of MDRB. The patients admitted in ICU of one hospital in 2013 were analyzed. The throat swab, blood, defecation, and urine of patients were actively collected for bacteria cultures to screen Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Acinetobacter baumannii in patients. All patients received screening of MDRB infection and colonization within 2 days and after 2 days of admission, the results showed that there were 418 infectious bacterial strains in total and P. aeruginosa was the main bacterium. The asymptomatic infection rates of P. aeruginosa, K. pneumonia, E. coli, S. aureus, and A. baumannii were 39.02, 24.74, 44.00, 29.17, and 33.33 %, respectively; the symptomatic infection rates were 60.98, 75.26, 56.00, 70.83, and 66.67 %. 59.70 % patients received antibiotics treatment, 27.45 % patients received trachea cannula, 32.95 % patients received mechanism ventilation, 2.27 % patients received arterial cannula or venous cannula and 4.00 % patients received indwelling urinary catheters. The main MDRB in ICU is P. aeruginosa. The active screening of MDRB infection and colonization can provide the opportunity to take the life-saving measure against MDRB and treat patients. This can decrease the infection risk and the nosocomial transmission of MDRB.

Application of an inline dry powder inhaler to deliver high dose pharmaceutical aerosols during low flow nasal cannula therapy.

PubMed

Farkas, Dale; Hindle, Michael; Longest, P Worth

2018-05-05

Inline dry powder inhalers (DPIs) offer a potentially effective option to deliver high dose inhaled medications simultaneously with mechanical ventilation. The objective of this study was to develop an inline DPI that is actuated using a low volume of air (LV-DPI) to efficiently deliver pharmaceutical aerosols during low flow nasal cannula (LFNC) therapy. A characteristic feature of the new inline LV-DPIs was the use of hollow capillary tubes that both pierced the capsule and provided a pathway for inlet air and exiting aerosol. Aerosolization characteristics, LFNC depositional losses and emitted dose (ED) were determined using 10 mg powder masses of a small-particle excipient enhanced growth (EEG) formulation. While increasing the number of inlet capillaries from one to three did not improve performance, retracting the inlet and outlet capillaries did improve ED by over 30%. It was theorized that high quality performance requires both high turbulent energy to deaggregate the powder and high wall shear stresses to minimize capsule retention. Best case performance included a device ED of approximately 85% (of loaded dose) and device emitted mass median aerodynamic diameter of 1.77 µm. Maximum ED through the LFNC system and small diameter (4 mm) nasal cannula was approximately 65% of the loaded dose. Potential applications of this device include the delivery of high dose inhaled medications such as surfactants, antibiotics, mucolytics, and anti-inflammatories. Copyright © 2018 Elsevier B.V. All rights reserved.

Cannula-Assisted Flap Elevation (CAFE): a novel technique for developing flaps during skin-sparing mastectomies.

PubMed

Grant, Michael D

2015-02-01

One of the most challenging procedures in breast surgery is the skin-sparing mastectomy (SSM). Various techniques and incisions have evolved that characterize this procedure; however, what is common in all of them is the smaller the incision, the more difficult it is to develop the skin flaps. A procedure was developed that incorporates the use of liposuction cannulas (without suction) to create the skin flaps. The technique and results are described in this manuscript. From October of 2012 to April 2014, 289 mastectomies (171 patients) were performed using the CAFE procedure on women of all shapes and sizes. Postoperatively, no problems were experienced with flap viability using this technique. The main difference in side effects between the CAFE technique and other standard techniques for developing flaps in SSMs was more bruising than normal, but this resolved rapidly. The results for use of this technique were consistently impressive. The learning curve for this procedure is very short, especially for those who perform SSMs using sharp technique (scissors). Residents and fellows became proficient with the CAFE technique in a relatively short amount of time. Plastic surgeons were pleased with the cosmetic outcomes of their reconstructions that follow this type of mastectomy. Patients were extremely satisfied with their reconstructions as well. Incorporating the use of liposuction cannulas (without suction) makes the creation of flaps for SSM a relatively simple and rapid method. It is especially useful to assist in developing skin flaps with even the smallest of skin incisions.

Assessment of the mobile bag method for estimation of in vivo starch digestibility.

PubMed

Ghoorchi, T; Lund, P; Larsen, M; Hvelplund, T; Hansen-Møller, J; Weisbjerg, M R

2013-02-01

The objective was to assess the ability of the in situ mobile nylon bag method for predicting small intestinal and total tract starch digestibility. Starch disappearance was measured for 18 samples of different cereals and legumes subjected to different physical and chemical processing methods and compared with coherent in vivo digestibility. Starch disappearance was measured both with and without initial ruminal pre-incubation during 4 h. Bags were retrieved from either the ileal cannula or faeces. Two dry Danish Holstein cows fitted with rumen cannulas were used for rumen pre-incubations and two lactating Danish Holstein cows fitted with duodenal and ileal cannulas were used for intestinal incubations. Rumen pre-incubation had no significant effect on disappearance from bags recovered in faeces. The disappearance of legume starch was lower, both in the rumen and small intestine, compared with starch from barley, wheat, oats, ear maize and maize. Transit times of the mobile bags from duodenum to ileum were not significantly different between feeds. A weak positive correlation was found between in vivo small intestinal and total tract digestibility of starch and disappearance obtained using the mobile bag technique across a broad range of starch sources. Omitting two less conventional starch sources (NaOH wheat and xylose-treated barley) resulted in a high (0.87) correlation between total tract in vivo digestibility and mobile bag disappearance. The use of the mobile bag method for estimation of in vivo starch digestibility will therefore depend on the starch type.

The Relationship between High Flow Nasal Cannula Flow Rate and Effort of Breathing in Children.

PubMed

Weiler, Thomas; Kamerkar, Asavari; Hotz, Justin; Ross, Patrick A; Newth, Christopher J L; Khemani, Robinder G

2017-10-01

To use an objective metric of effort of breathing to determine optimal high flow nasal cannula (HFNC) flow rates in children <3 years of age. Single-center prospective trial in a 24-bed pediatric intensive care unit of children <3 years of age on HFNC. We measured the percent change in pressure∙rate product (PRP) (an objective measure of effort of breathing) as a function of weight-indexed flow rates of 0.5, 1.0, 1.5, and 2.0 L/kg/minute. For a subgroup of patients, 2 different HFNC delivery systems (Fisher & Paykel [Auckland, New Zealand] and Vapotherm [Exeter, New Hampshire]) were compared. Twenty-one patients (49 titration episodes) were studied. The most common diagnoses were bronchiolitis and pneumonia. Overall, there was a significant difference in the percent change in PRP from baseline (of 0.5 L/kg/minute) with increasing flow rates for the entire cohort (P < .001) with largest change at 2.0 L/kg/min (-21%). Subgroup analyses showed no significant difference in percent change in PRP from baseline when comparing the 2 different HFNC delivery systems (P = .12). Patients ≤8 kg experienced a larger percent change in PRP as HFNC flow rates were increased (P = .001) than patients >8 kg. The optimal HFNC flow rate to reduce effort of breathing in infants and young children is approximately 1.5-2.0 L/kg/minute with more benefit seen in children ≤8 kg. Copyright © 2017 Elsevier Inc. All rights reserved.

Involvement of the basolateral amygdala in muscarinic cholinergic modulation of extinction memory consolidation

PubMed Central

Boccia, Mariano M.; Blake, Mariano G.; Baratti, Carlos M.; McGaugh, James L.

2009-01-01

Previous studies have reported that drugs affecting neuromodulatory systems within the basolateral amygdala (BLA), including drugs affecting muscarinic cholinergic receptors, modulate the consolidation of many kinds of training, including contextual fear conditioning (CFC). The present experiments investigated the involvement of muscarinic cholinergic influences within the BLA in modulating the consolidation of CFC extinction memory. Male Sprague Dawley rats implanted with unilateral cannula aimed at the BLA were trained on a CFC task, using footshock stimulation, and 24 and 48 h later were given extinction training by replacing them in the apparatus without footshock. Following each extinction session they received intra-BLA infusions of the cholinergic agonist oxotremorine (10 ng). Immediate post-extinction BLA infusions significantly enhanced extinction but infusions administered 180 min after extinction training did not influence extinction. Thus the oxotremorine effects were time-dependent and not attributable to non-specific effects on retention performance. These findings provide evidence that, as previously found with original CFC learning, cholinergic activation within the BLA modulates the consolidation of CFC extinction. PMID:18706510

Lithium modulates the muscarinic facilitation of synaptic plasticity and theta-gamma coupling in the hippocampal-prefrontal pathway.

PubMed

Ruggiero, Rafael N; Rossignoli, Matheus T; Lopes-Aguiar, Cleiton; Leite, João P; Bueno-Junior, Lezio S; Romcy-Pereira, Rodrigo N

2018-06-01

Mood disorders are associated to functional unbalance in mesolimbic and frontal cortical circuits. As a commonly used mood stabilizer, lithium acts through multiple biochemical pathways, including those activated by muscarinic cholinergic receptors crucial for hippocampal-prefrontal communication. Therefore, here we investigated the effects of lithium on prefrontal cortex responses under cholinergic drive. Lithium-treated rats were anesthetized with urethane and implanted with a ventricular cannula for muscarinic activation, a recording electrode in the medial prefrontal cortex (mPFC), and a stimulating electrode in the intermediate hippocampal CA1. Either of two forms of synaptic plasticity, long-term potentiation (LTP) or depression (LTD), were induced during pilocarpine effects, which were monitored in real time through local field potentials. We found that lithium attenuates the muscarinic potentiation of cortical LTP (<20 min) but enhances the muscarinic potentiation of LTD maintenance (>80 min). Moreover, lithium treatment promoted significant cross-frequency coupling between CA1 theta (3-5 Hz) and mPFC low-gamma (30-55 Hz) oscillations. Interestingly, lithium by itself did not affect any of these measures. Thus, lithium pretreatment and muscarinic activation synergistically modulate the hippocampal-prefrontal connectivity. Because these alterations varied with time, oscillatory parameters, and type of synaptic plasticity, our study suggests that lithium influences prefrontal-related circuits through intricate dynamics, informing future experiments on mood disorders. Copyright © 2018. Published by Elsevier Inc.

Effects of disrupting medial prefrontal cortex GABA transmission on decision-making in a rodent gambling task.

PubMed

Paine, T A; O'Hara, A; Plaut, B; Lowes, D C

2015-05-01

Decision-making is a complex cognitive process that is mediated, in part, by subregions of the medial prefrontal cortex (PFC). Decision-making is impaired in a number of psychiatric conditions including schizophrenia. Notably, people with schizophrenia exhibit reductions in GABA function in the same PFC areas that are implicated in decision-making. For example, expression of the GABA-synthesizing enzyme GAD67 is reduced in the dorsolateral PFC of people with schizophrenia. The goal of this experiment was to determine whether disrupting cortical GABA transmission impairs decision-making using a rodent gambling task (rGT). Rats were trained on the rGT until they reached stable performance and then were implanted with guide cannulae aimed at the medial PFC. Following recovery, the effects of intra-PFC infusions of the GABAA receptor antagonist bicuculline methiodide (BMI) or the GABA synthesis inhibitor L-allylglycine (LAG) on performance on the rGT were assessed. Intracortical infusions of BMI (25 ng/μl/side), but not LAG (10 μg/μl/side), altered decision-making. Following BMI infusions, rats made fewer advantageous choices. Follow-up experiments suggested that the change in decision-making was due to a change in the sensitivity to the punishments, rather than a change in the sensitivity to reward magnitudes, associated with each outcome. LAG infusions increased premature responding, a measure of response inhibition, but did not affect decision-making. Blocking GABAA receptors, but not inhibiting cortical GABA synthesis, within the medial PFC affects decision-making in the rGT. These data provide proof-of-concept evidence that disruptions in GABA transmission can contribute to the decision-making deficits in schizophrenia.

Using the Vessel Health and Preservation framework to enhance vein assessment and vascular access device selection.

PubMed

Shaw, Sally Jane

2017-07-12

There is a range of risk factors that can lead to peripheral intravenous (IV) cannula failure, and several failed cannulation attempts can result in the patient experiencing increased pain, discomfort and delays in receiving IV therapy. The Vessel Health and Preservation (VHP) framework is a tool that can be used to improve clinical decision-making and the patient experience in relation to vascular access and IV therapy. Use of the VHP framework can ensure the right vein and right vascular access device (VAD) is selected at the right time for each patient. This article describes how healthcare practitioners can use the VHP framework to support and enhance vein assessment and VAD selection. It outlines the various types of VAD available, focusing on short-term peripheral IV cannulae, which are the most commonly used devices. It also explores the potential benefits of implementing the VHP framework in clinical areas.

Technical note: assessment of recovery site of mobile nylon bags for measuring ileal digestibility of starch in dairy cows.

PubMed

Norberg, E; Volden, H; Harstad, O M

2007-01-01

The objective of this study was to evaluate recovery site of mobile nylon bags for measuring ileal digestibility of ruminally undegraded starch in dairy cows. Eight feed samples of untreated and treated concentrates were examined. Three lactating cows equipped with rumen fistula and duodenal and ileal cannulas were used in the experiment. The mobile nylon bags containing intact feeds or residues after a 12-h ruminal incubation were pretreated using a 2-step procedure to simulate abomasal digestion before insertion through the duodenal cannula. To assess the effect of hindgut fermentation on starch digestibility, approximately half of the bags were collected from the ileum and half from the feces. The results indicate that feed samples should be preincubated in rumen before insertion into duodenum, and that samples with relatively high fractions of rumen-undigestible starch should be collected from the ileum instead of from feces.

Air embolism during CT-guided transthoracic needle biopsy

PubMed Central

Lederer, Wolfgang; Schlimp, Christoph J; Glodny, Bernhard; Wiedermann, Franz J

2011-01-01

Air embolism (AE) is a potential complication during transthoracic needle biopsy (TNB). The authors report on venous and systemic AE during CT-guided TNB under general anaesthesia. During the intervention, the radiologist observed accumulation of air bubbles in the left heart chambers, in the right subclavian vein, the superior vena cava and the right atrium. This was presumably due to pressure infusion of contrast medium (CM) air entrained via a stop-cock improperly fixed to the venous cannula or via the injection valve of the cannula by Venturi forces. Prevention of AE related to CM infusion is a subject for institutional risk management. Stop-cocks and injection valves should not be used in intravenous lines supplied by pressure infusions. Adverse outcome may be avoided by placing the patient head down, increasing FiO2 to 1.0, administering antithrombotic therapy and immobilizing the patient on the intervention table until CT has proved complete remission of AE. PMID:22693299

High-flow nasal cannula therapy for adult patients

PubMed Central

Zhang, Jian; Lin, Ling; Pan, Konghan; Zhou, Jiancang

2016-01-01

High-flow nasal cannula (HFNC) oxygen therapy has several physiological advantages over traditional oxygen therapy devices, including decreased nasopharyngeal resistance, washing out of the nasopharyngeal dead space, generation of positive pressure in the pharynx, increasing alveolar recruitment in the lungs, humidification of the airways, increased fraction of inspired oxygen and improved mucociliary clearance. Recently, the use of HFNC in treating adult critical illness patients has significantly increased, and it is now being used in many patients with a range of different disease conditions. However, there are no established guidelines to direct the safe and effective use of HFNC for these patients. This review article summarizes the available published literature on the positive physiological effects, mechanisms of action, and the clinical applications of HFNC, compared with traditional oxygen therapy devices. The available literature suggests that HFNC oxygen therapy is an effective modality for the early treatment of critically adult patients. PMID:27698207

Intrauterine device for laser light diffusion and method of using the same

DOEpatents

Tadir, Yona; Berns, Michael W.; Svaasand, Lars O.; Tromberg, Bruce J.

1995-01-01

An improved device for delivery of photoenergy from a light source, such as a laser, into a uterine cavity for photodynamic therapy is comprised of a plurality of optic fibers, which are bundled together and inserted into the uterine cavity by means of a uterine cannula. The cannula is positioned within the uterine cavity at a preferred location and then withdrawn thereby allowing the plurality of optic fibers to splay or diverge one from the other within the cavity. Different portions of the distal tip of the optic fiber is provided with a light diffusing tip, the remainder being provided with a nondiffusing tip portion. The fiber optic shape, as well as the segment which is permitted to actively diffuse light through the tip, is selected in order to provide a more uniform exposure intensity of the photo energy or at least sufficient radiation directed to each segment of the uterine walls.

Intrauterine device for laser light diffusion and method of using the same

DOEpatents

Tadir, Y.; Berns, M.W.; Svaasand, L.O.; Tromberg, B.J.

1995-12-26

An improved device for delivery of photoenergy from a light source, such as a laser, into a uterine cavity for photodynamic therapy is comprised of a plurality of optic fibers, which are bundled together and inserted into the uterine cavity by means of a uterine cannula. The cannula is positioned within the uterine cavity at a preferred location and then withdrawn thereby allowing the plurality of optic fibers to splay or diverge one from the other within the cavity. Different portions of the distal tip of the optic fiber is provided with a light diffusing tip, the remainder being provided with a nondiffusing tip portion. The fiber optic shape, as well as the segment which is permitted to actively diffuse light through the tip, is selected in order to provide a more uniform exposure intensity of the photo energy or at least sufficient radiation directed to each segment of the uterine walls. 5 figs.

Air embolism after central venous catheterization.

PubMed

Kashuk, J L; Penn, I

1984-09-01

Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. A later manifestation is severe pulmonary edema. In a review of 24 patients, the mortality was 50 per cent. Among the survivors, five (42 per cent) had neurologic damage. Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.

Plastic in patient study: Prospective audit of adherence to peripheral intravenous cannula monitoring and documentation guidelines, with the aim of reducing future rates of intravenous cannula-related complications.

PubMed

Yagnik, Lokesh; Graves, Angela; Thong, Ken

2017-01-01

Peripheral intravenous cannula (PIVC) insertion is a universal intervention for inpatients and is associated with multiple complications. Effective, simple, reproducible interventions specific to PIVC complication prevention are few and often extrapolated from central venous catheter complication prevention strategies. The objective of this study is to improve compliance with documentation and monitoring PIVC guidelines in the medical ward of a secondary care center. This study is a prospective run-in audit of adherence to PIVC documentation and monitoring guidelines between the dates of August 30-November 14, 2014, with data recollection from December 25, 2014-January 30, 2015, after intervention implementation. Three interventions were implemented. The Plastic in Patient (PIP) strip is a dedicated column on the journey board, identifying inpatients with PIVCs, prompting assessment of indication at daily multidisciplinary meetings. PIP row is a prompt in the medical admission proforma to review PIVC indication. PIP poster is a visual cue on PIVC trolleys highlighting PIVC management practices. Baseline demographics were similar in the pre- and postintervention groups. Documentation significantly improved in the postintervention group (36.4 vs 50%, P = .025). Early identification of nonindicated PIVCs improved in the postintervention group (88.8% vs 97.1%, P = .018) and a trend toward a reduced PIVC-related early phlebitis rate (3.7% vs 0, P = .08). Simple, cost-effective interventions result in improvements in adherence to practice guidelines. Our results suggest a trend toward reduction in phlebitis rates. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

21 CFR 876.5090 - Suprapubic urological catheter and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... accessories is a flexible tubular device that is inserted through the abdominal wall into the urinary bladder with the aid of a trocar and cannula. The device is used to pass fluids to and from the urinary tract...

Effects of regional hemoconcentration during LBNP on plasma volume determinations. [Lower Body Negative Pressure

NASA Technical Reports Server (NTRS)

Loeppky, J. A.; Kobayashi, Y.; Venters, M. D.; Luft, U. C.

1979-01-01

Blood samples were obtained from forearm vein or artery with indwelling cannula (1) before, (2) during the last min, and (3) about 2 min after lower body negative pressure (LBNP) in 16 experiments to determine whether plasma volume (PV) estimates were affected by regional hemoconcentration in the lower body. Total hemoglobin (THb) was estimated with the CO method prior to LBNP. Hemoglobin (Hb) and hematocrit (Hct) values from (2) gave only a 3% (87 ml) loss in PV due to LBNP, assuming no change in THb. However, Hb and Hct values from (3) showed an 11% loss in PV (313 ml). This 72% underestimation of PV loss with (2) must have resulted from the sequestration of blood and subsequent hemoconcentration in the lower body during LBNP. The effects of LBNP on PV should be estimated 1-3 min after exposure, after mixing but before extravascular fluid returns to the circulation.

Viral bronchiolitis.

PubMed

Florin, Todd A; Plint, Amy C; Zorc, Joseph J

2017-01-14

Viral bronchiolitis is a common clinical syndrome affecting infants and young children. Concern about its associated morbidity and cost has led to a large body of research that has been summarised in systematic reviews and integrated into clinical practice guidelines in several countries. The evidence and guideline recommendations consistently support a clinical diagnosis with the limited role for diagnostic testing for children presenting with the typical clinical syndrome of viral upper respiratory infection progressing to the lower respiratory tract. Management is largely supportive, focusing on maintaining oxygenation and hydration of the patient. Evidence suggests no benefit from bronchodilator or corticosteroid use in infants with a first episode of bronchiolitis. Evidence for other treatments such as hypertonic saline is evolving but not clearly defined yet. For infants with severe disease, the insufficient available data suggest a role for high-flow nasal cannula and continuous positive airway pressure use in a monitored setting to prevent respiratory failure. Copyright © 2017 Elsevier Ltd. All rights reserved.

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

PubMed Central

Hawkins, Stephen; Huston, Stephanie; Campbell, Kristen; Halbower, Ann

2017-01-01

Study Objectives: Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Methods: Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Results: Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7–18.8 events/h) to 2.1 events/h (1.7–2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7–25.8 events/h) to 6.4 events/h (4.7–10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86–91 bpm) to 74 bpm (67–81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). Conclusions: High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy. Citation: Hawkins S, Huston S, Campbell K, Halbower A. High-flow, heated, humidified air via nasal cannula treats CPAP-intolerant children with obstructive sleep apnea. J Clin Sleep Med. 2017;13(8):981–989. PMID:28728621

Technical note: The development of a methodology for ruminal and colon tissue biopsying of young Holstein dairy calves.

PubMed

van Niekerk, J K; Middeldorp, M; Steele, M A

2018-05-09

The objectives of this study were to develop a methodology for biopsying the rumen and colon of young dairy calves and to collect suitable quality tissue samples for microscopic and gene expression analysis. Six Holstein dairy bull calves (45.0 ± 1.5 kg birth weight) were ruminally cannulated during the second week of life and weaned at the end of wk 6. Ruminal and colon tissue samples were collected at the end of wk 5, 6, 7, 8, and 12. Calves were not sedated but were restrained in a chute for sampling. The endoscope (100 cm length, 9.8 mm diameter) was introduced through the rumen cannula to harvest ruminal tissue. Endoscopic biopsies of the rumen with endoscopic biopsy forceps were unsuccessful 85% of the time because they were unable to shear the ruminal tissue. Thereafter, an Allis clamp was used to retrieve the blind sac through the rumen cannula to perform direct tissue biopsying with surgical scissors. To biopsy the colon, the lubricated distal tip of an endoscope was slowly inserted into the calf's anus. A total of 6 colon tissue samples (12.6 ± 0.74 mg) were collected per calf per time point from the distal colon 30 to 40 cm from the calf's anus using endoscopic biopsy forceps, which were inserted through the instrument channel. A new forcep was used between sites and calves. Between calves, the outside of the endoscope was washed with 4% chlorohexidine and rinsed with water and the instrument channel was washed with distilled water and 70% ethanol. Colon and ruminal samples were processed for histological measurements, and RNA was isolated and sequenced. High-quality RNA (RNA integrity number 8.8 ± 0.08) was collected from samples, and light and electron microscopy was performed on samples. In conclusion, endoscopic biopsying can be used for tissue harvest in the colon of young calves. However, it was found that collecting ruminal tissue by retracting the rumen from the cannula and taking samples with surgical scissors was more successful than an endoscopic biopsy. This method allows for tissue collection of the same animal throughout time, which can help the research community investigate the effect of weaning regimens, feed rations, and age on the structure and function of the gastrointestinal tract. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Post-treatment effects of local GDNF administration to the inner ears of deafened guinea pigs.

PubMed

Fransson, Anette; Maruyama, Jun; Miller, Josef M; Ulfendahl, Mats

2010-09-01

For patients with profound hearing loss, a cochlear implant is the only treatment available today. The function of a cochlear implant depends in part on the function and survival of spiral ganglion neurons. Following deafferentation, glial cell-derived neurotrophic factor (GDNF) is known to affect spiral ganglion neuron survival. The purpose of this study was to assess delayed GDNF treatment after deafening, the effects of cessation of GDNF treatment, and the effects of subsequent antioxidants on responsiveness and survival of the spiral ganglion neurons. Three-week deafened (by local neomycin administration) guinea pigs were implanted in the scala tympani with a combined cochlear implant electrode and cannula. GDNF (1 μg/mL) or artificial perilymph was then delivered for 4 weeks, following which the animals received systemic ascorbic acid  +  Trolox or saline for an additional 4 weeks. Thresholds for electrically-evoked auditory brain stem responses (eABRs) were significantly elevated at 3 weeks with deafness, stabilized with GDNF, and showed no change with GDNF cessation and treatment with antioxidants or saline. The populations of spiral ganglion neurons were reduced with deafness (by 40% at 3 weeks and 70% at 11 weeks), and rescued from cell death by GDNF with no further reduction at 8 weeks following 4 weeks of cessation of GDNF treatment equally in both the antioxidant- and saline-treated groups. Local growth factor treatment of the deaf ear may prevent deterioration in electrical responsiveness and rescue auditory nerve cells from death; these effects outlast the period of treatment, and may enhance the benefits of cochlear implant therapy for the deaf.

Effects of GABA-B receptor positive modulator on ketamine-induced psychosis-relevant behaviors and hippocampal electrical activity in freely moving rats.

PubMed

Ma, Jingyi; Stan Leung, L

2017-10-01

Decreased GABA B receptor function is proposed to mediate some symptoms of schizophrenia. In this study, we tested the effect of CGP7930, a GABA B receptor positive allosteric modulator, on ketamine-induced psychosis-relevant behaviors and hippocampal electrical activity in behaving rats. Electrodes were bilaterally implanted into the hippocampus, and cannulae were placed into the lateral ventricles of Long-Evans rats. CGP7930 or vehicle was injected intraperitoneally (i.p.) or intracerebroventricularly (i.c.v.), alone or 15 min prior to ketamine (3 mg/kg, subcutaneous) injection. Paired click auditory evoked potentials in the hippocampus (AEP), prepulse inhibition (PPI), and locomotor activity were recorded before and after drug injection. CGP7930 at doses of 1 mg/kg (i.p.) prevented ketamine-induced deficit of PPI. CGP7930 (1 mg/kg i.p.) also prevented the decrease in gating of hippocampal AEP and the increase in hippocampal gamma (65-100 Hz) waves induced by ketamine. Unilateral i.c.v. infusion of CGP7930 (0.3 mM/1 μL) also prevented the decrease in gating of hippocampal AEP induced by ketamine. Ketamine-induced behavioral hyperlocomotion was suppressed by 5 mg/kg i.p. CGP7930. CGP7930 alone, without ketamine, did not significantly affect integrated PPI, locomotion, gating of hippocampal AEP, or gamma waves. CGP7930 (1 mg/kg i.p.) increased heterosynaptically mediated paired pulse depression in the hippocampus, a measure of GABA B receptor function in vivo. CGP7930 reduces the behavioral and electrophysiological disruptions induced by ketamine in animals, and the hippocampus may be one of the neural targets where CGP7930 exerts its actions.

Totally implantable venous power ports of the forearm and the chest: initial clinical experience with port devices approved for high-pressure injections

PubMed Central

Goltz, J P; Noack, C; Petritsch, B; Kirchner, J; Hahn, D; Kickuth, R

2012-01-01

Objectives To evaluate the technical success, clinical outcome and safety of percutaneously placed totally implantable venous power ports (TIVPPs) approved for high-pressure injections, and to analyse their value for arterial phase CT scans. Methods Retrospectively, we identified 204 patients who underwent TIVPP implantation in the forearm (n=152) or chest (n=52) between November 2009 and May 2011. Implantation via an upper arm (forearm port, FP) or subclavian vein (chest port, CP) was performed under sonographic and fluoroscopic guidance. Complications were evaluated following the standards of the Society of Interventional Radiology. Power injections via TIVPPs were analysed, focusing on adequate functioning and catheter's tip location after injection. Feasibility of automatic bolus triggering, peak injection pressure and arterial phase aortic enhancement were evaluated and compared with 50 patients who had had power injections via classic peripheral cannulas. Results Technical success was 100%. Procedure-related complications were not observed. Catheter-related thrombosis was diagnosed in 15 of 152 FPs (9.9%, 0.02/100 catheter days) and in 1 of 52 CPs (1.9%, 0.002/100 catheter days) (p<0.05). Infectious complications were diagnosed in 9 of 152 FPs (5.9%, 0.014/100 catheter days) and in 2 of 52 CPs (3.8%, 0.003/100 catheter days) (p>0.05). Arterial bolus triggering succeeded in all attempts; the mean injection pressure was 213.8 psi. Aortic enhancement did not significantly differ between injections via cannulas and TIVPPs (p>0.05). Conclusions TIVPPs can be implanted with high technical success rates, and are associated with low rates of complications if implanted with sonographic and fluoroscopic guidance. Power injections via TIVPPs are safe and result in satisfying arterial contrast. Conventional ports should be replaced by TIVPPs. PMID:22674705

Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush.

PubMed

Groth, Sylvia L; Greider, Kelsi L; Sponsel, William Eric

2015-01-01

To assess the utility of viscoelastic injection to induce bleb expansion and decrease intraocular pressure (IOP) in eyes with encapsulated glaucoma tube shunt blebs. Case series. Forty-three glaucomatous eyes, including 13 eyes with congenital, 13 uveitic, 5 neovascular, 5 open angle, 4 narrow angle and 3 traumatic glaucomas. Methods, interventions or testing: All patients underwent viscoelastic flush procedure. A pre-bent 27 or 30-gauge cannula was passed through a 25-gauge paracentesis, advanced over the iris across the anterior chamber, and insinuated into the tube shunt lumen. Once the cannula was firmly lodged in position, 0.45 to 0.85 ml of viscoelastic was injected to hyperinflate the bleb. Paired t-tests were performed comparing preoperative IOP and number of medications used preoperatively vs levels measured at 1, 6, 12, 18 and 24 months. Intraocular pressure was reduced from a mean preoperative level of 26.0 ± 1.2 (sem) mm Hg to 15.8 ± 1.0 at 1 month, remaining stable thereafter at each 6-month interval with 15.1 ± 1.1 mm Hg at 24 months (p < 0.0001). Medication use did not vary significantly from baseline. Pressure remained < 21 mm Hg after 2 years in 85% of eyes cannulated within 1 year of primary tube shunt implantation (n = 23), and in 62% of eyes cannulated more than 1 year after tube shunt placement (n = 20). Tube shunt expansion with bolus viscoelastic flush successfully restored encapsulated bleb function, providing a substantial (~10 mm Hg) IOP decrease into the mid-normal pressure range. This persisted in the majority of treated eyes for the entire study period. How to cite this article: Groth SL, Greider KL, Sponsel WE. Utility of Operative Glaucoma Tube Shunt Viscoelastic Bolus Flush. J Curr Glaucoma Pract 2015;9(3):73-76.

Digestive development in neonatal dairy calves with either whole or ground oats in the calf starter.

PubMed

Suarez-Mena, F X; Heinrichs, A J; Jones, C M; Hill, T M; Quigley, J D

2015-05-01

A series of 3 trials was conducted to determine effects of whole or ground oats in starter grain on reticulorumen fermentation and digestive system development of preweaned calves. Male Holstein calves (43.1±2.3kg at birth; n=8, 9, and 7 for trials 1, 2, and 3, respectively) were housed in individual pens in a heated facility; bedding was covered with landscape fabric to prevent consumption of bedding by the calves. In trials 1 and 2 only, calves were fitted with rumen cannulas by wk 2 of life. In all trials, a fixed amount of starter (containing 25% oats either ground and in the pellet or whole) was offered daily; orts were fed through the cannula in trials 1 and 2. Calves were randomly assigned to an all-pelleted starter or pellets plus whole oats. Rumen contents (trials 1 and 2) were sampled weekly at -8, -4, 0, 2, 4, 8, and 12 h after grain feeding for determination of pH and volatile fatty acids. Calves were killed 3 wk (trial 1) or 4 wk (trials 2 and 3) after grain was offered; organs were harvested, emptied, rinsed, and weighed to gauge digestive organ development. Starter intake was not different between treatments. Weekly measurements of rumen digesta pH did not change and only subtle changes were observed in molar proportions of individual volatile fatty acids. Molar proportion of butyrate and pH linearly decreased with age, whereas acetate proportion increased. Reticulorumen weight and papillae length tended to be greater for calves fed pelleted starter, whereas abomasum weight was greater for calves fed pellets plus whole oats. Fecal particle size and starch content were greater for calves fed pellets plus whole oats. Under the conditions of this study, physical form of oats in starter grain did not affect rumen fermentation measurements; greater rumen weight and papillae length in calves fed pelleted starter may be the result of greater nutrient availability of ground oats. Under the conditions of this study with young calves on treatments for <4 wk, increasing particle size of the starter by feeding whole oats did not affect rumen fermentation nor did it improve digestive system development. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Straw particle size in calf starters: Effects on digestive system development and rumen fermentation.

PubMed

Suarez-Mena, F X; Heinrichs, A J; Jones, C M; Hill, T M; Quigley, J D

2016-01-01

Two trials were conducted to determine effects of straw particle size in calf starter on rumen fermentation and development in calves. Holstein calves (n=17 in trial 1; n=25 in trial 2) were housed in individual pens; bedding (wood shavings) was covered with landscape fabric to completely avoid consumption of bedding. Milk replacer was fed at 12% of birth body weight per day and water offered free choice. Calves were randomly assigned to 4 treatments differing in geometric mean particle length (Xgm) of straw comprising 5% of starter dry matter. Straw was provided within the pellet at manufacture (PS; 0.82 mm Xgm) or mixed with the pellet at time of feeding at Xgm of 3.04 (SS), 7.10 (MS), or 12.7 (LS) mm. Calves (n=12; 3/treatment) in trial 1 were fitted with a rumen cannula by wk 2 of age. A fixed amount of starter that was adjusted with age and orts were fed through the cannula in cannulated calves. Calves were euthanized 6 wk after starter was offered (9 and 7 wk of age for trials 1 and 2, respectively). Rumen digesta pH linearly decreased with age, whereas volatile fatty acid concentration increased with age. Overall pH had a cubic trend with SS lower than that of PS and MS. Molar proportion of acetate decreased with age whereas propionate proportion increased. Overall molar proportions of volatile fatty acids were not affected by diet. Fecal Xgm was not different in spite of changes in diet particle size and rumen digesta of PS being greater than SS, MS, and LS at slaughter. Fecal pH and starch concentration were not affected by diet; however, pH decreased whereas starch content increased with age. Weight of stomach compartments, rumen papillae length and width, and rumen wall thickness did not differ between diets. Omasum weight as a percentage of body weight at harvest linearly decreased as straw particle size increased. Under the conditions of this study, modifying straw particle length in starter grain resulted in minimal rumen fermentation parameter changes and no changes in rumen development. Rumen pH and fermentation changes with age were likely effects of increasing starter intake. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Prediction of the amino acid digestibility of legume seeds in growing pigs: a meta-analysis approach.

PubMed

Messad, F; Létourneau-Montminy, M P; Charbonneau, E; Sauvant, D; Guay, F

2018-05-01

On pig farms, a high proportion of the cost of production comes from feed costs. However, the use of alternative ingredients such as legume seeds may help to reduce this cost. In fact, legume seeds are an important source of essential amino acids (EAA) and can therefore be an alternative to oilseed meals. However, the accurate use of these legume seeds requires a precise knowledge of the standardized ileal digestibility (SID) of EAA, which may vary depending on its botanical variety. A meta-analysis was performed on a database compiling data from 41 studies published between 1981 and 2013 and 178 dietary treatments. Models of prediction of the SID of EAA as well as the dietary concentration of digestible standardized EAA (dEAA) were obtained, based on the chemical composition of ingredients reported in the publications. The effect of the type of legume seeds (faba bean, lupin, pea and soya bean), surgical procedures (T-cannula, re-entrant cannulas, post valve T-cannulas and ileo-rectal anastomosis), and BW of pigs (BW⩽25 kg BW>25 kg) were also tested in each model. Results showed that dietary CP and crude fibre (CF) were, respectively, the best predictors of each EAA SID for faba bean, lupin and pea (R 2=0.42 to 0.89) and soya bean (R 2=0.32 to 0.77). For the dEAA content, the best prediction models included dietary CP and ADF for faba bean, lupin and pea and soya bean, respectively, with R 2 ranging from 0.66 to 0.98. Models developed in this study allow predicting the digestibility of EAA in these alternatives feedstuffs.

In situ control of cardiotomy suction reduces blood trauma.

PubMed

Tevaearai, H T; Mueller, X M; Horisberger, J; Augstburger, M; Bock, H; Knorr, A; von Segesser, L K

1998-01-01

Cardiotomy suction is known for its deleterious effects on formed and unformed blood elements. The authors investigated an "intelligent" remote controlled automatic suction system. A suction cannula with an optic sensor at its tip was connected to a special closed cardiotomy reservoir. Contact with blood immediately generated a reservoir vacuum from 0 to -100 mmHg, permitting aspiration until the blood was no longer detected (automatic shut off). Blood trauma was evaluated in a bovine model, comparing the automatic suction system vs standard continuous aspiration (control) adjusted to -100 mmHg. After full systemic heparinization, five calves (weight, 62.5 +/- 4.4 kg) for the automatic suction system group, and four (weight, 62.8 +/- 5.1 kg) for the control group, were equipped with a jugular cannula connected via a roller pump to the cardiotomy reservoir. Through a small thoracotomy, a standardized hole was created in the right atrium, allowing for a blood loss of approximately 400 ml/min. The suction cannula was placed into the chest cavity in a fixed position. Blood samples were drawn at regular intervals for cell count and chemistry. Lactate dehydrogenase values, for the automatic suction system and the control groups, respectively, expressed as percent of baseline value, were 88 +/- 14 vs 116 +/- 22 after 1 hr; 94 +/- 16 vs 123 +/- 23 after 2 hr; and 97 +/- 19 vs 140 +/- 48 after 3 hr (p < 0.05). Values for free hemoglobin in plasma (percent of baseline value), for the automatic suction system and the control groups, respectively, were 102 +/- 18 vs 200 +/- 69 after 1 hr; 98 +/- 29 vs 163 +/- 37 after 2 hr; and 94 +/- 37 vs 179 +/- 42 after 3 hr (p < 0.05). Compared with a standard continuous aspiration system, in situ regulation of suction significantly reduces blood trauma.

Effectiveness of Needles Vial Adaptors and Blunt Cannulas for Drug Administration in a Microgravity Environment

NASA Technical Reports Server (NTRS)

Hailey, Melinda; Bayuse, Tina

2009-01-01

The need for a new system of injectable medications aboard the International Space Station (ISS) was identified. It is desired that this system fly medications in their original manufacturer's packaging, allowing the system to comply with United States Pharmacopeia (USP) guidelines while minimizing the resupply frequency due to medication expiration. Pre-filled syringes are desired, however, the evolving nature of the healthcare marketplace requires flexibility in the redesign. If medications must be supplied in a vial, a system is required that allows for the safe withdrawal of medication from the vial into a syringe for administration in microgravity. During two reduced gravity flights, the effectiveness of two versions of a blunt cannula and needleless vial adaptors was evaluated to facilitate the withdrawal of liquid medication from a vial into a syringe for injection. Other parameters assessed included the ability to withdraw the required amount of medication and whether this is dependent on vial size, liquid, or the total volume of fluid within the vial. Injectable medications proposed for flight on ISS were used for this evaluation. Due to differing sizes of vials and the fluid properties of the medications, the needleless vial adaptors proved to be too cumbersome to recommend for use on the ISS. The blunt cannula, specifically the plastic version, proved to be more effective at removing medication from the various sizes of vials and are the recommended hardware for ISS. Fluid isolation within the vials and syringes is an important step in preparing medication for injection regardless of the hardware used. Although isolation is a challenge in the relatively short parabolas during flight, it is not an obstacle for sustained microgravity. This presentation will provide an overview of the products tested as well as the challenges identified during the microgravity flights.

Transconjunctival drainage of serous and hemorrhagic choroidal detachment.

PubMed

Rezende, Flávio A; Kickinger, Mônica C; Li, Gisèle; Prado, Renata F; Regis, Luiz Gustavo T

2012-02-01

To describe a novel surgical technique for drainage of bullous serous and hemorrhagic choroidal detachments. A prospective, consecutive case series of 6 eyes with serous and/or hemorrhagic choroidal detachments secondary to intraocular surgery was documented to evaluate the feasibility of using the 25-gauge and 20-gauge transconjunctival trocar/cannula systems to drain choroidal detachments. Two eyes had expulsive hemorrhagic choroidal detachments and 4 eyes had serous choroidal detachments after glaucoma surgeries. A 25-gauge infusion line was placed in the anterior chamber. A 20-gauge (in eyes with hemorrhagic choroidal detachments) or a 25-gauge (in eyes with serous detachments) trocar/cannula system was inserted into the suprachoroidal space 7.0 mm from limbus. After drainage, the cannulas were removed and no sutures were placed. Pars plana vitrectomy was performed only in eyes with concomitant pathology that demanded the additional procedure. The primary outcome measure was presence of choroidal detachment at 1 week, 2 weeks, and 1 month postoperatively. Secondary outcome measures were visual acuity at 6 months and intraocular pressure at 1 week and 1, 3, and 6 months postoperatively. Drainage of hemorrhagic choroidal detachments resulted in resolution of the detachments by 1 month postoperatively. In eyes with serous detachments, resolution was achieved by 1 week postdrainage. In both groups, intraocular pressure increased to at least 10 mmHg by postoperative Week 1. The visual acuity improved in all eyes. No complications related to the transconjunctival technique were noted. Transconjunctival drainage of serous and hemorrhagic choroidal detachments seems to be a feasible and simple surgical option with minimal scleral and conjunctival damage. Pars plana vitrectomy may not be necessary when draining choroidal detachments in this manner.

A healthy volunteer study to investigate trace element contamination of blood samples by stainless steel venepuncture needles.

PubMed

Hodnett, Darragh; Wood, David M; Raja, Kishor; Dargan, Paul I; Shah, Anoop D

2012-02-01

The trace elements cobalt (Co), chromium (Cr), manganese (Mn) and nickel (Ni) are normally present at low concentrations in blood. There has been a concern that stainless steel venepuncture needles typically used for collection of blood samples may contaminate these samples, leading to the masking of deficiency states or causing potential clinical confusion as to whether an individual has a "toxic" concentration. To determine whether there is any difference between the concentrations of the trace elements obtained by different methods of blood sampling. We took blood samples using a standard venepuncture needle, a "butterfly" winged infusion needle (three consecutive samples) and a plastic intravenous cannula (three consecutive samples) from 10 healthy volunteers. We measured the concentrations of Co, Cr, Mn and Ni in the samples using Inductively Coupled Plasma Mass Spectrometry, and used analysis of variance (ANOVA) to investigate if there was any difference between the methods of blood sampling. The mean ± standard deviation blood metal concentrations were: Co 0.33 ± 0.2 μg/l, Cr 2.43 ± 1.55 μg/l, Mn 8.07 ± 7.74 μg/l and Ni 10.4 ± 4.69 μg/l. There was considerable variation between blood metal concentrations of individual subjects and a few sporadic high values. By ANOVA, there was no significant difference between the metal concentrations measured using different methods of blood collection. It is not necessary to routinely use a plastic cannula for blood sampling for trace element analysis. However, it is possible that sporadic contamination due to stainless steel needles may occur, so we would recommend that unexpected high concentrations are verified by taking a second sample taken through a plastic cannula.

Characterization of Carbon Dioxide Washout Measurement Techniques in the Mark-III Space Suit

NASA Technical Reports Server (NTRS)

Meginnis, Ian M.; Norcross, Jason; Bekdash, Omar; Ploutz-Snyder, Robert

2016-01-01

A space suit must provide adequate carbon dioxide (CO2) washout inside the helmet to prevent symptoms of hypercapnia. In the past, an oronasal mask has been used to measure the inspired air of suited subjects to determine a space suit's CO2 washout capability. While sufficient for super-ambient pressure testing of space suits, the oronasal mask fails to meet several human factors and operational criterion needed for future sub-ambient pressure testing (e.g. compatibility with a Valsalva device). This paper describes the evaluation of a nasal cannula as a device for measuring inspired air within a space suit. Eight test subjects were tasked with walking on a treadmill or operating an arm ergometer to achieve target metabolic rates of 1000, 2000, and 3000 British thermal units per hour (BTU/hr), at flow rates of 2, 4, and 6 actual cubic feet per minute (ACFM). Each test configuration was conducted twice, with subjects instructed to breathe either through their nose only, or however they felt comfortable. Test data shows that the nasal cannula provides more statistically consistent data across test subjects than the oronasal mask used in previous tests. The data also shows that inhaling/exhaling through only the nose provides a lower sample variance than a normal breathing style. Nose-only breathing reports better CO2 washout due to several possible reasons, including a decreased respiratory rate, an increased tidal volume, and because nose-only breathing directs all of the exhaled CO2 down and away from the oronasal region. The test subjects in this study provided feedback that the nasal cannula is comfortable and can be used with the Valsalva device.

Dopamine and noradrenaline efflux in the prefrontal cortex in the light and dark period: effects of novelty and handling and comparison to the nucleus accumbens.

PubMed

Feenstra, M G; Botterblom, M H; Mastenbroek, S

2000-01-01

We used on-line microdialysis measurements of dopamine and noradrenaline extracellular concentrations in the medial prefrontal cortex of awake, freely moving rats during the dark and the light period of the day to study whether (i) basal efflux would be higher in the active, dark period than in the inactive, light period; (ii) the activation induced by environmental stimuli would be dependent on these conditions. When determined one day after cannula placement, noradrenaline and dopamine levels were higher during the dark. Maximal relative increases induced by novelty and handling were 150% and 175-200%, respectively, and were very similar in the light and the dark, but the net increases were higher in the dark. Separate groups were tested one week after cannula placement to ensure recovery of possibly disturbed circadian rhythms. While basal levels in the dark were now approximately twice those in the light, the maximal relative and net increases after both novelty and handling were very similar. Basal levels of dopamine in the nucleus accumbens (one day after cannula placement) were not different in the light or dark, but were increased by novelty and handling to about 130% only in the light period, not in the dark. Thus, in the prefrontal cortex, dopamine strongly resembles noradrenaline, in that basal efflux was state dependent, whereas activation by stimuli was not. In the nucleus accumbens, basal dopamine efflux was not state dependent, but activation by stimuli was. These results suggest that there are differential effects of circadian phase on basal activity and responsiveness of the mesolimbic vs the mesocortical dopamine system.

Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay.

PubMed

Hoffman, Suma B; Terrell, Natalie; Driscoll, Colleen Hughes; Davis, Natalie L

2016-10-01

Heated humidified high-flow nasal cannula (HFNC) is thought to be comparable with nasal CPAP. The effect of multimodality mid-level respiratory support use in the neonatal ICU is unknown. The objective of this work was to evaluate the effect of introducing HFNC on length of respiratory support and stay. A chart review was conducted on subjects at 24-32 weeks gestation requiring mid-level support (HFNC/nasal CPAP) 1 y before and after HFNC implementation. The 2 groups were compared for clinical and demographic data using t test or chi-square analysis. Further, multivariate linear and logistic regression was done to determine significant risk factors for outcomes controlling for covariates. Eighty subjects were eligible in the pre-HFNC group, and 83 were eligible in the post-HFNC group. Subjects were similar in their baseline characteristics. In clinical outcomes, the post-HFNC group had higher rates of retinopathy of prematurity (P = .02) and a trend toward higher bronchopulmonary dysplasia rates (P = .063). The post-HFNC subjects had longer duration of mid-level support and were older at the time they were weaned to stable low-flow nasal cannula (P < .05). Although the length of respiratory support and stay and corrected gestational age at discharge were similar, those in the pre-HFNC period were more likely to be receiving full oral feeds and be discharged home versus being transferred to an intermediate care facility (P < .05). HFNC introduction was significantly associated with a longer duration of mid-level respiratory support, decrease in oral feeding at discharge, increased retinopathy of prematurity rates, and higher use of intermediate care facilities, leading us to examine our noninvasive ventilation and weaning strategies. Copyright © 2016 by Daedalus Enterprises.

The 3DBiopsy Prostate Biopsy System: Preclinical Investigation of a Needle, Actuator, and Specimen Collection Device Allowing Sampling of Individualized Prostate Lengths Between 20 and 60 mm.

PubMed

Stone, Nelson N; Mouraviev, Vladimir; Schechter, David; Lucia, M Scott; Smith, Elizabeth E; Arangua, Paul; Hoenemeyer, John; Rosa, Jim; Bawa, Rajan; Crawford, E David

2017-09-01

To increase the likelihood of detecting anterior cancers within the prostate and provide a specimen that spans the length of the gland. Newly designed 17- and 15-gauge (G) biopsy needles, a variable actuator, and an integrated pathology system intended for the longer cores were developed and tested for this purpose. Testing was performed comparing 2 common cannula tip grinds, a Vet-point (sharp tip) and a Menghini-point (atraumatic tip), and were tested against 18-G Bard Monopty in porcine kidney. A variable actuator was developed to fire the needle 20-60 mm and tested in cadaver prostates. The aggregate firings for 3 different shot lengths comparing the Vet- with the Menghini-tip cannulas demonstrated 91% vs 85.2% fill (length of specimen/length of core bed, P = .007). A 15-G trocar needle with the Vet-tip cannula also had the best performance, with an aggregate standard deviation of 6.4% across 3 firing ranges and a minimum to maximum specimen length of 81%-105% of potential fill. Cadaver testing with the Vet-tip needles in the actuator for the transrectal (17-G) and transperineal (15-G) biopsies demonstrated mean fills of 93.3% and 76.5%, respectively. The new transrectal ultrasound needle obtained a 2-fold increase in specimen length over the standard Bard device (P <.001). Longer and consistent cores were obtained using the new biopsy needles. Combined with an adjustable actuator, the physician can obtain specimens that include peripheral and anterior zone tissue in 1 core. Determination of cancer location on the longer specimens could enhance focal therapy planning. Copyright © 2017 Elsevier Inc. All rights reserved.

A calf model for left ventricular centrifugal mechanical assist.

PubMed

Mann, F A; Wagner-Mann, C C; Curtis, J J; Demmy, T L; Turk, J R

1996-06-01

The increased use of centrifugal mechanical assist (CMA) for treatment of refractory postcardiotomy cardiogenic shock highlights the need for experimental testing to improve clinical results. This report describes the preoperative conditioning, anesthetic and surgical technique, and postoperative management of a reliable calf model refined in this laboratory for in vivo subchronic (96 h) testing of CMA. Holstein bull calves (2 to 3 months old; mean body weight, 78 kg; n = 35) were instrumented for left ventricular CMA; 4 of these calves were sham-operated controls. Anesthetic recovery and postoperative restraint were accomplished in a specially designed crate to which each calf was preconditioned extensively. Younger calves were more readily conditioned and more tolerant of postoperative restraint than older calves. One calf died of ventricular fibrillation intraoperatively. One calf that had been heparinized developed uncontrollable hemothorax and died 12 h postoperatively. One calf prematurely dislodged his aortic cannula 15 h postoperatively and exsanguinated. Six calves developed pelvic limb paresis or paralysis because of lumbar spinal cord thromboembolism by 36 h postoperatively, and 3 of these calves were sacrificed by 42 h postoperatively. Fifteen calves required sedation in the first 12 h after the operation. Tachycardia associated with bottle feeding occurred in 15 calves. Second-degree atrioventricular block was noted frequently during deep relaxation. Postmortem examination demonstrated the absence of surgical wound and distant infection, security of cannulae in all but the calf that prematurely dislodged the aortic cannula, absence of thrombus formation at cannulation sites, and presence of thromboembolism in 51% of the calves. The incidence of thromboembolic lesions was not influenced by the need for chemical restraint, by the occurrence of feeding-associated tachycardia, or by the presence of atrioventricular block. There were no thromboembolic lesions in any of the sham-operated controls.

Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study.

PubMed

Ergul, Ayse Betul; Calıskan, Emrah; Samsa, Hasan; Gokcek, Ikbal; Kaya, Ali; Zararsiz, Gozde Erturk; Torun, Yasemin Altuner

2018-06-18

The effectiveness of using a face mask with a small diffuser for oxygen delivery (OxyMask) was compared to use of a high-flow nasal cannula (HFNC) in patients with moderate or severe bronchiolitis.The study population in this open, phase 4, randomized controlled trial consisted of 60 patients aged 1-24 months diagnosed with moderate or severe bronchiolitis and admitted to an intensive care unit (ICU) for oxygen therapy. The patients were randomized into two groups according to the method of oxygen delivery: a diffuser mask group and an HFNC group.There were seven failures in the mask group and none in the HFNC group. The survival probability differed significantly between the two treatment methods (p = 0.009).Time to weaning off oxygen therapy was 56 h in the HFNC group and 96 h in the mask group (p < 0.001). HFNC use decreased the treatment failure rate and the duration of both oxygen therapy and ICU treatment compared to the diffuser mask, which implies that an HFNC should be the first choice for treating patients admitted to the ICU with severe bronchiolitis. What is known: • A high-flow nasal cannula (HFNC) does not significantly reduce the time on oxygen compared to standard therapy in children with moderate to severe bronchiolitis. Observational studies show that, since the introduction of HFNC, fewer children with bronchiolitis need intubation. For children with moderate to severe bronchiolitis there is no proof of its benefit. What Is New: • In children with moderate to severe bronchiolitis, HFNC provides faster and more effective improvement than can be achieved with a diffuser mask.

Contrast agent comparison for three-dimensional micro-CT angiography: A cadaveric study.

PubMed

Kingston, Mitchell J; Perriman, Diana M; Neeman, Teresa; Smith, Paul N; Webb, Alexandra L

2016-07-01

Barium sulfate and lead oxide contrast media are frequently used for cadaver-based angiography studies. These contrast media have not previously been compared to determine which is optimal for the visualisation and measurement of blood vessels. In this study, the lower limb vessels of 16 embalmed Wistar rats, and four sets of cannulae of known diameter, were injected with one of three different contrast agents (barium sulfate and resin, barium sulfate and gelatin, and lead oxide combined with milk powder). All were then scanned using micro-computed tomography (CT) angiography and 3-D reconstructions generated. The number of branching generations of the rat lower limb vessels were counted and compared between the contrast agents using ANOVA. The diameter of the contrast-filled cannulae, were measured and used to calculate the accuracy of the measurements by comparing the bias and variance of the estimates. Intra- and inter-observer reliability were calculated using intra-class correlation coefficients. There was no significant difference (mean difference [MD] 0.05; MD 95% confidence interval [CI] -0.83 to 0.93) between the number of branching generations for barium sulfate-resin and lead oxide-milk powder. Barium sulfate-resin demonstrated less bias and less variance of the estimates (MD 0.03; standard deviation [SD] 1.96 mm) compared to lead oxide-milk powder (MD 0.11; SD 1.96 mm) for measurements of contrast-filled cannulae scanned at high resolution. Barium sulfate-resin proved to be more accurate than lead oxide-milk powder for high resolution micro-CT scans and is preferred due to its non-toxicity. This technique could be applied to any embalmed specimen model. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Rumen Bacterial Community Composition in Holstein and Jersey Cows Is Different under Same Dietary Condition and Is Not Affected by Sampling Method

PubMed Central

Paz, Henry A.; Anderson, Christopher L.; Muller, Makala J.; Kononoff, Paul J.; Fernando, Samodha C.

2016-01-01

The rumen microbial community in dairy cows plays a critical role in efficient milk production. However, there is a lack of data comparing the composition of the rumen bacterial community of the main dairy breeds. This study utilizes 16S rRNA gene sequencing to describe the rumen bacterial community composition in Holstein and Jersey cows fed the same diet by sampling the rumen microbiota via the rumen cannula (Holstein cows) or esophageal tubing (both Holstein and Jersey cows). After collection of the rumen sample via esophageal tubing, particles attached to the strainer were added to the sample to ensure representative sampling of both the liquid and solid fraction of the rumen contents. Alpha diversity metrics, Chao1 and observed OTUs estimates, displayed higher (P = 0.02) bacterial richness in Holstein compared to Jersey cows and no difference (P > 0.70) in bacterial community richness due to sampling method. The principal coordinate analysis displayed distinct clustering of bacterial communities by breed suggesting that Holstein and Jersey cows harbor different rumen bacterial communities. Family level classification of most abundant (>1%) differential OTUs displayed that OTUs from the bacterial families Lachnospiraceae and p-2534-18B5 to be predominant in Holstein cows compared to Jersey cows. Additionally, OTUs belonging to family Prevotellaceae were differentially abundant in the two breeds. Overall, the results from this study suggest that the bacterial community between Holstein and Jersey cows differ and that esophageal tubing with collection of feed particles associated with the strainer provides a representative rumen sample similar to a sample collected via the rumen cannula. Thus, in future studies esophageal tubing with addition of retained particles can be used to collect rumen samples reducing the cost of cannulation and increasing the number of animals used in microbiome investigations, thus increasing the statistical power of rumen microbial community evaluations. PMID:27536291

Immunosuppressive and Anti-Inflammatory Effects of Nicotine Administered by Patch in an Animal Model

PubMed Central

Kalra, Roma; Singh, Shashi P.; Pena-Philippides, Juan C.; Langley, Raymond J.; Razani-Boroujerdi, Seddigheh; Sopori, Mohan L.

2004-01-01

To study the immunological effects of nicotine, there are several rodent models for chronic nicotine administration. These models include subcutaneously implanted miniosmotic pumps, nicotine-spiked drinking water, and self-administration via jugular cannulae. Administration of nicotine via these routes affects the immune system. Smokers frequently use nicotine patches to quit smoking, and the immunological effects of nicotine patches are largely unknown. To determine whether the nicotine patch affects the immune system, nicotine patches were affixed daily onto the backs of Lewis rats for 3 to 4 weeks. The patches efficiently raised the levels of nicotine and cotinine in serum and strongly inhibited the antibody-forming cell response of spleen cells to sheep red blood cells. The nicotine patch also suppressed the concanavalin A-induced T-cell proliferation and mobilization of intracellular Ca2+ by spleen cells, as well as the fever response of animals to subcutaneous administration of turpentine. Moreover, immunosuppression was associated with chronic activation of protein tyrosine kinase and phospholipase C-γ1 activities. Thus, in this animal model of nicotine administration, the nicotine patch efficiently raises the levels of nicotine and cotinine in serum and impairs both the immune and inflammatory responses. PMID:15138183

The effect of pelleting on in situ rumen degradability of compound feed containing brown rice for dairy cows.

PubMed

Tagawa, Shin-Ichi; Yoshida, Norio; Iino, Yukihiro; Horiguchi, Ken-Ichi; Takahashi, Toshiyoshi; Watanabe, Maria; Takemura, Kei; Ito, Syuhei; Mikami, Toyoji

2017-01-01

This study was conducted to determine the effect of pelleting on in situ dry matter degradability of pelleted compound feed containing brown rice for dairy cows. Mash feed of the same composition was used as a control and the in situ study was conducted using three non-lactating Holstein steers fitted with a rumen cannula. The feeds contained 32.3% brown rice, 19.4% rapeseed meal, 11.4% wheat bran and 10.6% soybean meal (fresh weight basis). Except for moisture content, the chemical composition of the feed was not affected by pelleting. In situ dry matter disappearance of the feed increased from 0 to 2 h and after 72 h of incubation with pellet processing. Integration of the dry matter disappearance values over time revealed that degradability parameter a (soluble fraction) increased with pellet processing, whereas parameter b (potentially degradable fraction) decreased. Parameter c (fractional rate of degradation) and effective degradability (5% passage rate) were not affected by pellet processing. We concluded that pellet processing promotes rumen degradability at early incubation hours when the pelleted feed contains brown rice. © 2016 Japanese Society of Animal Science.

Use of a Left Ventricular Assist Device as a Bridge to Transplantation in a Pediatric Patient

PubMed Central

Frazier, O.H.; Bricker, J. Timothy; Macris, Michael P.; Cooley, Denton A.

1989-01-01

Despite many advances in heart transplantation and in mechanical circulatory support, the benefits of staged cardiac transplantation have not been extended to the pediatric transplant recipient, chiefly because implantable circulatory assist devices are still too large. Extracorporeal devices, however, can overcome this impediment. Here we report the 1st case, to our knowledge, in which an extracorporeal left ventricular assist device has been used in a child to support circulation prior to cardiac transplantation. The patient was a 9-year-old boy in New York Heart Association functional class IV, with congestive heart failure as a result of idiopathic biventricular cardiomegaly. In mid-May of 1987, while awaiting a suitable donor, he suffered severe oliguria after an episode of circulatory arrest. Therefore we decided to maintain his circulation—and consequently his peripheral organ function—with an extracorporeal left ventricular assist device. After establishing cardiopulmonary bypass under normothermia and without cardiac arrest, we established flow from the left ventricle through a 36-Fr wire-reinforced straight cannula to a Biomedicus BP-80 centrifugal force pump, with return to the proximal ascending aorta through a 28-Fr wire-reinforced straight cannula. The patient's hemodynamic course under subsequent mechanical circulatory support was remarkably stable, with controllable systemic hypertension and no evidence of hemolysis. Although cardiac activity was minimal and systemic blood flow nonpulsatile, the patient's renal, pulmonary, and hepatic functions improved, and his peripheral circulation was well preserved. After 12 hours of support, a donor heart became available, and a routine orthotopic cardiac transplant was performed. Upon removal, the left ventricular assist device showed a small amount of thrombus formation. The patient's postoperative recovery has been easily manageable, and 20 months after transplant he enjoys unrestricted physical activity. We conclude that an extracorporeal left ventricular assist device can be used as a bridge to cardiac transplantation in children. Moreover, this application of a continuous force centrifugal pump without adverse effect encourages the conclusion that long-term maintenance of terminal heart disease patients might be possible through development of small, implantable pumps with the potential of lower power requirements and reduced thrombogenesis. (Texas Heart Institute Journal 1989;16:46-50) PMID:15227237

Effects of chewing behavior and ruminal digestion processes on voluntary intake of grass silages by lactating dairy cows.

PubMed

Teller, E; Vanbelle, M; Kamatali, P; Collignon, G; Page, B; Matatu, B

1990-11-01

Four primiparous Holstein-Friesian cows (518 kg average BW) with ruminal and duodenal cannulas were used to examine voluntary intake of direct cut (DC) or wilted (W) grass silage in relation to ruminal characteristics and chewing behavior. Dry matter content of the silages was 17.0 and 38.1%, concentrate DM intake was restricted to 5.0 and 5.3 kg/d, and voluntary DM intake from silages averaged 7.4 and 9.5 kg/d (P = .008), respectively. The acetate/propionate ratio in ruminal fluid decreased from 4.0 on DC to 3.3 on W silage (P = .021). The protein content in milk increased from 26.3 to 27.5 g/liter (P = .042) and the protein yield from 469 to 574 g/d (P = .038). The distribution of concentrates (38% of DM intake) with a mean particle size of .04 cm reduced differences in fecal mean particle size between diets. There was a shift from eating to ruminating on W silage with regard to daily duration (min/d) and number of jaw movements (no./d). However, ruminating index (no./kg DM intake) remained unchanged, irrespective of wilting and chop length of the silages or physiological state of the animals. These results are interpreted to indicate that the time lag for functional density of feed particles in the reticulorumen to increase, as affected by ruminating activity, not rate of reduction of the particle size, limits voluntary intake of grass silage by cattle.

21 CFR 878.5040 - Suction lipoplasty system.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... The device consists of a powered suction pump (containing a microbial filter on the exhaust and a microbial in-line filter in the connecting tubing between the collection bottle and the safety trap), collection bottle, cannula, and connecting tube. The microbial filters, tubing, collection bottle, and...

21 CFR 878.5040 - Suction lipoplasty system.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... The device consists of a powered suction pump (containing a microbial filter on the exhaust and a microbial in-line filter in the connecting tubing between the collection bottle and the safety trap), collection bottle, cannula, and connecting tube. The microbial filters, tubing, collection bottle, and...

A chandelier-illuminated anterior chamber maintainer for use during descemet stripping automated endothelial keratoplasty in patients with advanced bullous keratopathy.

PubMed

Inoue, Tomoyuki; Oshima, Yusuke; Hori, Yuich; Maeda, Naoyuki

2010-08-01

A new 25-gauge illuminated anterior chamber maintainer composed of a 25-gauge infusion cannula through which a 29-gauge chandelier fiber probe passes was developed for use during Descemet stripping automated endothelial keratoplasty to treat patients with advanced bullous keratopathy. This device, which is compatible with a xenon or mercury vapor illuminator to generate powerful wide-angle illumination from the cone-shaped chandelier fiber tip, is self-retained at the corneal limbus after insertion of the infusion cannula through a corneal side port. Because of its bifunctionality, that is, bright illumination and adequate irrigation flow, excellent visibility with stable anterior chamber maintenance can be concurrently obtained for Descemet stripping, endothelial graft insertion, and subsequent intraocular manipulations without the need for use of a biologic staining technique or ophthalmic viscosurgical products even in patients with severe corneal haze. This new device facilitates safe and simple intraocular manipulation during Descemet stripping automated endothelial keratoplasty.

Factors contributing to the failure of Humidified High-Flow Nasal Cannulae.

PubMed

Teoh, Sophia; Clyde, Elizabeth; Dassios, Theodore; Greenough, Anne

2018-05-24

The use of humidified high-flow nasal cannulae (HHFNC) as an alternative mode of non-invasive ventilation (NIV) in neonates has become widespread. A survey of UK neonatal units showed the proportion using HHFNC had increased from 56% in 2012 to 87% in 2015 (1). A recently reported Cochrane Review (2) comparing the use of HHFNC against other NIV modes of ventilation immediately after birth or following extubation showed no significant difference in the rates of bronchopulmonary dysplasia (BPD) or death and no significant difference in the rates of treatment failure/reintubation. Benefits cited include a significantly reduced risk of nasal trauma as compared to continuous positive airway pressure (CPAP). Furthermore, both medical staff and parents (3) were found to prefer HHFNC to CPAP. Identification of infants in whom use of HHFNC as either a primary or step-down mode of respiratory support may be inappropriate might further reduce the failure rate of HHFNC. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection.

PubMed

Okita, Yutaka; Matsumori, Masamichi; Kano, Hiroya

2016-04-01

The cases of 3 patients with brain malperfusion secondary to acute aortic dissection who underwent preoperative perfusion of the right common carotid artery are presented. The patients were 64, 65 and 72 years old and 2 were female. All were in a comatose or semi-comatose state with left hemiplegia. The right common carotid artery was exposed and directly cannulated, using a 12-Fr paediatric arterial cannula. The right common femoral artery was chosen for arterial drainage, using a 14-Fr double-lumen cannula. The circuit contained a small roller pump and heat exchanger coil. Target flow was set at 90 ml/min and blood temperature at 30 °C. Durations of right carotid perfusion were 120, 100 and 45 min, respectively. All underwent partial arch replacement and survived. Postoperative neurological sequelae were minimal in all cases. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Benefits of adopting good radiation practices in reducing the whole body radiation dose to the nuclear medicine personnel during (18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging.

PubMed

Verma, Shashwat; Kheruka, Subhash Chand; Maurya, Anil Kumar; Kumar, Narvesh; Gambhir, Sanjay; Kumari, Sarita

2016-01-01

Positron emission tomography has been established as an important imaging modality in the management of patients, especially in oncology. The higher gamma radiation energy of positron-emitting isotopes poses an additional radiation safety problem. Those working with this modality may likely to receive higher whole body doses than those working only in conventional nuclear medicine. The radiation exposure to the personnel occurs in dispensing the dose, administration of activity, patient positioning, and while removing the intravenous (i.v.) cannula. The estimation of radiation dose to Nuclear Medicine Physician (NMP) involved during administration of activity to the patient and technical staff assisting in these procedures in a positron emission tomography/computed tomography (PET/CT) facility was carried out. An i.v access was secured for the patient by putting the cannula and blood sugar was monitored. The activity was then dispensed and measured in the dose calibrator and administered to the patient by NMP. Personnel doses received by NMP and technical staff were measured using electronic pocket dosimeter. The radiation exposure levels at various working locations were assessed with the help of gamma survey meter. The radiation level at working distance while administering the radioactivity was found to be 106-170 μSv/h with a mean value of 126.5 ± 14.88 μSv/h which was reduced to 4.2-14.2 μSv/h with a mean value of 7.16 ± 2.29 μSv/h with introduction of L-bench for administration of radioactivity. This shows a mean exposure level reduction of 94.45 ± 1.03%. The radiation level at working distance, while removing the i.v. cannula postscanning was found to be 25-70 μSv/h with a mean value of 37.4 ± 13.16 μSv/h which was reduced to 1.0-5.0 μSv/h with a mean value of 2.77 ± 1.3 μSv/h with introduction of L-bench for removal of i.v cannula. This shows a mean exposure level reduction of 92.85 ± 1.78%. This study shows that good radiation practices are very helpful in reducing the personnel radiation doses. Use of radiation protection devices such as L-bench reduces exposure significantly. PET/CT staff members must use their personnel monitors diligently and should do so in a consistent manner so that comparisons of their doses are meaningful from one monitoring period to the next.

Nitrogen digestion and urea recycling in Hokkaido native horses fed hay-based diets.

PubMed

Obitsu, Taketo; Hata, Hiroshi; Taniguchi, Kohzo

2015-02-01

Nitrogen (N) digestion and urea-N metabolism in Hokkaido native horses fed roughage-based diets containing different types and levels of protein sources were studied. Horses (173 ± 4.8 kg) fitted with an ileum cannula were fed four diets consisting of 100% timothy hay (TH), 88% TH and 12% soybean meal (SBM), 79% TH and 21% SBM, and 51% TH and 49% alfalfa hay at 2.2% of body weight. Dietary protein content varied from 5% to 15% of dry matter. Apparent N digestibilities in the pre-cecum and total tract for the TH diet were lower than those for other diets. However, the proportion of post-ileum N digestion to N intake was not affected by the diets. Urea-N production was linearly related to N intake, but gut urea-N entry was not affected by the diets. The proportion of gut urea-N entry to urea-N production tended to be higher for the TH diet (57%) than the two SBM diets (39%). Anabolic use of urea-N entering the gut was not affected by the diets (20-36% of gut urea-N entry). These results indicate that urea-N recycling provides additional N sources for microbial fermentation in the hindgut of Hokkaido native horses fed low-quality roughages. © 2014 Japanese Society of Animal Science.

A novel robotic platform for single-port abdominal surgery

NASA Astrophysics Data System (ADS)

Singh, Satwinder; Cheung, Jo L. K.; Sreedhar, Biji; Hoa, Xuyen Dai; Ng, Hoi Pang; Yeung, Chung Kwong

2018-03-01

In this paper, a novel robot-assisted platform for single-port minimally invasive surgery is presented. A miniaturized seven degrees of freedom (dof) fully internalized in-vivo actuated robotic arm is designed. Due to in-vivo actuation, the system has a smaller footprint and can generate 20 N of gripping force. The complete work envelop of the robotic arms is 252 mm × 192 mm × 322 m. With the assistance of the cannula-swivel system, the robotic arms can also be re-positioned and have multi-quadrant reachability without any additional incision. Surgical tasks, such as lifting, gripping suturing and knot tying that are commonly used in a standard surgical procedure, were performed to verify the dexterity of the robotic arms. A single-port trans-abdominal cholecystectomy in a porcine model was successfully performed to further validate its functionality.

Effects of feeding lauric acid or coconut oil on ruminal protozoa numbers, fermentation pattern, digestion, omasal nutrient flow, and milk production in dairy cows.

PubMed

Faciola, A P; Broderick, G A

2014-01-01

The objectives of this study were to evaluate the feeding of coconut oil (CO), in which lauric acid (La) comprises about 50% of the fatty acid composition, as a practical rumen protozoa (RP) suppressing agent, to assess whether the source of La affects ruminal fermentation and animal performance and to test whether suppressing RP improves N utilization, nutrient digestion, nutrient flow at the omasal canal, and milk production. Fifteen multiparous Holstein cows (3 fitted with ruminal cannulas) and 15 primiparous Holstein cows (3 fitted with ruminal cannulas) were used in a replicated 3×3 Latin square experiment with 14d of adaptation and 14d of sample collection. Diets were fed as total mixed ration and contained (dry matter basis) 10% corn silage, 50% alfalfa silage, and 40% concentrate. The control diet contained 3% (dry matter basis) calcium soaps of palm oil fatty acids (Megalac, Church & Dwight Co. Inc., Princeton, NJ) as a ruminally inert fat source and had no added La or CO. Diets with La and CO were formulated to contain equal amounts of La (1.3%, dry matter basis). Dry matter intake was not affected by treatment. Both CO and La reduced RP numbers by about 40%. Lauric acid reduced yield of milk and milk components; however, CO did not affect yield of milk and yields of milk components. Both La and CO caused small reductions in total VFA concentration; CO increased molar proportion of ruminal propionate, reduced ruminal ammonia and branched-chain volatile fatty acids, suggesting reduced protein degradation, and reduced milk urea N and blood urea N concentrations, suggesting improved protein efficiency. Lauric acid reduced total-tract apparent digestibility of neutral detergent fiber and acid detergent fiber as well as ruminal apparent digestibility of neutral detergent fiber and acid detergent fiber as measured at the omasal canal; however, CO did not alter fiber digestion. Microbial protein flow at the omasal canal, as well as the flow of N fractions at the omasal canal, did not differ among treatments. Results from this experiment have confirmed that dietary La is not a practical agent for suppressing RP population in dairy cows, mainly because of its negative effects on fiber digestion and ruminal fermentation. Intake of CO appeared to reduce ruminal and improve protein efficiency, but did not improve milk production, milk composition, or increase microbial outflow from the rumen. Based on the results of this study, a 40% reduction of RP population is not sufficient to improve N utilization in dairy cows. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Mini-tapping sugar maples for sap-sugar testing

Treesearch

William J. Gabriel

1982-01-01

Describes a technique using cannulas, surgical tubing, and small containers to obtain sap samples for use in determining the sugar content of sap in small sugar maple trees. This technique is used on trees directly exposed to the weather, and sets a minimum tappable tree diameter of 1.5 cm.

Effects of Post-Training Hippocampal Injections of Midazolam on Fear Conditioning

ERIC Educational Resources Information Center

Gafford, Georgette M.; Parsons, Ryan G.; Helmstetter, Fred J.

2005-01-01

Benzodiazepines have been useful tools for investigating mechanisms underlying learning and memory. The present set of experiments investigates the role of hippocampal GABA[subscript A]/benzodiazepine receptors in memory consolidation using Pavlovian fear conditioning. Rats were prepared with cannulae aimed at the dorsal hippocampus and trained…

Complementary home mechanical ventilation techniques. SEPAR Year 2014.

PubMed

Chiner, Eusebi; Sancho-Chust, José N; Landete, Pedro; Senent, Cristina; Gómez-Merino, Elia

2014-12-01

This is a review of the different complementary techniques that are useful for optimizing home mechanical ventilation (HMV). Airway clearance is very important in patients with HMV and many patients, particularly those with reduced peak cough flow, require airway clearance (manual or assisted) or assisted cough techniques (manual or mechanical) and suctioning procedures, in addition to ventilation. In the case of invasive HMV, good tracheostomy cannula management is essential for success. HMV patients may have sleep disturbances that must be taken into account. Sleep studies including complete polysomnography or respiratory polygraphy are helpful for identifying patient-ventilator asynchrony. Other techniques, such as bronchoscopy or nutritional support, may be required in patients on HMV, particularly if percutaneous gastrostomy is required. Information on treatment efficacy can be obtained from HMV monitoring, using methods such as pulse oximetry, capnography or the internal programs of the ventilators themselves. Finally, the importance of the patient's subjective perception is reviewed, as this may potentially affect the success of the HMV. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

Extinction learning, which consists of the inhibition of retrieval, can be learned without retrieval.

PubMed

de Carvalho Myskiw, Jociane; Furini, Cristiane Regina Guerino; Schmidt, Bianca; Ferreira, Flávia; Izquierdo, Ivan

2015-01-13

In the present study we test the hypothesis that extinction is not a consequence of retrieval in unreinforced conditioned stimulus (CS) presentation but the mere perception of the CS in the absence of a conditioned response. Animals with cannulae implanted in the CA1 region of hippocampus were subjected to extinction of contextual fear conditioning. Muscimol infused intra-CA1 before an extinction training session of contextual fear conditioning (CFC) blocks retrieval but not consolidation of extinction measured 24 h later. Additionally, this inhibition of retrieval does not affect early persistence of extinction when tested 7 d later or its spontaneous recovery after 2 wk. Furthermore, both anisomycin, an inhibitor of ribosomal protein synthesis, and rapamycin, an inhibitor of extraribosomal protein synthesis, given into the CA1, impair extinction of CFC regardless of whether its retrieval was blocked by muscimol. Therefore, retrieval performance in the first unreinforced session is not necessary for the installation, maintenance, or spontaneous recovery of extinction of CFC.

Effects of multibuffer supplementation on acid-base balance and 2,3-diphosphoglycerate following repetitive anaerobic exercise.

PubMed

Kraemer, W J; Gordon, S E; Lynch, J M; Pop, M E; Clark, K L

1995-12-01

The purpose of this investigation was to determine the effects of a 3.5-day dietary multibuffer supplement (containing predominantly inorganic phosphate, or Pi, along with bicarbonate and carnosine, i.e., PhosFuel) on repetitive (four trials separated by 2 min rest) Wingate test (WT) performances and whole blood 2,3-diphosphoglycerate (2,3-DPG) concentrations in 10 recreationally trained road cyclists (T) and 10 normally active but untrained (UT) men. A 2-week washout period was utilized between experimental sessions. Venous blood samples were obtained via cannula once before exercise (baseline), immediately post each WT, and 3 min after the final WT (recovery). The data indicate that this supplement does not affect acid-base status with following intense anaerobic exercise and does not improve repetitive WT performance. However, the supplement does enhance post-exercise levels of 2,3-DPG and the 2,3-DPG/Hb ratio in recreationally trained cyclists while improving acute recovery of peak power in these men.

Development of a fescue toxicosis model using a fescue seed extract

USDA-ARS?s Scientific Manuscript database

This study was designed to examine the efficacy of a fescue seed extract for inducing fescue toxicosis in cattle. Four growing Holstein steers (BW = 309±36kg) surgically fitted with ruminal cannulas were utilized in a four phase crossover design experiment. The basal diet consisted of endophyte fr...

An improvised mould for vaginoplasty.

PubMed

Viegas, T; Thomas, R; Guido, N L

1989-07-01

The use of a simple, improvised mould for vaginoplasty is described. It is made of rubber foam rolled over a winged infusion cannula and covered over by condoms. It offers a number of advantages over conventional moulds, the main ones being its simplicity of construction and its ease of application and removal from the neo-vagina.

Intraosseous samples can be used for opioid measurements--an experimental study in the anaesthetized pig.

PubMed

Larsson, Torsten; Strandberg, Gunnar; Eriksson, Mats; Bondesson, Ulf; Lipcsey, Miklos; Larsson, Anders

2013-03-01

The intraosseous route provides access to the systemic circulation in an emergency situation when other forms of vascular access are unavailable and there is an urgent need for fluid or drug therapy. The intraosseous access has also been used for collecting samples for laboratory testing. A question that may arise in an unconscious or severely exhausted patient is whether this condition is caused by an unknown drug. We aimed to evaluate whether intraosseous samples could be used to measure opioids and to study the accuracy and precision of such measurements. Five healthy, anaesthetized pigs were treated with a continuous morphine infusion as part of the anaesthesia procedure. Samples for morphine testing were collected hourly for 6 h from two tibial intraosseous cannulae and a central venous catheter. The differences in morphine concentrations between the two tibial intraosseous cannulae were less than 10% in 32/33 times. The values were also relatively stable over time. Our findings suggest that intraosseous samples can be used for the analysis of opioids if an IV route is not available.

'Reverse expansion': A new technique of breast reconstruction with autologous tissue.

PubMed

Fabiocchi, L; Semprini, G; Cattin, F; Dellachiesa, L; Fogacci, T; Frisoni, G; Samorani, D

2017-11-01

The treatment for breast cancer is sometimes long and requires a multidisciplinary approach. In 2010, in our centre, we began to perform fat grafting for breast reconstruction using the so-called 'reverse expansion' technique. This consists of the insertion of a skin expander during mastectomy, in its expansion and then in its gradual deflation in the surgical theatre during fat grafting. We performed a complete breast reconstruction in 57 patients by reverse expansion. We harvested fat from the fat excess areas using a normal liposuction cannula. From each patient, an average of 640 ccs of was collected and then centrifuged in a 4000-rpm centrifuge for 3 min. The obtained adipocytes were then injected in the operated breast using a normal lipofilling cannula. We injected an average of 318.05 ccs of adipocytes for each patient each time. The average number of sessions per patient was 3.6. Reverse expansion can be a safe and effective technique for breast reconstruction in all the breast cancer patients. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Hippocampal Infusion of Zeta Inhibitory Peptide Impairs Recent, but Not Remote, Recognition Memory in Rats

PubMed Central

Hales, Jena B.; Ocampo, Amber C.; Broadbent, Nicola J.; Clark, Robert E.

2015-01-01

Spatial memory in rodents can be erased following the infusion of zeta inhibitory peptide (ZIP) into the dorsal hippocampus via indwelling guide cannulas. It is believed that ZIP impairs spatial memory by reversing established late-phase long-term potentiation (LTP). However, it is unclear whether other forms of hippocampus-dependent memory, such as recognition memory, are also supported by hippocampal LTP. In the current study, we tested recognition memory in rats following hippocampal ZIP infusion. In order to combat the limited targeting of infusions via cannula, we implemented a stereotaxic approach for infusing ZIP throughout the dorsal, intermediate, and ventral hippocampus. Rats infused with ZIP 3–7 days after training on the novel object recognition task exhibited impaired object recognition memory compared to control rats (those infused with aCSF). In contrast, rats infused with ZIP 1 month after training performed similar to control rats. The ability to form new memories after ZIP infusions remained intact. We suggest that enhanced recognition memory for recent events is supported by hippocampal LTP, which can be reversed by hippocampal ZIP infusion. PMID:26380123

[The Huber needle as a special cannula for the puncture of implanted ports and pumps--a mistake in multiple variations].

PubMed

Müller, H; Zierski, J

1988-10-03

Huber-point needles, which are thought to be noncoring, are usually recommended for puncture of implanted drug-delivery devices, such as ports and pumps. Nevertheless, we found occlusion by silicone chips deriving from the silicone inlet septum to be a major technical complication. Electron microscopic investigations demonstrated substantial loss of material from the port membrane after repeated puncture with this type of needle. During an in vitro test, multiple puncture with Huber-type cannulas led to a pressure-dependent leakage of a port after only 150 to 750 insertions of a needle. In addition, the forces necessary for puncture or for withdrawal of the needle were increased with Huber-point needles, possibly due to a coring effect. Another disadvantage of the available port needles is the formation of a hook at the tip, which may lead to additional lesion of the port or pump membrane. In our opinion, resterilization of Huber needles, recommended by the manufactures, is not advisable, because it is well known that safe sterilization of small lumina, e.g., the lumen of the needle, is impossible.

Optical fiber spectroscopy measures perfusion of the brain in a murine Alzheimer's disease model

NASA Astrophysics Data System (ADS)

Ahn, Hyung Jin; Strickland, Sidney; Krueger, James; Gareau, Daniel

2014-02-01

Optical fiber spectroscopy is a versatile tool for measuring diffuse reflectance and extracting absorption information that can noninvasively quantify the presence of chromophores such as oxyhemoglobin and deoxy-hemoglobin in tissues. Cerebrovascular abnormalities were widely recognized in Alzheimer's disease (AD) patients. We analyzed blood volume fraction and level of oxygenated hemoglobin in Tg6799 mice, which are transgenic mice expressing five different familial Alzheimer disease-associated mutations in the human amyloid precursor protein and presenilin-1 genes. Diffuse reflectance spectra were iteratively fit as weighted sums of oxy- and deoxy-hemoglobin. Our observations showed slightly hypoxic conditions and significantly increased blood volume in the Alzheimer's mice versus wild type. These results suggest that hyperperfusion of our AD mice may be a compensating mechanism for impaired cerebral vascular function and somehow relevant with early stage of AD patients. Ongoing work focuses on developing a cannula fixture that allows measurement in awake, behaving animals.

Influence of the upper airway on breathing pattern and expiratory time constant in unanesthetized dog pups.

PubMed

England, S J; Stogryn, H A

1986-11-01

Unanesthetized dog pups (2 to 31 days old) respond to sudden opening of a tracheal cannula to atmospheric pressure with a marked increase in breathing frequency. This response is achieved with a 25% decrease in inspiratory and 40% decrease in expiratory times. Expiratory thyroarytenoid muscle activity increased concomitantly, while inspiratory diaphragmatic and posterior cricoarytenoid muscle activities were reduced. These responses are interpreted as a compensatory mechanism for maintenance of an elevated end-expiratory lung volume with functional loss of the upper airway. The changes in expiratory time and thyroarytenoid muscle activity were not observed when positive pressure was applied at the trachea. The expiratory time constant was assessed during spontaneous breathing. The mean value was twice as long during nasal breathing than during tracheal breathing. The nasal value was substantially increased when the thyroarytenoid muscle was active during expiration.

Estrous cycle and food availability affect feeding induced by amygdala 5-HT receptor blockade.

PubMed

Parker, Graham C; Bishop, Christopher; Coscina, Donald V

2002-04-01

We have recently reported that bilateral infusions of the 5-HT receptor antagonist metergoline (MET) into the posterior basolateral amygdala (pBLA) elicit feeding in female rats tested at mid-light cycle. The present study was performed to determine whether (1) testing at two different phases of the estrous cycle, and/or (2) the palatability of the food might modify this effect. Subjects were 18 adult females with bilateral pBLA cannulae. Following familiarization with Froot Loops cereal, a within-subjects design tested all animals for 1- and 2-h food intake under 2 Drug (0.3 nmol MET vs. Vehicle), 2 Estrous Cycle (diestrus vs. estrus) and 2 Food (lab chow vs. Froot Loops) conditions. Rats weighed more at diestrus than at proestrus (P<.05) or estrus (P<.005). Multivariate analyses of variance (MANOVAs) revealed a preference for Froot Loops over lab chow (P<.0001). MET increased feeding regardless of food type (P<.0001). Rats ate more Froot Loops (P<.01), but not lab chow, at diestrus vs. estrus. A three-way interaction (P<.05) showed rats ate more during the first hour in estrus than in diestrus to lab chow but not Froot Loops. These data suggest pBLA MET differentially affects feeding over the estrous cycle depending on the palatability of food available.

Modulation of Memory Consolidation by the Basolateral Amygdala or Nucleus Accumbens Shell Requires Concurrent Dopamine Receptor Activation in Both Brain Regions

ERIC Educational Resources Information Center

LaLumiere, Ryan T.; Nawar, Erene M.; McGaugh, James L.

2005-01-01

Previous findings indicate that the basolateral amygdala (BLA) and the nucleus accumbens (NAc) interact in influencing memory consolidation. The current study investigated whether this interaction requires concurrent dopamine (DA) receptor activation in both brain regions. Unilateral, right-side cannulae were implanted into the BLA and the…

Rats Can Acquire Conditional Fear of Faint Light Leaking through the Acrylic Resin Used to Mount Fiber Optic Cannulas

ERIC Educational Resources Information Center

Eckmier, Adam; de Marcillac, Willy Daney; Maître, Agnès; Jay, Thérèse M.; Sanders, Matthew J.; Godsil, Bill P.

2016-01-01

Rodents are exquisitely sensitive to light and optogenetic behavioral experiments routinely introduce light-delivery materials into experimental situations, which raises the possibility that light could leak and influence behavioral performance. We examined whether rats respond to a faint diffusion of light, termed caplight, which emanated through…

Intravenous Perfluorocarbon After Onset of Decompression Sickness Decreases Mortality in 20-kg Swine

DTIC Science & Technology

2010-06-01

administration of 0.1-1.5 ml· 10 kg- • Euthasol. After confirmation of death, the heart was exposed via thoracotomy and a large-bore cannula p laced in the...from undersea diving. Neural Clin 1992; 10:1031-45. 18. Hallenbeck JM, Bove AA, Elliott DH. Mechanisms underlying spinal cord damage in decompression

Demonstration of extrapulmonary activity of angiotensin converting enzyme in intact tissue preparations.

PubMed

Lembeck, F; Griesbacher, T; Eckhardt, M

1990-05-01

1. The activity of angiotensin converting enzyme (ACE) has been studied on functional parameters of intact isolated preparations of extrapulmonary tissues. The conversion of angiotensin I (A I) to angiotensin II (A II) and the cleavage of bradykinin (BK) were used as indicators of ACE activity. Captopril was employed as a specific inhibitor of ACE. 2. Captopril augmented the BK-induced contractions of the rat isolated uterus, the BK- and substance P-induced contractions of the guinea-pig ileum, and the BK-induced venoconstriction in the isolated perfused ear of the rabbit. Degradation of BK by ACE was calculated to be 52% in the rat uterus and 75% in the rabbit perfused ear. 3. Captopril inhibited the A I-induced contractions of the rat isolated colon, the A I-induced vasoconstriction in the isolated perfused ear of the rabbit and the rise in blood pressure induced by i.a. injections of A I in pithed rats. Conversion of A I to A II was calculated to be 13% in the rat colon and 26% in the rabbit perfused ear. 4. From estimations of the A II activity (bioassay on the rat colon) in the effluent of the perfused ear of the rabbit after injections of A I into the arterial inflow cannula it was calculated that approximately one tenth of A I was converted to A II during a single passage through the ear (less than 15 s). 5. The present experiments suggest that the high activity of ACE in endothelium of blood vessels of extrapulmonary tissues may provide an additional (endothelium-dependent) local vasoconstrictor mechanism by the rapid formation of A II and inactivation of BK. The ACE activity in non-vascular smooth muscles, other than those of blood vessels, may also affect the physiological functions of these tissues.

Short communication: Comparison of pH, volatile fatty acids, and microbiome of rumen samples from preweaned calves obtained via cannula or stomach tube.

PubMed

Terré, M; Castells, L; Fàbregas, F; Bach, A

2013-08-01

The objective of this study was to compare rumen samples from young dairy calves obtained via a stomach tube (ST) or a ruminal cannula (RC). Five male Holstein calves (46±4.0 kg of body weight and 11±4.9 d of age) were ruminally cannulated at 15 d of age. Calves received 4 L/d of a commercial milk replacer (25% crude protein and 19.2% fat) at 12.5% dry matter, and were provided concentrate and chopped oats hay ad libitum throughout the study (56 d). In total, 29 paired rumen samples were obtained weekly throughout the study in most of the calves by each extraction method. These samples were used to determine pH and volatile fatty acids (VFA) concentration, and to quantify Prevotella ruminicola and Streptococcus bovis by quantitative PCR. Furthermore, a denaturing gradient gel electrophoresis was performed on rumen samples harvested during wk 8 of the study to determine the degree of similarity between rumen bacteria communities. Rumen pH was 0.30 units greater in ST compared with RC samples. Furthermore, total VFA concentrations were greater in RC than in ST samples. However, when analyzing the proportion of each VFA by ANOVA, no differences were found between the sampling methods. The quantification of S. bovis and P. ruminicola was similar in both extraction methods, and values obtained using different methods were highly correlated (R(2)=0.89 and 0.98 for S. bovis and P. ruminicola, respectively). Fingerprinting analysis showed similar bacteria band profiles between samples obtained from the same calves using different extraction methods. In conclusion, when comparing rumen parameters obtained using different sampling techniques, it is recommended that VFA profiles be used rather than total VFA concentrations, as total VFA concentrations are more affected by the method of collection. Furthermore, although comparisons of pH across studies should be avoided when samples are not obtained using the same sampling method, the comparison of fingerprinting of a bacteria community or a specific rumen bacterium is valid. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The clinical utility of long-term humidification therapy in chronic airway disease.

PubMed

Rea, Harold; McAuley, Sue; Jayaram, Lata; Garrett, Jeffrey; Hockey, Hans; Storey, Louanne; O'Donnell, Glenis; Haru, Lynne; Payton, Matthew; O'Donnell, Kevin

2010-04-01

Persistent airway inflammation with mucus retention in patients with chronic airway disorders such as COPD and bronchiectasis may lead to frequent exacerbations, reduced lung function and poor quality of life. This study investigates if long-term humidification therapy with high flow fully humidified air at 37 degrees C through nasal cannulae can improve these clinical outcomes in this group of patients. 108 patients diagnosed with COPD or bronchiectasis were randomised to daily humidification therapy or usual care for 12 months over which exacerbations were recorded. Lung function, quality of life, exercise capacity, and measures of airway inflammation were also recorded at baseline, 3 and 12 months. Patients on long-term humidification therapy had significantly fewer exacerbation days (18.2 versus 33.5 days; p = 0.045), increased time to first exacerbation (median 52 versus 27 days; p = 0.0495) and reduced exacerbation frequency (2.97/patient/year versus 3.63/patient/year; p = 0.067) compared with usual care. Quality of life scores and lung function improved significantly with humidification therapy compared with usual care at 3 and 12 months. Long-term humidification therapy significantly reduced exacerbation days, increased time to first exacerbation, improved lung function and quality of life in patients with COPD and bronchiectasis. Clinical trial registered with www.actr.org.au; Number ACTRN2605000623695. Copyright 2010 Elsevier Ltd. All rights reserved.

Depletion of CD4 T Lymphocytes at the time of infection with M. avium subsp. paratuberculosis does not accelerate disease progression

USDA-ARS?s Scientific Manuscript database

A calf model was used to determine if the depletion of CD4 T cells prior to inoculation of Mycobacterium avium subsp. paratuberculosis (Map) would delay development of an immune response to Map and accelerate disease progression. Ileal cannulas were surgically implanted in 5 bull calves at two month...

Effects of lauric acid on ruminal protozoal numbers and fermentation pattern and milk production in lactating dairy cows

USDA-ARS?s Scientific Manuscript database

The objectives of this study were to evaluate lauric acid (LA) as a practical agent to suppress ruminal protozoa (RP), and to assess the effects of RP suppression on fermentation patterns and milk production in dairy cows. In experiment 1, six Holstein cows fitted with ruminal cannulae were used in ...

The Orexin Component of Fasting Triggers Memory Processes Underlying Conditioned Food Selection in the Rat

ERIC Educational Resources Information Center

Ferry, Barbara; Duchamp-Viret, Patricia

2014-01-01

To test the selectivity of the orexin A (OXA) system in olfactory sensitivity, the present study compared the effects of fasting and of central infusion of OXA on the memory processes underlying odor-malaise association during the conditioned odor aversion (COA) paradigm. Animals implanted with a cannula in the left ventricle received ICV infusion…

Closed-chest cardiopulmonary bypass and cardioplegia: basis for less invasive cardiac surgery.

PubMed

Peters, W S; Siegel, L C; Stevens, J H; St Goar, F G; Pompili, M F; Burdon, T A

1997-06-01

We developed a method of closed-chest cardiopulmonary bypass to arrest and protect the heart with cardioplegic solution. This method was used in 54 dogs and the results were retrospectively analyzed. Bypass cannulas were placed in the right femoral vessels. A balloon occlusion catheter was passed via the left femoral artery and positioned in the ascending aorta. A pulmonary artery vent was placed via the jugular vein. In 17 of the dogs retrograde cardioplegia was provided with a percutaneous coronary sinus catheter. Cardiopulmonary bypass time was 111 +/- 27 minutes (mean +/- standard deviation) and cardiac arrest time was 66 +/- 21 minutes. Preoperative cardiac outputs were 2.9 +/- 0.70 L/min and postoperative outputs were 2.9 +/- 0.65 L/min (p = not significant). Twenty-one-French and 23F femoral arterial cannulas that allowed coaxial placement of the ascending aortic balloon catheter were tested in 3 male calves. Line pressures were higher, but not clinically limiting, with the balloon catheter placed coaxially. Adequate cardiopulmonary bypass and cardioplegia can be achieved in the dog without opening the chest, facilitating less invasive cardiac operations. A human clinical trial is in progress.

A Novel Vesicoscopic Bladder Wall Suture Fixation Technique to Aid Endoscopic Vesicostomy Button Insertion

PubMed Central

Adam, Ahmed; Sookram, Jayveer

2018-01-01

Background To describe a novel bladder fixation technique for use during endoscopic vesicostomy button insertion. Methods After standard cystoscopic visualization of the bladder, a standard 18 G intravenous cannula was inserted into the bladder. A non-absorbable suture thread was placed through this intravenous cannula under cystoscopic vision. The proximal end of the suture was then removed using standard ureteroscopic grasping forceps (3 Fr) through another needle (15 G) inserted next to the initial puncture site (following a path at 30 degrees from the initial puncture tract) into the bladder. The suture ends were brought out of the bladder and tied at the skin level, 2 cm from the intended vesicostomy site. Sutures were removed on the second postoperative day. Results This fixation technique allows for adequate fixation of the bladder dome to the anterior abdominal wall. These sutures also have less potential for cutaneous scarring and pain. No complications were reported. Conclusion This simple fixation technique is easily performed using materials found in every urology suite. It also avoids the skills required with other previously reported fixation suture techniques, and can also be utilized for bladder fixation in cases of vesicoscopic laparoscopic or robotic assisted laparoscopic procedures. PMID:29692696

A new minimal-stress freely-moving rat model for preclinical studies on intranasal administration of CNS drugs.

PubMed

Stevens, Jasper; Suidgeest, Ernst; van der Graaf, Piet Hein; Danhof, Meindert; de Lange, Elizabeth C M

2009-08-01

To develop a new minimal-stress model for intranasal administration in freely moving rats and to evaluate in this model the brain distribution of acetaminophen following intranasal versus intravenous administration. Male Wistar rats received one intranasal cannula, an intra-cerebral microdialysis probe, and two blood cannulas for drug administration and serial blood sampling respectively. To evaluate this novel model, the following experiments were conducted. 1) Evans Blue was administered to verify the selectivity of intranasal exposure. 2) During a 1 min infusion 10, 20, or 40 microl saline was administered intranasally or 250 microl intravenously. Corticosterone plasma concentrations over time were compared as biomarkers for stress. 3) 200 microg of the model drug acetaminophen was given in identical setup and plasma, and brain pharmacokinetics were determined. In 96% of the rats, only the targeted nasal cavity was deeply colored. Corticosterone plasma concentrations were not influenced, neither by route nor volume of administration. Pharmacokinetics of acetaminophen were identical after intravenous and intranasal administration, although the Cmax in microdialysates was reached a little earlier following intravenous administration. A new minimal-stress model for intranasal administration in freely moving rats has been successfully developed and allows direct comparison with intravenous administration.

Maximizing the success of bile duct cannulation studies in rats: recommendations for best practice.

PubMed

Burden, Natalie; Kendrick, John; Knight, Lindsay; McGregor, Victoria; Murphy, Helen; Punler, Malcolm; van Wijk, Hans

2017-10-01

Bile duct cannulation (BDC) studies are usually carried out in the rat to support the absorption, distribution, metabolism and excretion profiling of novel agrochemicals and pharmaceuticals. The different aspects of these studies (e.g. surgical preparation, dosing and collection of bile) can be intricate and/or technically complex. The animals are often kept singly housed for the duration of the studies following surgical implantation of the cannulas. The generation of insufficient data to meet the study objectives, for example due to failure in cannula patency, can result in the need to repeat these studies. A working group of contract research organizations that routinely carry out BDC studies was brought together by the National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) to share their experiences, and to establish the key factors necessary to ensure routinely high success rates. Through these discussions the group has identified opportunities for best practice across various aspects of the studies. The aim of these recommendations is to support all staff involved in conducting BDC studies to maximize the amount of useful data generated using the fewest animals possible, while ensuring the highest possible standards of animal welfare.

A re-assessment of the effects of intracortical delivery of inosine on transmidline growth of corticospinal tract axons after unilateral lesions of the medullary pyramid

PubMed Central

Steward, Oswald; Sharp, Kelli; Yee, Kelly Matsudaira

2011-01-01

This study was undertaken as part of the NIH “Facilities of Research Excellence-Spinal Cord Injury”, which supports independent replication of published studies. Here, we repeat an experiment reporting that intracortical delivery of inosine promoted trans-midline growth of corticospinal tract (CST) axons in the spinal cord after unilateral injury to the medullary pyramid. Rats received unilateral transections of the medullary pyramid and 1 day later, a cannula assembly was implanted into the sensorimotor cortex contralateral to the pyramidotomy to deliver either inosine or vehicle. The cannula assembly was attached to an osmotic minipump that was implanted sub-cutaneously. Seventeen or 18 days post-injury, the CST was traced by making multiple injections of miniruby-BDA into the sensorimotor cortex. Rats were killed for tract tracing 14 days after the BDA injections. Sections through the cervical spinal cord were stained for BDA and immunostained for GAP43 and GFAP. Our results revealed no evidence for enhanced growth of CST axons across the midline of the dorsal column in rats that received intracortical infusion of inosine. Possible reasons for the failure to replicate are discussed. PMID:21946267

Effects on sleep and dopamine levels of microdialysis perfusion of cannabidiol into the lateral hypothalamus of rats.

PubMed

Murillo-Rodríguez, Eric; Palomero-Rivero, Marcela; Millán-Aldaco, Diana; Mechoulam, Raphael; Drucker-Colín, René

2011-03-14

The major non-psychoactive component of Cannabis sativa, cannabidiol (CBD), displays a plethora of actions including wakefulness. In the present study, we addressed whether perfusing CBD via microdialysis into lateral hypothalamus (LH) during the lights-on period would modify the sleep-wake cycle of rats as well as the contents of dopamine (DA) collected from nucleus accumbens (AcbC). Additionally, we tested whether perfusion of CBD into LH would block the sleep rebound after a sleep deprivation period. Electroencephalogram and electromyogram electrodes were implanted in rats as well as a guide-cannula aimed to LH or AcbC. CBD perfusion was carried out via cannulae placed into LH whereas contents of DA were collected from AcbC and analyzed using HPLC means. We found that microdialysis perfusion of CBD (30, 60, or 90 nM) into LH of rat enhances alertness and suppresses sleep. This effect was accompanied with an increase in DA extracellular levels collected from the AcbC. Furthermore, perfusion of CBD into LH after total sleep deprivation prevented the sleep rebound. These findings enhance the investigation about the neurobiological properties of CBD on sleep modulation. Copyright © 2011 Elsevier Inc. All rights reserved.

The meniscal ossicle revisited: etiology and an arthroscopic technique for treatment.

PubMed

Raustol, Ole A; Poelstra, Kornelis A; Chhabra, Annikar; Diduch, David R

2006-06-01

We describe a new arthroscopic technique for repair of meniscal ossicles in support of the theory that meniscal ossicles are traumatic in nature. Using a standard inferolateral portal, the arthroscope is passed under the posterior cruciate ligament to permit visualization of the "root" of the medial meniscus with a matching donor lesion on the tibia. A limited debridement should be performed of the donor site as well as the posterior horn of the meniscus if it has healed over with fibrocartilage to allow bone-to-bone healing. A posteromedial working portal is made at an angle amenable to the repair and a 6-mm cannula is placed. A Beath passing pin commonly used for anterior cruciate ligament reconstruction is used to pass suture for the outside-inside-out repair. The pin is passed through the cannula in the posterior medial portal. The root of the medial meniscus and the avulsed ossicle are pierced with the Beath pin and tensioned, after which the pin is drilled into the matching donor site and out through the tibia. Two passes are used to create a mattress suture through the ossicle, and the suture is tied over a bone bridge on the anterolateral tibia.

Refinements of the radiographic cadaver injection technique for investigating minute lymphatic vessels.

PubMed

Suami, Hiroo; Taylor, G Ian; O'Neill, Jennifer; Pan, Wei-Ren

2007-07-01

The authors previously reported a new technique with which to delineate the lymphatic vessels, using hydrogen peroxide to identify them and a lead oxide suspension to demonstrate them on radiographs. This technique provided excellent studies of the lymph vessels in human cadavers, but there was still room for improvement. Lymph collecting vessels run superficially in some regions, where they may be damaged while the surgeon is attempting to find them. Vessels smaller than 0.3 mm in diameter could not be cannulated with a 30-gauge needle, which was the smallest the authors had available, and the lead oxide suspension often blocked this cannula. The authors also encountered problems holding the cannula steady. The authors solved these problems by using a mixture of hydrogen peroxide and ink to better identify the lymphatics, an extruded glass tube instead of a metal needle to cannulate them, an agate pestle and mortar to grind the lead oxide into finer particles, powdered milk to suspend the lead oxide, and a micromanipulator to facilitate accurate and steady cannulation of the vessels. This study developed these modifications to focus on tributaries of the collecting lymphatic channels that are smaller than 0.3 mm in diameter.

Ruminal Ca and P Releases from Diets with Different Portion of the Sugarcane Bagasse

NASA Astrophysics Data System (ADS)

Pangestu, E.; Wahyono, F.; Nuswantara, L. K.; Achmadi, J.

2018-02-01

The in sacco technique was used to study the ruminal Ca and P releases from diets with different portion of sugarcane bagasse. Three diets containing 15, 25, and 35% of sugarcane bagase were tested their kinetic of ruminal Ca and P degradabilities. Two adult male sheep fitted with rumen cannula were used in the in sacco technique. In the in sacco experiment, feed samples were placed in the nylon bag and inserted into ruminal cannula for 0, 1, 3, 6, 12, 24, and 48 h. The kinetic of ruminal Ca and P degradabilities were focused on rapidly soluble fraction (fraction a), potentially degradable fraction (fraction b), and the degradation rate of fraction b (c). The data were tested using analyse of variance based on a completely randomized design. While the portion of sugarcane bagasse increased (P<0.05) fraction a of Ca diet, the portion b of P diet was decreased (P<0.05) by the portion of sugarcane bagasse.In conclusion, the effect of increasing portion of sugarcane bagasse in diet on ruminal release of Ca may be differed with that ofthe ruminal P release.

Successful Deployment of High Flow Nasal Cannula in a Peruvian Pediatric Intensive Care Unit Using Implementation Science-Lessons Learned.

PubMed

Nielsen, Katie R; Becerra, Rosario; Mallma, Gabriela; Tantaleán da Fieno, José

2018-01-01

Acute lower respiratory infections are the leading cause of death outside the neonatal period for children less than 5 years of age. Widespread availability of invasive and non-invasive mechanical ventilation in resource-rich settings has reduced mortality rates; however, these technologies are not always available in many low- and middle-income countries due to the high cost and trained personnel required to implement and sustain their use. High flow nasal cannula (HFNC) is a form of non-invasive respiratory support with growing evidence for use in pediatric respiratory failure. Its simple interface makes utilization in resource-limited settings appealing, although widespread implementation in these settings lags behind resource-rich settings. Implementation science is an emerging field dedicated to closing the know-do gap by incorporating evidence-based interventions into routine care, and its principles have guided the scaling up of many global health interventions. In 2016, we introduced HFNC use for respiratory failure in a pediatric intensive care unit in Lima, Peru using implementation science methodology. Here, we review our experience in the context of the principles of implementation science to serve as a guide for others considering HFNC implementation in resource-limited settings.

[High-Flow Nasal Cannulae (HFNC) in Neonates: A Survey of Current Practice in Level 1 Perinatal Centres in the German State of North Rhine-Westphalia].

PubMed

Hepping, N; Garbe, W; Schneider, K

2015-12-01

High-flow nasal cannulae (HFNC) is a kind of non-invasive respiratory support. In recent years, its application has gained increasing popularity for treating neonates with respiratory failure. Within this study, neonatologists employed at high level perinatal centres within the region of North Rhine-Westphalia, Germany were interviewed. We evaluated their personal experience as well as the underlying indication for using HFNC. We undertook an online survey. 93% of the interviewed participants use HFNC systems in their NICU. The most prominent indications were CPAP-weaning, nasal trauma, and apnoea of prematurity. Both initial flow and maximum and minimum flow rates varied widely. The primary benefit of HFNC vs. conventional CPAP was the improved neonate tolerance, less nasal traumata and ease of application and care. A common disadvantage was the inability to conduct PEEP measurements. The application of the HFNC system is increasing for specific neonatal indications, thereby increasing the data for the evaluation of effectivity and safety. Nevertheless, detailed investigations of the appropriate flow rate settings are still lacking. © Georg Thieme Verlag KG Stuttgart · New York.

Self-administration of morphine into the lateral hypothalamus in the mouse.

PubMed

Cazala, P; Darracq, C; Saint-Marc, M

1987-07-28

BALB/c mice were chronically and unilaterally implanted with a guide cannula, the tip of which was positioned 1 mm above the lateral hypothalamus (LH). On each experimental day, a stainless-steel injection cannula was inserted into the LH, and self-administration of morphine or vehicle in this brain area was studied by using a spatial discrimination test in a Y-maze. In a first experiment, we observed that when mice had access to morphine (0.1 microgram by injection) they rapidly discriminated the reinforced arm from the neutral arm of the maze in order to self administer, with increasing frequency, the drug into the LH. In contrast when only vehicle was present, the two arms were no longer discriminated. In a second experiment we compared the effects of 3 doses of morphine (0.1 microgram, 0.05 microgram and 0.025 microgram by injection); optimal discrimination was obtained with the lowest dose used. In a third experiment we observed that subcutaneous injections of naloxone (4 mg/kg) progressively reduced the number of self-administrations of morphine into the LH, a result which suggests that this response is dependent on an opiate receptor mechanism.

Effects of Meat Cooking, and of Ingested Amount, on Protein Digestion Speed and Entry of Residual Proteins into the Colon: A Study in Minipigs

PubMed Central

Bax, Marie-Laure; Buffière, Caroline; Hafnaoui, Noureddine; Gaudichon, Claire; Savary-Auzeloux, Isabelle; Dardevet, Dominique; Santé-Lhoutellier, Véronique; Rémond, Didier

2013-01-01

The speed of protein digestion impacts on postprandial protein anabolism. After exercise or in the elderly, fast proteins stimulate protein synthesis more efficiently than slow proteins. It has been shown that meat might be a source of fast proteins. However, cooking temperature, acting on the macrostructure and microstructure of the meat could affect both the speed, and efficiency, of protein digestion. This study aims to evaluate, in vivo, the effect of meat cooking on digestion parameters, in the context of a complete meal. Six minipigs fitted with an ileal cannula and an arterial catheter were used. In order to measure the true ileal digestibility, tested meat was obtained from a calf, the muscle proteins of which were intrinsically labelled with 15N-amino acids. Three cooking temperatures (60, 75 and 95°C; core temperature for 30 min), and three levels of intake (1, 1.45, and 1.90 g protein/kg body weight) were tested. Following meat ingestion, ileal digesta and arterial blood were collected over a 9-h period. The speed of digestion, evaluated from the kinetics of amino acid appearance in blood within the first 3 h, was greater for the cooking temperature of 75°C, than for 60 or 95°C. The true ileal digestibility, which averaged 95%, was not affected by cooking temperature or by the level of meat intake. The amino acid composition of the digesta flowing at the ileum was not affected by cooking temperature. These results show that cooking temperature can modulate the speed of meat protein digestion, without affecting the efficiency of the small intestinal digestion, and consequently the entry of meat protein residues into the colon. PMID:23593443

Cardiovascular responses to injections of angiotensin II or carbachol into the rostral ventrolateral medulla in rats with AV3V lesions.

PubMed

Vieira, Alexandre Antonio; Colombari, Eduardo; De Luca, Laurival A; Colombari, Débora S A; De Paula, Patrícia M; Menani, José V

2013-11-27

Injection of l-glutamate (GLU) into the rostral ventrolateral medulla (RVLM) produces sympathetically-mediated pressor responses that depend on the integrity of the tissue surrounding the anteroventral third ventricle (AV3V region). The injection of angiotensin II (ANG II) or the cholinergic agonist carbachol into the RVLM also produces pressor responses. In the present study, we investigated if the lesion of the AV3V region affects the pressor responses to ANG II or carbachol injected into the RVLM in unanesthetized rats. Male Holtzman rats with sham or electrolytic AV3V lesions and a stainless steel cannula implanted into the RVLM were used. The pressor responses to ANG II (200ng/100nl) injected into the RVLM were reduced by acute (1 day) (12±3 vs. sham lesions: 26±4mmHg) or chronic (15 days) AV3V lesions (12±5 vs. sham lesions: 27±4mmHg), whereas acute or chronic AV3V lesions did not affect the pressor responses to carbachol (1nmol/100nl) injected into the RVLM. The present results suggest that the AV3V region modulates the excitability of the RVLM neurons involved with the pressor response produced by the activation of angiotensinergic mechanisms in this area. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

In Vivo Model to Test Implanted Biosensors for Blood pH

NASA Technical Reports Server (NTRS)

Arnaud, Sara B.; Somps, Chris J.; Madou, Marc; Hines, John; Wade, Charles E. (Technical Monitor)

1997-01-01

Biosensors for monitoring physiologic data continuously through telemetry are available for heart rate, respiration, and temperature but not for blood pH or ions affected by hydrogen ion concentration. A telemetric biosensor for monitoring blood pH on-line could be used to identify and manage problems in fluid and electrolyte metabolism, cardiac and respiratory function during space flight and the acid-base status of patients without the need for venipuncture in patients on Earth. Critical to the development of biosensors is a method for evaluating their performance after implantation. Mature rats, prepared with jugular, cannulas for repeated blood samples, were exposed to a gas mixture containing high levels of carbon dioxide (7%) in a closed environment to induce mild respiratory acidosis. Serial blood gas and pH measurements in venous blood were compared with electrical responses from sensors implanted in the subcutaneous tissue. Animals became slightly tachypneic after exposure to excess CO2, but remained alert and active. After 5 minutes, basal blood pH decreased from 7.404 +/- 0.013 to 7.289 +/- 0.010 (p less than 0.001)and PC02 increased from 45 +/- 6 to 65 +/- 4 mm. Hg (p les than 0.001). Thereafter pH and blood gas parameters remained stable. Implanted sensors showed a decrease in millivolts (mV) which paralleled the change in pH and averaged 5-6 mV per 0.1 unit pH. Implanted sensors remained sensitive to modest changes in tissue pH for one week. A system for inducing acidosis in rats was developed to test the in vivo performance of pH biosensors. The system provides a method which is sensitive, rapid and reproducible in the same and different animals with full recovery, for testing the performance of sensors implanted in subcutaneous tissues.

Intraoperative blood salvage.

PubMed

Pineda, A A; Valbonesi, M

1990-04-01

Interest in and use of IBS have increased recently. This form of haemotherapy involves the retrieval of blood shed perioperatively. IBS, together with other forms of ABT, has gained a prominent role in transfusion medicine, largely due to an increased awareness of the risks associated with transfusion of homologous blood. In addition to conserving erythrocytes, IBS prevents disease transmission, other adverse transfusion reactions, and alloimmunization to antigens in blood cells and plasma which may result from homologous blood use. An array of IBS devices is presently available, ranging from disposable canisters to complete processing systems. The devices are capable of recovering, filtering, washing and reinfusing shed erythrocytes. They can be divided into slow-flow and rapid-flow systems based on the rapidity of blood processing. Most systems use a dual channel aspiration cannula through which shed blood is aspirated and mixed with anticoagulant solution. The salvage procedure requires operator control at every step, even for the highly automated instruments. Various health care personnel have been trained to operate IBS equipment; a transfusion service nurse with blood bank expertise has proved to be a highly reliable operator in our practice. Extensive clinical observation has shown that salvaged erythrocytes function and survive normally. IBS has been applied in many surgical fields; it has two relative contraindications: its use in areas affected by infection or malignancy. Operative procedures characterized by large blood losses provide a cost-efficient application of IBS, including cardiac surgery, orthopaedic procedures, trauma, vascular surgery, and liver transplantation. New, highly efficient technology is emerging that is capable of recovering other blood components. Consequently, what presently amounts to erythrocyte recovery will be expanded shortly to include platelets and plasma, with its many constituents.

Evaluation of pressor and visceromotor reflex responses to bladder distension in urethane anesthetized rats.

PubMed

Blatt, Lauren K; Lashinger, Erin S R; Laping, Nicholas J; Su, Xin

2009-01-01

We tested cardiovascular and visceromotor reflex (VMR) responses to urinary bladder distension (UBD) in urethane anesthetized rats to see if it can replicate the response pattern and the inhibition of bladder nociceptive transmission by analgesics seen in isoflurane anesthetized animals. Female Sprague-Dawley rats under 3% isoflurane anesthesia were acutely instrumented with jugular venous, carotid arterial, and bladder cannulas for drug administration, blood pressure (BP) measurement, and bladder distension, respectively. Needle electrodes were placed directly into the abdominal musculature to measure myoelectrical activity subsequent to phasic UBD (30 sec in 3 min intervals). A cardiovascular response (pressor) and a VMR response (a contraction of abdominal and hind limb musculature) to UBD were evaluated in urethane (1.2 g/kg, i.v.) or isoflurane (1%) anesthetized rats. Pressor and VMR responses to noxious UBD (60 mmHg) were generated under both anesthesics. The thresholds of stimulus response functions for both pressor and VMR responses were not affected by either anesthesics. However, the magnitude of the maximal pressor response was significantly reduced in urethane anesthesia. The analgesics, morphine, and mexiletine, significantly inhibited the VMR response to noxious UBD under both anesthetics, but the intensities of the inhibition from both analgesics under urethane anesthesia were much lower than under isoflurane anesthesia (ID50: 2.07 mg/kg vs. 0.88 mg/kg for morphine, >10 mg/kg vs. 0.47 mg/kg for mexiletine). The rat urinary bladder distension model in urethane anesthetized rats demonstrates a blunted maximal pressor response and a reduced inhibition of visceral nociceptive transmission by analgesics. Neurourol. Urodynam. 28:442-446, 2009. (c) 2008 Wiley-Liss, Inc.

Use of plasma concentrations to estimate bioavailability of methionine in rumen-protected products fed to dairy cows

USDA-ARS?s Scientific Manuscript database

Plasma AA level was used to estimate Met bioavailability in 2 sources of rumen-protected Met (RPM): Mepron (RPM1) and Smartamine M (RPM2). Eight cows, consuming 22 kg DM/d, yielding 34 kg milk/d and fitted with ruminal cannulae, were fed a basal TMR containing (DM basis) 14% alfalfa silage, 54% corn...

Surgery of the Forestomach.

PubMed

Lozier, Joseph W; Niehaus, Andrew J

2016-11-01

Indications for rumen surgery include rumen tympany (bloat), toxic plant ingestion, to provide enteral nutrition, to perform elective cannula placement, and to access other forestomach compartments (reticulum/omasum). The rumen is a highly contaminated viscus and special care should be taken to avoid peritoneal contamination from rumen contents. Diseases causing forestomach dysfunction and surgical procedures on the forestomach compartments are discussed here. Copyright © 2016 Elsevier Inc. All rights reserved.

Seventh Symposium on Subtypes of Musccarinic Receptors.

DTIC Science & Technology

1997-01-01

promises fewer and less severe side effects because of its favourable receptor profile and pharmacokinetic properties (2, 3). This compound has been...6). Following median laparotomy electromagnetic flow probes were positioned on one or both renal arteries. A cannula was introduced into a femoral...equipment for thermodilution and electromagnetic flow measurement (IFD, Miuhlheim, Germany) was used. Respiratory rate was evaluated from the C0 2

Variability in Nose-to-Lung Aerosol Delivery

PubMed Central

Walenga, Ross L; Tian, Geng; Hindle, Michael; Yelverton, Joshua; Dodson, Kelley; Longest, P. Worth

2014-01-01

Nasal delivery of lung targeted pharmaceutical aerosols is ideal for drugs that need to be administered during high flow nasal cannula (HFNC) gas delivery, but based on previous studies losses and variability through both the delivery system and nasal cavity are expected to be high. The objective of this study was to assess the variability in aerosol delivery through the nose to the lungs with a nasal cannula interface for conventional and excipient enhanced growth (EEG) delivery techniques. A database of nasal cavity computed tomography (CT) scans was collected and analyzed, from which four models were selected to represent a wide range of adult anatomies, quantified based on the nasal surface area-to-volume ratio (SA/V). Computational fluid dynamics (CFD) methods were validated with existing in vitro data and used to predict aerosol delivery through a streamlined nasal cannula and the four nasal models at a steady state flow rate of 30 L/min. Aerosols considered were solid particles for EEG delivery (initial 0.9 μm and 1.5 μm aerodynamic diameters) and conventional droplets (5 μm) for a control case. Use of the EEG approach was found to reduce depositional losses in the nasal cavity by an order of magnitude and substantially reduce variability. Specifically, for aerosol deposition efficiency in the four geometries, the 95% confidence intervals (CI) for 0.9 and 5 μm aerosols were 2.3-3.1 and 15.5-66.3%, respectively. Simulations showed that the use of EEG as opposed to conventional methods improved delivered dose of aerosols through the nasopharynx, expressed as penetration fraction (PF), by approximately a factor of four. Variability of PF, expressed by the coefficient of variation (CV), was reduced by a factor of four with EEG delivery compared with the control case. Penetration fraction correlated well with SA/V for larger aerosols, but smaller aerosols showed some dependence on nasopharyngeal exit hydraulic diameter. In conclusion, results indicated that the EEG technique not only improved lung aerosol delivery, but largely eliminated variability in both nasal depositional loss and lung PF in a newly developed set of nasal airway models. PMID:25308992

Air embolism and maternal death from therapeutic abortion.

PubMed

Munsick, R A

1972-05-01

The case report of a fatal result in an abortion requested because X-ray diagnostic studies of the gallbladder and intestine had been made during an undiagnosed early pregnancy is presented. A uterine vacuum aspirator had not been purchased by the hospital. A portable laboratory vacuum pump with an appropriate suction trap was used. The apparatus had been used previously in several abortion cases. After dilatation of the cervix and insertion of the aspirating cannula, the pump was turned on. A sudden massive effusion of bloody froth issued from around the cannula. The cannula was removed immediately. It was found that the tubing had been incorrectly connected. The aspirator tube was connected with the pressure outlet of the pump. The tubing was then correctly placed and the uterus emptied. The patient was given succinyl choline, intubated, placed in the Trendelenburg position, and monitored cardiographically. About 30 seconds after the uterine insufflation blood pressure became unobtainable. The pulse slowed to 50 beats/minute and respiration diminished. Cardiac ausculation revealed no sounds. Respiration was maintained using oxygen through an endoctracheal tube. The pulse was still palpable and the EKG showed abnormal QRS complexes. Cyanosis then became evident. Closed chest cardiac massage was used for 1 minute but the patient became pulseless and QRS complexes were bizarre. Then the chest was opened and each ventricle was needled. From each ventricle of the distended heart air hissed under pressure through the needle vent site. The ascending aorta was needled and air escaped under pressure. Cardiac color and action improved when aided by massage. Iv isoproterenol and intracardiac epinephrine were given. An electric defibrillator converted the cardiac rhythm to a sinus rhythm. Norepinephirne brought about hypertension. Blood and albumin were given iv. The patient never regained consciousness. Tracheostomy and a feeding gastrostomy were required. Urinary and respiratory infections followed and the patient died after 2 1/2 months. Autopsy revealed tracheobronchitis, bronchopneumonia, and pulmonary edema. The brain showed extensive cerebral cortical necrosis. The heart was normal. This maternal death was preventable.

Detection of Sleep Disordered Breathing and Its Central/Obstructive Character Using Nasal Cannula and Finger Pulse Oximeter

PubMed Central

Sommermeyer, Dirk; Zou, Ding; Grote, Ludger; Hedner, Jan

2012-01-01

Study Objective: To assess the accuracy of novel algorithms using an oximeter-based finger plethysmographic signal in combination with a nasal cannula for the detection and differentiation of central and obstructive apneas. The validity of single pulse oximetry to detect respiratory disturbance events was also studied. Methods: Patients recruited from four sleep laboratories underwent an ambulatory overnight cardiorespiratory polygraphy recording. The nasal flow and photoplethysmographic signals of the recording were analyzed by automated algorithms. The apnea hypopnea index (AHIauto) was calculated using both signals, and a respiratory disturbance index (RDIauto) was calculated from photoplethysmography alone. Apnea events were classified into obstructive and central types using the oximeter derived pulse wave signal and compared with manual scoring. Results: Sixty-six subjects (42 males, age 54 ± 14 yrs, body mass index 28.5 ± 5.9 kg/m2) were included in the analysis. AHImanual (19.4 ± 18.5 events/h) correlated highly significantly with AHIauto (19.9 ± 16.5 events/h) and RDIauto (20.4 ± 17.2 events/h); the correlation coefficients were r = 0.94 and 0.95, respectively (p < 0.001) with a mean difference of −0.5 ± 6.6 and −1.0 ± 6.1 events/h. The automatic analysis of AHIauto and RDIauto detected sleep apnea (cutoff AHImanual ≥ 15 events/h) with a sensitivity/specificity of 0.90/0.97 and 0.86/0.94, respectively. The automated obstructive/central apnea indices correlated closely with manually scoring (r = 0.87 and 0.95, p < 0.001) with mean difference of −4.3 ± 7.9 and 0.3 ± 1.5 events/h, respectively. Conclusions: Automatic analysis based on routine pulse oximetry alone may be used to detect sleep disordered breathing with accuracy. In addition, the combination of photoplethysmographic signals with a nasal flow signal provides an accurate distinction between obstructive and central apneic events during sleep. Citation: Sommermeyer D; Zou D; Grote L; Hedner J. Detection of sleep disordered breathing and its central/obstructive character using nasal cannula and finger pulse oximeter. J Clin Sleep Med 2012;8(5):527-533. PMID:23066364

Compartmental analysis of the disposition of benzo[a]pyrene in rats.

PubMed

Bevan, D R; Weyand, E H

1988-11-01

We have previously reported the disposition of benzo[a]pyrene (B[a]P) and its metabolites in male Sprague-Dawley rats following intratracheal instillation of [3H]B[a]P [Weyand, E.H. and Bevan, D.R. (1986) Cancer Res., 46, 5655-5661]. In some experiments, cannulas were implanted in the bile duct of the animals prior to administration of [3H]B[a]P [Weyand, E.H. and Bevan, D.R. (1987) Drug Metab. Disposition, 15, 442-448]. Based on these data, we have developed a compartmental model of the distribution of radioactivity to provide a quantitative description of the fate of B[a]P and its metabolites in rats. Modeling of the distribution of radioactivity was performed using the Simulation, Analysis and Modeling (SAAM) and conversational SAAM (CONSAM) computer programs. Compartments in the model included organs into which the largest amounts of radioactivity were distributed as well as pathways for excretion of radioactivity from the animals. Data from animals with and without cannulas implanted in the bile duct were considered simultaneously during modeling. Radioactivity was so rapidly absorbed from the lungs that an absorption phase into blood was not apparent at the earliest sampling times. Using the model of extrapolate to shorter times, it was predicted that the maximum amount of radioactivity was present in blood within 2 min after administration. In addition, considerable recycling of radioactivity back to lungs from blood was predicted by the model. Transfer of radioactivity from blood to liver and carcass (skin, muscle, bones, fat and associated blood) also was extensive. Carcass was modeled as the sum of two compartments to obtain agreement between the model and experimental data. The model accounted for enterohepatic circulation of B[a]P metabolites; data also required that intestinal secretion be included in the model. Quantitative data obtained from compartmental analysis included rate constants for transfer of radioactivity among compartments as well as statistical parameters indicating the identifiability of the rate constants. That the model is consistent with two sets of data, those obtained in animals with and without a biliary cannula, indicates its potential utility in predicting the disposition of B[a]P and its metabolites in vivo.

Effect of butyrate infusion into the rumen on butyrate flow to the duodenum, selected gene expression in the duodenum epithelium, and nutrient digestion in sheep.

PubMed

Górka, P; Śliwiński, B; Flaga, J; Wieczorek, J; Godlewski, M M; Wierzchoś, E; Zabielski, R; Kowalski, Z M

2017-05-01

The aim of the study was to determine the effect of butyrate infusion into the rumen on butyrate flow to the duodenum, expression of short-chain fatty acid (SCFA) transporters (monocarboxylate transporter-1, -2, and -4) and receptors (G protein coupled receptor-41 and -43) in the duodenal epithelium and nutrient digestion in sheep. Eight wethers (39.0 ± 3.00 kg; mean ± SD) with ruminal and T-shape duodenal cannulas were allocated to 4 × 4 replicated Latin square design with each experimental period lasting for 21 d (12 d of adaptation and 9 d for data and sample collection). Experimental treatments were: 1) distilled water infusion into the rumen (CONT); 2) 15 g/d of butyric acid infusion into the rumen (BUT15); 3) 30 g/d of butyric acid infusion into the rumen (BUT30); and 4) 45 g/d of butyric acid infusion into the rumen (BUT45). The daily dose of butyrate was infused into the rumen via the rumen cannula, with 200 mL of solution of butyric acid and distilled water, at a constant rate (0.1389 mL/min) throughout the day using a peristaltic pump. Correspondingly, 200 mL/d of distilled water was infused into the rumen of CONT. The wethers were fed daily 900 g of chopped meadow hay and 200 g of concentrate in two equal meals at 0600 and 1800 h. Butyrate infusion into the rumen did not affect total SCFA concentration in the rumen fluid ( > 0.11). Molar proportion of butyrate in total SCFA linearly increased, and molar proportion of acetate and isovalerate linearly decreased ( ≤ 0.02) with an increasing amount of butyrate infused into the rumen. The molar proportion of butyrate in total SCFA in the duodenal digesta linearly increased ( < 0.01), and butyrate flow to duodenum tended to linearly increase ( = 0.06) with an increasing dose of exogenous butyrate delivered to the rumen. Butyrate infusion into the rumen did not affect ( ≥ 0.14) the mRNA expression of monocarboxylate transporter-2 and -4 and G protein coupled receptor-43 in the duodenal epithelium. The G protein coupled receptor-41 and monocarboxylate transporter-1 mRNA expression in the duodenal epithelium was very low in many of the analyzed samples. Digestibility of organic matter, neutral detergent fiber, and acid detergent fiber in the stomach (forestomach and abomasum) decreased for BUT15 and BUT30 and then increased for BUT45 (quadratic, ≤ 0.04); however, neither digestibility in the intestine nor total tract digestibility differed between treatments ( ≥ 0.10).

Role of Swallowing Function of Tracheotomised Patients in Major Head and Neck Cancer Surgery.

PubMed

Bartella, Alexander K; Kamal, Mohammad; Berman, Sean; Steiner, Timm; Frölich, Dirk; Hölzle, Frank; Lethaus, Bernd

2018-03-01

Tracheotomy is a frequent procedure in extended head and neck cancer surgery and known to be a risk factor for prolonged hospitalization. The authors hypothesized that the clinical course and delayed decannulation of patients are not only influenced by airway narrowing, but also by a compromised postoperative swallowing function. The investigators implemented a retrospective cohort study. The sample was composed of a tertiary care center patients who underwent major head and neck cancer surgery, each receiving a tracheostomy. Data collected include general clinical data as well as endoscopical evaluation of swallowing function and aspiration rate. Descriptive and bivariate statistics were computed and the P value was set at.05. The sample was composed of 96 patients with an average age of 64.2 and sex ratio of 1.4:1 (m:f). There was a strong statistically significant relation between swallowing function and timing of decannulation (P < 0.001) and duration of hospitalization (P < 0.001). Age (P = 0.55), sex (P = 0.54), tumor size (P = 0.12), general diseases (P = 0.24), distant metastases (P = 0.15), or extent of neck dissection (P = 0.15) were not significantly associated to swallowing function. Permanent cannulation was significantly correlated to a primary cancer of the soft palate or base of the tonge (P < 0.001). The results of this study confirm the importance of the evaluation of swallowing function before the removal of the tracheotomy cannula in head and neck cancer patients.

Multimodality stereotactic brain tissue identification: the NASA smart probe project

NASA Technical Reports Server (NTRS)

Andrews, R.; Mah, R.; Aghevli, A.; Freitas, K.; Galvagni, A.; Guerrero, M.; Papsin, R.; Reed, C.; Stassinopoulos, D.

1999-01-01

Real-time tissue identification can benefit procedures such as stereotactic brain biopsy, functional neurosurgery and brain tumor excision. Optical scattering spectroscopy has been shown to be effective at discriminating cancer from noncancerous conditions in the colon, bladder and breast. The NASA Smart Probe extends the concept of 'optical biopsy' by using neural network techniques to combine the output from 3 microsensors contained within a cannula 2. 7 mm in diameter (i.e. the diameter of a stereotactic brain biopsy needle). Experimental data from 5 rats show the clear differentiation between tissues such as brain, nerve, fat, artery and muscle that can be achieved with optical scattering spectroscopy alone. These data and previous findings with other modalities such as (1) analysis of the image from a fiberoptic neuroendoscope and (2) the output from a microstrain gauge suggest the Smart Probe multiple microsensor technique shows promise for real-time tissue identification in neurosurgical procedures. Copyright 2000 S. Karger AG, Basel.

Biocompatible Pressure Sensing Skins for Minimally Invasive Surgical Instruments

PubMed Central

Arabagi, Veaceslav; Felfoul, Ouajdi; Gosline, Andrew H.; Wood, Robert J.; Dupont, Pierre E.

2016-01-01

This paper presents 800-μm thick, biocompatible sensing skins composed of arrays of pressure sensors. The arrays can be configured to conform to the surface of medical instruments so as to act as disposable sensing skins. In particular, the fabrication of cylindrical geometries is considered here for use on endoscopes. The sensing technology is based on polydimethylsiloxane synthetic silicone encapsulated microchannels filled with a biocompatible salt-saturated glycerol solution, functioning as the conductive medium. A multi-layer manufacturing approach is introduced that enables stacking sensing microchannels, mechanical stress concentration features, and electrical routing via flexcircuits in a thickness of less than 1 mm. The proposed approach is inexpensive and does not require clean room tools or techniques. The mechanical stress concentration features are implemented using a patterned copper layer that serves to improve sensing range and sensitivity. Sensor performance is demonstrated experimentally using a sensing skin mounted on a neuroendoscope insertion cannula and is shown to outperform previously developed non-biocompatible sensors. PMID:27642266

The Correlation Between End-Tidal Carbon Dioxide Measured By Capnoxygen (trademark) Mask and Nasal Cannula

DTIC Science & Technology

2000-10-01

Chair: Maura S. McAuliffe, CRNA, Ph.D. Date...dedicate this research to my two children, Kelly and Danny, who endured the long hours and the separation that was necessary to complete this project...shredded. Questions If you have any questions about this research study, you should contact LT Leo J. Fitzpatrick at 301-650-0009, or Maura S. McAuliffe

The Correlation Between End-Tidal Carbon Dioxide Measured by Capnoxygen (Trade Mark) Mask and Nasal Cannula

DTIC Science & Technology

2000-10-01

Chair: Maura S. McAuliffe, CRNA, Ph.D. Date...monitored anesthesia care procedures or conscious sedation. viii DEDICATION I would like to dedicate this research to my two children, Kelly and Danny, who...research study, you should contact LT Leo J. Fitzpatrick at 301-650-0009, or Maura S. McAuliffe, Ph.D., CRNA at 301-295-6565, chair of my thesis committee

Estimation of rumen outflow in dairy cows fed grass silage-based diets by use of reticular sampling as an alternative to sampling from the omasal canal

USDA-ARS?s Scientific Manuscript database

TA study was conducted to compare nutrient flows determined by a reticular sampling technique with those made by sampling of digesta from the omasal canal. Six lactating dairy cows fitted with ruminal cannulas were used in a design with a 3 x 2 factorial arrangement of treatments and 4 periods. Trea...

Assessment of Regenerative Capacity in the Dolphin

DTIC Science & Technology

2010-10-10

liposuction ; cells released during the digestion of the adipose tissue were analyzed for cytology, assayed for the total number of colony-forming cells... liposuction was used to harvest subcutaneous adipose from the nuchal pad of six dolphins at the Navy Marine Mammal Program (NMMP). Adipose samples...and aid in the placement of the liposuction cannula in the adipose depot. The difference between the various layers of muscle and adipose tissue

Clinical Investigation Program (Tripler Army Medical Center)

DTIC Science & Technology

1991-10-01

temperatures - arterial and central venous blood pressure, relevant blood and urinary hormones, and urine flows will be measured via indwelling catheters...Analysis of central venous pressure recordings are not yet complete, but all experimentation is complete. 21 Detail Summary Sheet Prot No: llA91 Status... catheterized newborn rats are performed. Rats are instrumented with arterial, venous , and stomach catheters and a bladder cannula 3 to 7 days before

Tribosupplementation with Lubricin in Prevention of Post-Traumatic Arthritis

DTIC Science & Technology

2013-10-01

was performed and synovial fluid was collected from the joint for use as a lubricant during mechanical testing. For the Arthroscopy specimens (n=4...arthroscopic irrigation was performed as follows: an arthrotomy was made in the superior capsule and an arthroscopy cannula was introduced. The joint...been cycled through the joint and saved for use as a lubricant during mechanical testing. For both Control and Arthroscopy knees, paired, full

Using high-flow nasal cannulas for infants with bronchiolitis admitted to paediatric wards is safe and feasible.

PubMed

Heikkilä, Paula; Sokuri, Paula; Mecklin, Minna; Nuolivirta, Kirsi; Tapiainen, Terhi; Peltoniemi, Outi; Renko, Marjo; Korppi, Matti

2018-05-26

Using a high-flow nasal cannula (HFNC) for infant bronchiolitis is increasingly common, but insufficiently studied. In this retrospective study, we examined the outcomes of HFNC and compared infants who did and did not respond to this oxygen delivery method. This 2012-2015 study of six Finnish hospitals focused on 88 infants under 12 months who received HFNC: 53 on paediatric wards and 35 in paediatric intensive care units (PICUs). We reviewed patient files for underlying factors, clinical parameters and HFNC treatment. The treatment failed if the patient was transferred to another respiratory support. We found HFNC treatment was successful in 76 (86%) infants, including all 53 on the paediatric wards and 23/35 PICU patients. The responders' heart rates were significantly lower, and their oxygen saturation was significantly higher at 60 minutes after HFNC treatment started and then stayed relatively constant. Their respiratory rate was only significantly lower after 360 minutes. In non-responders, the respiratory rate initially decreased but was higher at 180 and 360 minutes after the start of HFNC. We found preliminary evidence that oxygen support needs and heart rate were useful early predictors of HFNC therapy success in infants hospitalised with bronchiolitis, but respiratory rate was not. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture.

PubMed

Inoue, Makoto; Abulon, Dina Joy K; Hirakata, Akito

2014-01-01

To compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture. We tested one ridged microvitreoretinal (MVR), one non-ridged MVR, one pointed beveled, and one round-tipped beveled blade (n=10 per blade design per incision type). Each blade's straight and oblique incision architecture was assessed in a silicone disc simulating the sclera. Wound leakage under pressure and endoscopic observations were conducted on sclerotomy sites of isolated porcine eyes (n=4 per blade design) after simulated vitrectomy. Differences in blade design created distinct incision architecture. Incisions were linear with the ridged MVR blade, flattened "M-shaped" with the non-ridged MVR blade, asymmetrical chevron-shaped with the pointed beveled blade, and curved with the round-tipped beveled blade. With the exception of oblique entry incision thickness, both MVR blade designs created thinner incisions than the beveled blades at entry and exit sites. Only the ridged MVR blade created incisions with no leakage. Vitreous incarceration was observed with all trocar cannula systems. Wound closure in porcine eyes was similar with all blades despite differences in incision architecture. Wound leakage occurred at low to moderate infusion pressures with most blades; no wound leakage was observed with ridged MVR blades.

Comparison of the effects of 23-gauge and 25-gauge microincision vitrectomy blade designs on incision architecture

PubMed Central

Inoue, Makoto; Abulon, Dina Joy K; Hirakata, Akito

2014-01-01

Purpose To compare the effects of different 23- and 25-gauge microincision vitrectomy trocar cannula entry systems on incision architecture. Methods We tested one ridged microvitreoretinal (MVR), one non-ridged MVR, one pointed beveled, and one round-tipped beveled blade (n=10 per blade design per incision type). Each blade’s straight and oblique incision architecture was assessed in a silicone disc simulating the sclera. Wound leakage under pressure and endoscopic observations were conducted on sclerotomy sites of isolated porcine eyes (n=4 per blade design) after simulated vitrectomy. Results Differences in blade design created distinct incision architecture. Incisions were linear with the ridged MVR blade, flattened “M-shaped” with the non-ridged MVR blade, asymmetrical chevron-shaped with the pointed beveled blade, and curved with the round-tipped beveled blade. With the exception of oblique entry incision thickness, both MVR blade designs created thinner incisions than the beveled blades at entry and exit sites. Only the ridged MVR blade created incisions with no leakage. Vitreous incarceration was observed with all trocar cannula systems. Conclusion Wound closure in porcine eyes was similar with all blades despite differences in incision architecture. Wound leakage occurred at low to moderate infusion pressures with most blades; no wound leakage was observed with ridged MVR blades. PMID:25429201

Effectiveness of Needleless Vial Adaptors and Blunt Cannulas for Drug Administration in a Microgravity Environment

NASA Technical Reports Server (NTRS)

Hailey, M.; Bayuse, T.

2010-01-01

Fluid Isolation in the medication vial: Air/ fluid isolation maneuvers were used to move the medication to the septum end of vial. This isolation may be achieved in multiple ways based on the experience of the astronaut with fluid management in microgravity. If vial adaptors/blunt cannula or syringe assembly is inserted into the to vial before fluid isolation commences, the stability of this assembly should be considered in an effort to limit the risk of "slinging off" of the vial during isolation. Alternatively, fluid isolation can be performed prior to attaching the syringe/vial adaptor assembly. Terrestrial practices for medication withdrawal from a nonvented vial require injection of an equivalent amount of air as the expected medication volume prior to withdrawing liquid. In microgravity, this action is still valid, however the injection of additional air into the vial creates a multitude of micro bubbles and increases the volume of medication mixed with air that then must be withdrawn to achieve the desired drug volume in syringe. This practice is more likely to be required when using vials >30ml in size and injection volumes >10mL. It is felt that based on the microgravity flight, the practice of air injection is more of a hindrance than help.

Optimisation of the round window opening in cochlear implant surgery in wet and dry conditions: impact on intracochlear pressure changes.

PubMed

Mittmann, Philipp; Ernst, A; Mittmann, M; Todt, I

2016-11-01

To preserve residual hearing in cochlear implant candidates, the atraumatic insertion of the cochlea electrode has become a focus of cochlea implant research. In a previous study, intracochlear pressure changes during the opening of the round window membrane were investigated. In the current study, intracochlear pressure changes during opening of the round window membrane under dry and transfluid conditions were investigated. Round window openings were performed in an artificial cochlear model. Intracochlear pressure changes were measured using a micro-optical pressure sensor, which was placed in the apex. Openings of the round window membrane were performed under dry and wet conditions using a cannula and a diode laser. Statistically significant differences in the intracochlear pressure changes were seen between the different methods used for opening of the round window membrane. Lower pressure changes were seen by opening the round window membrane with the diode laser than with the cannula. A significant difference was seen between the dry and wet conditions. The atraumatic approach to the cochlea is assumed to be essential for the preservation of residual hearing. Opening of the round window under wet conditions produce a significant advantage on intracochlear pressure changes in comparison to dry conditions by limiting negative outward pressure.

Percutaneous Biopsy of Osteoid Osteomas Prior to Percutaneous Treatment Using Two Different Biopsy Needles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Laredo, Jean-Denis, E-mail: jean-denis.laredo@lrb.aphp.fr; Hamze, Bassam; Jeribi, Riadh

2009-09-15

Biopsy is usually performed as the first step in percutaneous treatment of osteoid osteomas prior to laser photocoagulation. At our institution, 117 patients with a presumed diagnosis of osteoid osteoma had a trephine biopsy before a percutaneous laser photocoagulation. Biopsies were made using two different types of needles. A Bonopty biopsy needle (14-gauge cannula, 16-gauge trephine needle; Radi Medical Systems, Uppsala, Sweden) was used in 65 patients, and a Laurane biopsy needle (11-gauge cannula, 12.5-gauge trephine needle; Laurane Medical, Saint-Arnoult, France) in 43 patients. Overall biopsy results were positive for osteoid osteoma in 83 (70.9%) of the 117 cases. Themore » Laurane needle provided a significantly higher positive rate (81.4%) than the Bonopty needle (66.1%; p < 0.05). This difference was not due to the size of the nidus, which was similar in the two groups (p < 0.05) and may be an effect of differences in needle caliber (12.5 vs. 14 gauge) as well as differences in needle design. The rate of positive biopsy results obtained in the present series with the Laurane biopsy needle is, to our knowledge, the highest rate reported in series dealing with percutaneous radiofrequency ablation and laser photocoagulation of osteoid osteomas.« less

Direct effects of endogenous pyrogen on medullary temperature-responsive neurons in rabbits.

PubMed

Sakata, Y; Morimoto, A; Takase, Y; Murakami, N

1981-01-01

The effect of endogenous pyrogen (E.P.) injected directly into the tissue near the recording site were examined on the activities of the medullary temperature-responsive (TR) neurons in rabbits anesthetized with urethane. Endogenous pyrogen prepared from rabbit's whole blood was administered by a fine glass cannula (100-200 micrometer in diameter) in a fluid volume of 1 to 4 microliter. The cannula was fixed to the manipulator in parallel with a microelectrode and their tips were less than 0.05 mm apart. In rabbits with the intact preoptic/anterior hypothalamic (PO/AH) region, 4 warm-responsive neurons out of 7 were inhibited and 6 cold-responsive neuron out of 7 were excited by the direct administration of the E.P. In rabbits with lesions of the PO/AH, 5 warm-responsive neurons out of 9 were inhibited and 6 cold-responsive neurons out of 8 were facilitated by E.P. Antipyretics administered locally after the E.P. antagonized the pyretic effect, causing a return of the discharge of TR neuron to the control rate within 2.4 +/- 1.2 (mean +/- S.D.) min. The medullary TR neuron itself has the ability to respond to the E.P. and contributes to the development of fever.

The 50th anniversary of long-term hemodialysis: University of Washington Hospital, March 9th, 1960.

PubMed

Blagg, Christopher R

2011-01-01

The first 6 months of 1960 saw the development of the shunt that first made long-term hemodialysis possible for patients dying from chronic kidney failure. A brief account of hemodialysis for acute kidney failure prior to 1960 is followed by a description of the work of Belding Scribner, Wayne Quinton and David Dillard at the University of Washington in Seattle. Scribner had the idea of a shunt connecting indwelling arterial and venous cannulas in the forearm between dialyses, to maintain patency of the cannulas, Quinton used Teflon tubing to make the device, and Dillard was the surgeon who implanted the first shunt on March 9th, 1960. The patient, Clyde Shields, was a 39-year-old man dying from uremia secondary to chronic glomerulonephritis. The shunt worked, and Clyde lived a further 11 years on dialysis. Scribner took Quinton and Clyde to the American Society for Artificial Internal Organs (ASAIO) meeting in April and showed Clyde to physicians interested in dialysis, and Quinton demonstrated fabrication of the shunt. In June 1960, 2 landmark papers describing cannulation and the treatment were published in the Transactions of the ASAIO. Today there are some 2 million patients with end-stage renal disease living worldwide.

Evaluation of drug effects on cerebral blood flow and glucose uptake in un-anesthetized and un-stimulated rats: application of free-moving apparatus enabling to keep rats free during PET/SPECT tracer injection and uptake.

PubMed

Sugita, Taku; Kondo, Yusuke; Ishino, Seigo; Mori, Ikuo; Horiguchi, Takashi; Ogawa, Mikako; Magata, Yasuhiro

2018-05-15

The purpose of this study is the development of novel fluorine-18-fluorodeoxyglucose (F-FDG)-PET and Tc-hexamethylpropylene amine oxime (HMPAO) SPECT methods with free-moving apparatus on conscious rats to investigate brain activity without the effects of anesthesia and tactual stimulation. We also assessed the sensitivity of the experimental system by an intervention study using fluoxetine as a reference drug. A catheter was inserted into the femoral vein and connected to a free-moving cannula system. After fluoxetine administration, the rats were given an injection of F-FDG or Tc-HMPAO via the intravenous cannula and released into a free-moving cage. After the tracer was trapped in the brain, the rats were anesthetized and scanned with PET or SPECT scanners. Then a volume of interest analysis and statistical parametric mapping were performed. We could inject the tracer without touching the rats, while keeping them conscious until the tracers were distributed and trapped in the brain using the developed system. The effects of fluoxetine on glucose uptake and cerebral blood flow were perceptively detected by volume of interest and statistical parametric mapping analysis. We successfully developed free-moving F-FDG-PET and Tc-HMPAO-SPECT imaging systems and detected detailed glucose uptake and cerebral blood flow changes in the conscious rat brain with fluoxetine administration. This system is expected to be useful to assess brain activity without the effects of anesthesia and tactual stimulation to evaluate drug effect or animal brain function.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.

Relationship between body weight and level of fat supplementation on fatty acid digestion in feedlot cattle.

PubMed

Plascencia, A; Mendoza, G D; Vásquez, C; Zinn, R A

2003-11-01

Eight Holstein steers with cannulas in the rumen and proximal duodenum were used in a split-plot design experiment to evaluate the interaction of body weight (175 vs. 370 kg) and level of fat supplementation (0, 3, 6, and 9% yellow grease) on characteristics of digestion and feeding value of fat in finishing diets. Dry matter intake was restricted to 2% of BW. There were no interactions between BW and level of fat supplementation (P > 0.10) on ruminal or total-tract digestion. Level of supplemental fat decreased (linear, P < 0.01) ruminal digestion of OM and NDF, and increased (linear, P < 0.05) ruminal N efficiency. There were no treatment effects (P > 0.10) on postruminal digestion of OM, NDF, and N. There tended to be an interaction (P < 0.10) between BW and level of fat supplementation on postruminal starch digestion. Increasing level of fat supplementation increased postruminal digestion of starch in heavier steers but did not affect starch digestion in lighter steers. There were no interactions (P > 0.10) between BW and level of fat supplementation on postruminal fatty acid digestion. Increasing level of fat supplementation decreased (linear, P < 0.01) postruminal fatty acid digestion, which was due to a decreased (linear, P < 0.01) postruminal digestion of C16:0 and C18:0. Supplemental fat decreased (linear, P < 0.01) total-tract digestion of OM and NDF. The estimated NEm (Mcal/kg) of yellow grease averaged (linear, P < 0.01) 6.02, 5.70, and 5.06 for the 3, 6, and 9% of level supplementation, respectively. We conclude that intestinal fatty acid digestion (FAD, %) is a predictable function (r2 = 0.89; P < 0.01) of total fatty acid intake per unit body weight (FAI, g/kg BW): FAD = 87.560 - 8.591FAI. Depressions in fatty acid digestion with increasing level of intake were due primarily to decreased intestinal absorption of palmitic and stearic acid. Level of fatty acids intake did not appreciably affect intestinal absorption of unsaturated fatty acid. Changes in intestinal fatty acid digestion accounted for most of the variation in the NE value of supplemental fat.

Brain physiological state evaluated by real-time multiparametric tissue spectroscopy in vivo

NASA Astrophysics Data System (ADS)

Mayevsky, Avraham; Barbiro-Michaely, Efrat; Kutai-Asis, Hofit; Deutsch, Assaf; Jaronkin, Alex

2004-07-01

The significance of normal mitochondrial function in cellular energy homeostasis as well as its involvement in acute and chronic neurodegenerative disease was reviewed recently (Nicholls & Budd. Physiol Rev. 80: 315-360, 2000). Nevertheless, monitoring of mitochondrial function in vivo and real time mode was not used by many investigators and is very rare in clinical practice. The main principle tool available for the evaluation of mitochondrial function is the monitoring of NADH fluorescence. In order to interpret correctly the changes in NADH redox state in vivo, it is necessary to correlate this signal to other parameters, reflecting O2 supply to the brain. Therefore, we have developed and applied a multiparametric optical monitoring system, by which microcirculatory blood flow and hemoglobin oxygenation is measured, together with mitochondrial NADH fluorescence. Since the calibration of these signals is not in absolute units, the simultaneous monitoring provide a practical tool for the interpretation of brain functional state under various pathophysiological conditions. The monitoring system combines a time-sharing fluorometer-reflectometer for the measurement of NADH fluorescence and hemoglobin oxygenation as well as a laser Doppler flowmeter for the recording of microcirculatory blood flow. A combined fiber optic probe was located on the surface of the brain using a skull cemented cannula. Rats and gerbils were exposed to anoxia, ischemia and spreading depression and the functional state of the brain was evaluated. The results showed a clear correlation between O2 supply/demand as well as, energy balance under the various pathophysiological conditions. This monitoring approach could be adapted to clinical monitoring of tissue vitality.

Overcoming the Practical Barriers to Spinal Cord Cell Transplantation for ALS

DTIC Science & Technology

2012-10-01

ABSTRACT: This grant will provide critical data on tolerance and toxicity of cell dosing and numbers of permissible spinal cord injections. Rigorous...Surgical Technique) will provide critical data on tolerance and toxicity of cell dosing and numbers of permissible spinal cord injections. Aim 2 (Graft...connected to a rigid needle of the same gauge as the floating cannula one – Figure 7) using the maximum volume/number of injections could result in

Neuropeptides in Experimental Head Injury.

DTIC Science & Technology

1987-02-28

Harvard Apparatus, Milton, MA). Drugs were administered through a cannula placed in the inferior vena cava via the femoral vein, The femoral artery was...with a slightly flared end was placed in the left atrium via a thoracotomy (see reference 6), and the chest was sutured closed. Page 10 For each CBF...a vortex mixer, microspheres were injected into the left atrium over approximately 30 sec. The injection of this number of microspheres insured that

Role of Neurotensin in Radiation-Induced Hypothermia in Rats

DTIC Science & Technology

1991-01-01

radiation-in- appears to mediate neurotensin-induced hylothemnia becaus duced hypothermia and to elucidate the mechanisms in- th mas cell stabilizer...of neurotensin an- tibody alone had no effect on body temperature. An ICV administration of the mast cell stabilizer disodium cromo- 30 3 120glycate...David Kopf Instruments. No. 320) A single cannula was in- pear to be centrally mediated (4. 5). H- stamine has been serteil aseptically into the

Acute Resuscitation and Transfer Management of Burned and Electrically Injured Patients,

DTIC Science & Technology

1994-01-01

patient. When all visible chemical the hospital and is usually provided by is removed , copious irrigation with water local fire or emergency medical... remove the victim chemicals, especially alkaline agents, may from the fire environment to a safe area. continue to irritate for hours, irrigation Once...veins and then sutured in place. vical spine if injury is suspected), and Cannulas traversing burned skin are ac- Exposure ( removal of all clothing and

Effects of alkyl polyglycoside, a nonionic surfactant, and forage-to-concentrate ratio on rumen fermentation, amino acid composition of rumen content, bacteria and plasma in goats.

PubMed

Zeng, Bo; Tan, Zhiliang; Tang, Shaoxun; Han, Xuefeng; Tan, Chuanyan; Zhong, Rongzhen; Hea, Zhixiong; Arigbede, Oluwasanmi Moses

2011-06-01

In the present study, the effects of different forage-to-concentrate ratios (F:C) and an alkyl polyglycoside (APG) supplementation on parameters of rumen and blood metabolism were investigated in goats. A 2 x 2 factorial experiment was arranged within a 4 x 4 Latin square design (four 22-day periods), using four wether goats equipped with permanent ruminal cannulas. The experimental diets included two F:C levels (40:60 vs. 60:40), and two APG supplementation levels (None or 13 ml APG daily per animal). Rumen contents and blood samples were collected at the end of each period. Dietary F:C alteration affected plasma urea and influenced the proportions of leucine, histidine, arginine, glycine, proline, alanine, valine, phenylalanine, cysteine and tyrosine in rumen content, and the proportions of methionine, threonine and proline in solid-associated bacteria (SAB) significantly. Dietary APG decreased the proportions of valine and phenylalanine in rumen content, and the histidine content of liquid-associated bacteria. The interaction between dietary F:C and APG was significant for the proportions of glycine and alanine in rumen content, and the proportions of lysine and threonine in SAB. The proportion of lysine was greater, but the proportion of threonine was less in SAB for goats fed high F:C diet without APG supplementation. The proportions of plasma free amino acids and glucose concentration were not affected by experimental treatments. These results indicated that dietary APG addition affected the amino acid composition of the rumen content and ruminal bacteria, but this depended on the dietary F:C ratio. It is necessary to validate the effectiveness of dietary APG supplementation in further studies with more animals.

Quantitative analysis of ruminal bacterial populations involved in lipid metabolism in dairy cows fed different vegetable oils.

PubMed

Vargas-Bello-Pérez, E; Cancino-Padilla, N; Romero, J; Garnsworthy, P C

2016-11-01

Vegetable oils are used to increase energy density of dairy cow diets, although they can provoke changes in rumen bacteria populations and have repercussions on the biohydrogenation process. The aim of this study was to evaluate the effect of two sources of dietary lipids: soybean oil (SO, an unsaturated source) and hydrogenated palm oil (HPO, a saturated source) on bacterial populations and the fatty acid profile of ruminal digesta. Three non-lactating Holstein cows fitted with ruminal cannulae were used in a 3×3 Latin square design with three periods consisting of 21 days. Dietary treatments consisted of a basal diet (Control, no fat supplement) and the basal diet supplemented with SO (2.7% of dry matter (DM)) or HPO (2.7% of DM). Ruminal digesta pH, NH3-N and volatile fatty acids were not affected by dietary treatments. Compared with control and HPO, total bacteria measured as copies of 16S ribosomal DNA/ml by quantitative PCR was decreased (P<0.05) by SO. Fibrobacter succinogenes, Butyrivibrio proteoclasticus and Anaerovibrio lipolytica loads were not affected by dietary treatments. In contrast, compared with control, load of Prevotella bryantii was increased (P<0.05) with HPO diet. Compared with control and SO, HPO decreased (P<0.05) C18:2 cis n-6 in ruminal digesta. Contents of C15:0 iso, C18:11 trans-11 and C18:2 cis-9, trans-11 were increased (P<0.05) in ruminal digesta by SO compared with control and HPO. In conclusion, supplementation of SO or HPO do not affect ruminal fermentation parameters, whereas HPO can increase load of ruminal P. bryantii. Also, results observed in our targeted bacteria may have depended on the saturation degree of dietary oils.

AT1 and AT2 Receptors in the Prelimbic Cortex Modulate the Cardiovascular Response Evoked by Acute Exposure to Restraint Stress in Rats.

PubMed

Brasil, Taíz F S; Fassini, Aline; Corrêa, Fernando M

2018-01-01

The prelimbic cortex (PL) is an important structure in the neural pathway integrating stress responses. Brain angiotensin is involved in cardiovascular control and modulation of stress responses. Blockade of angiotensin receptors has been reported to reduce stress responses. Acute restraint stress (ARS) is a stress model, which evokes sustained blood pressure increase, tachycardia, and reduction in tail temperature. We therefore hypothesized that PL locally generated angiotensin and angiotensin receptors modulate stress autonomic responses. To test this hypothesis, we microinjected an angiotensin-converting enzyme (ACE) inhibitor or angiotensin antagonists into the PL, prior to ARS. Male Wistar rats were used; guide cannulas were bilaterally implanted in the PL for microinjection of vehicle or drugs. A polyethylene catheter was introduced into the femoral artery to record cardiovascular parameters. Tail temperature was measured using a thermal camera. ARS was started 10 min after PL treatment with drugs. Pretreatment with ACE inhibitor lisinopril (0.5 nmol/100 nL) reduced the pressor response, but did not affect ARS-evoked tachycardia. At a dose of 1 nmol/100 nL, it reduced both ARS pressor and tachycardic responses. Pretreatment with candesartan, AT1 receptor antagonist reduced ARS-evoked pressor response, but not tachycardia. Pretreatment with PD123177, AT2 receptor antagonist, reduced tachycardia, but did not affect ARS pressor response. No treatment affected ARS fall in tail temperature. Results suggest involvement of PL angiotensin in the mediation of ARS cardiovascular responses, with participation of both AT1 and AT2 receptors. In conclusion, results indicate that PL AT1-receptors modulate the ARS-evoked pressor response, while AT2-receptors modulate the tachycardic component of the autonomic response.

Sidestream cigarette smoke effects on cardiovascular responses in conscious rats: involvement of oxidative stress in the fourth cerebral ventricle.

PubMed

Valenti, Vitor E; de Abreu, Luiz Carlos; Sato, Monica A; Ferreira, Celso; Adami, Fernando; Fonseca, Fernando L A; Xavier, Valdelias; Godoy, Moacir; Monteiro, Carlos B; Vanderlei, Luiz Carlos M; Saldiva, Paulo H N

2012-03-30

Cigarette exposure increases brain oxidative stress. The literature showed that increased brain oxidative stress affects cardiovascular regulation. However, no previous study investigated the involvement of brain oxidative stress in animals exposed to cigarette and its relationship with cardiovascular regulation. We aimed to evaluate the effects of central catalase inhibition on baroreflex and cardiovascular responses in rats exposed to sidestream cigarette smoke (SSCS). We evaluated males Wistar rats (320-370 g), which were implanted with a stainless steel guide cannula into the fourth cerebral ventricle (4th V). Femoral artery and vein were cannulated for mean arterial pressure (MAP) and heart rate (HR) measurement and drug infusion, respectively. Rats were exposed to SSCS during three weeks, 180 minutes, 5 days/week (CO: 100-300 ppm). Baroreflex was tested with a pressor dose of phenylephrine (PHE, 8 μg/kg, bolus) to induce bradycardic reflex and a depressor dose of sodium nitroprusside (SNP, 50 μg/kg, bolus) to induce tachycardic reflex. Cardiovascular responses were evaluated before, 5, 15, 30 and 60 minutes after 3-amino-1,2,4-triazole (ATZ, catalase inhibitor, 0.001 g/100 μL) injection into the 4th V. Central catalase inhibition increased basal HR in the control group during the first 5 minutes. SSCS exposure increased basal HR and attenuated bradycardic peak during the first 15 minutes. We suggest that SSCS exposure affects cardiovascular regulation through its influence on catalase activity.

Sidestream cigarette smoke effects on cardiovascular responses in conscious rats: involvement of oxidative stress in the fourth cerebral ventricle

PubMed Central

2012-01-01

Background Cigarette exposure increases brain oxidative stress. The literature showed that increased brain oxidative stress affects cardiovascular regulation. However, no previous study investigated the involvement of brain oxidative stress in animals exposed to cigarette and its relationship with cardiovascular regulation. We aimed to evaluate the effects of central catalase inhibition on baroreflex and cardiovascular responses in rats exposed to sidestream cigarette smoke (SSCS). Methods We evaluated males Wistar rats (320-370 g), which were implanted with a stainless steel guide cannula into the fourth cerebral ventricle (4th V). Femoral artery and vein were cannulated for mean arterial pressure (MAP) and heart rate (HR) measurement and drug infusion, respectively. Rats were exposed to SSCS during three weeks, 180 minutes, 5 days/week (CO: 100-300 ppm). Baroreflex was tested with a pressor dose of phenylephrine (PHE, 8 μg/kg, bolus) to induce bradycardic reflex and a depressor dose of sodium nitroprusside (SNP, 50 μg/kg, bolus) to induce tachycardic reflex. Cardiovascular responses were evaluated before, 5, 15, 30 and 60 minutes after 3-amino-1,2,4-triazole (ATZ, catalase inhibitor, 0.001 g/100 μL) injection into the 4th V. Results Central catalase inhibition increased basal HR in the control group during the first 5 minutes. SSCS exposure increased basal HR and attenuated bradycardic peak during the first 15 minutes. Conclusion We suggest that SSCS exposure affects cardiovascular regulation through its influence on catalase activity. PMID:22463380

Humidification and heating of inhaled gas in patients with artificial airway. A narrative review

PubMed Central

Plotnikow, Gustavo Adrián; Accoce, Matias; Navarro, Emiliano; Tiribelli, Norberto

2018-01-01

Instrumentation of the airways in critical patients (endotracheal tube or tracheostomy cannula) prevents them from performing their function of humidify and heating the inhaled gas. In addition, the administration of cold and dry medical gases and the high flows that patients experience during invasive and non-invasive mechanical ventilation generate an even worse condition. For this reason, a device for gas conditioning is needed, even in short-term treatments, to avoid potential damage to the structure and function of the respiratory epithelium. In the field of intensive therapy, the use of heat and moisture exchangers is common for this purpose, as is the use of active humidification systems. Acquiring knowledge about technical specifications and the advantages and disadvantages of each device is needed for proper use since the conditioning of inspired gases is a key intervention in patients with artificial airway and has become routine care. Incorrect selection or inappropriate configuration of a device can have a negative impact on clinical outcomes. The members of the Capítulo de Kinesiología Intensivista of the Sociedad Argentina de Terapia Intensiva conducted a narrative review aiming to show the available evidence regarding conditioning of inhaled gas in patients with artificial airways, going into detail on concepts related to the working principles of each one. PMID:29742220

Humidification and heating of inhaled gas in patients with artificial airway. A narrative review.

PubMed

Plotnikow, Gustavo Adrián; Accoce, Matias; Navarro, Emiliano; Tiribelli, Norberto

2018-03-01

Instrumentation of the airways in critical patients (endotracheal tube or tracheostomy cannula) prevents them from performing their function of humidify and heating the inhaled gas. In addition, the administration of cold and dry medical gases and the high flows that patients experience during invasive and non-invasive mechanical ventilation generate an even worse condition. For this reason, a device for gas conditioning is needed, even in short-term treatments, to avoid potential damage to the structure and function of the respiratory epithelium. In the field of intensive therapy, the use of heat and moisture exchangers is common for this purpose, as is the use of active humidification systems. Acquiring knowledge about technical specifications and the advantages and disadvantages of each device is needed for proper use since the conditioning of inspired gases is a key intervention in patients with artificial airway and has become routine care. Incorrect selection or inappropriate configuration of a device can have a negative impact on clinical outcomes. The members of the Capítulo de Kinesiología Intensivista of the Sociedad Argentina de Terapia Intensiva conducted a narrative review aiming to show the available evidence regarding conditioning of inhaled gas in patients with artificial airways, going into detail on concepts related to the working principles of each one.

Methylene blue dyeing of cellular nuclei during salpingoscopy, a new in-vivo method to evaluate vitality of tubal epithelium.

PubMed

Marconi, G; Quintana, R

1998-12-01

The Fallopian tube can be damaged by different noxious substances that may change cellular ultrastructure and function. Alteration of the cell membrane allows the passage of certain aniline dyes, which can stain the nucleus. A total of 310 Fallopian tubes from 163 patients who underwent a surgical or diagnostic laparoscopy during fertility studies was analysed by salpingoscopy. Cellular nuclei were stained by injection of 20 ml of a 10% solution of methylene blue in saline solution (NaCl 10%) through the cervical cannula prior to salpingoscopy. Evaluation of nuclear staining with methylene blue, adhesions, vascular alterations, and the flattening of folds in relation to pregnancy outcome was undertaken. Quantification of salpingoscopic findings was carried out according to a score. Flattening of folds and vascular alterations showed no difference in the pregnant and non-pregnant groups. On the other hand, adhesions and nuclear dyeing were significantly greater in the non-pregnant group (adhesions 13.6 versus 26.8%, P < 0.004, and nuclear dyeing: 25 versus 41.7%, P < 0.009, pregnant versus non-pregnant). Methylene blue dye is a new tool to evaluate in vivo cyto-histological tubal damage, and is a useful and simple method to provide a prognosis of salpingean function.

Comparative effects of parathion and chlorpyrifos on extracellular endocannabinoid levels in rat hippocampus: Influence on cholinergic toxicity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Jing; Parsons, Loren; Pope, Carey, E-mail: carey.pope@okstate.edu

2013-11-01

Parathion (PS) and chlorpyrifos (CPF) are organophosphorus insecticides (OPs) that elicit acute toxicity by inhibiting acetylcholinesterase (AChE). Endocannabinoids (eCBs, N-arachidonoylethanolamine, AEA; 2-arachidonoylglycerol, 2AG) can modulate neurotransmission by inhibiting neurotransmitter release. We proposed that differential inhibition of eCB-degrading enzymes (fatty acid amide hydrolase, FAAH, and monoacylglycerol lipase, MAGL) by PS and CPF leads to differences in extracellular eCB levels and toxicity. Microdialysis cannulae were implanted into hippocampus of adult male rats followed by treatment with vehicle (peanut oil, 2 ml/kg, sc), PS (27 mg/kg) or CPF (280 mg/kg) 6–7 days later. Signs of toxicity, AChE, FAAH and MAGL inhibition, and extracellularmore » levels of AEA and 2AG were measured 2 and 4 days later. Signs were noted in PS-treated rats but not in controls or CPF-treated rats. Cholinesterase inhibition was extensive in hippocampus with PS (89–90%) and CPF (78–83%) exposure. FAAH activity was also markedly reduced (88–91%) by both OPs at both time-points. MAGL was inhibited by both OPs but to a lesser degree (35–50%). Increases in extracellular AEA levels were noted after either PS (about 2-fold) or CPF (about 3-fold) while lesser treatment-related 2-AG changes were noted. The cannabinoid CB1 receptor antagonist/inverse agonist AM251 (3 mg/kg, ip) had no influence on functional signs after CPF but markedly decreased toxicity in PS-treated rats. The results suggest that extracellular eCBs levels can be markedly elevated by both PS and CPF. CB1-mediated signaling appears to play a role in the acute toxicity of PS but the role of eCBs in CPF toxicity remains unclear. - Highlights: • Chlorpyrifos and parathion both extensively inhibited hippocampal cholinesterase. • Functional signs were only noted with parathion. • Chlorpyrifos and parathion increased hippocampal extracellular anandamide levels. • 2-Arachidonoylglycerol levels were lesser affected. • The CB1 antagonist AM251 had no effect on chlorpyrifos but reduced parathion toxicity.« less

The effect of resveratrol on angiotensin II levels and the rate of transcription of its receptors in the rat cardiac hypertrophy model.

PubMed

Dorri Mashhadi, Fahimeh; Zavvar Reza, Javad; Jamhiri, Mohabbat; Hafizi, Zeinab; Zare Mehrjardi, Fatemeh; Safari, Fatemeh

2017-03-01

This study investigated the effect of resveratrol on serum and cardiac levels of angiotensin II and transcription of its main receptors following pressure overload induced-hypertrophy. Rats were divided into untreated (Hyp) and resveratrol treated hypertrophied groups (H + R). Intact animals served as the control (Ctl). Cardiac hypertrophy was induced by abdominal aortic banding. Blood pressure (BP) was recorded via left carotid artery cannula. Fibrosis was confirmed by Masson trichrome staining. Angiotensin II level was measured using an ELIZA test. Gene expression was assessed by a real time PCR (RT-PCR) technique. We observed that in the H + R group BP and heart weight/body weight were decreased significantly (p < 0.001, p < 0.05, respectively vs Hyp). The cardiac levels of angiotensin II and AT1a mRNA were increased in the Hyp group (p < 0.01 vs Ctl). In the H + R group the AT1a mRNA level was decreased significantly (p < 0.05 vs Hyp). It could be concluded that resveratrol protects the heart against hypertrophy progression in part by affecting cardiac AT1a transcription.

Effect of di-amphetamine injected into N. Accumbens on ethanol self-administration in the rat

DOE Office of Scientific and Technical Information (OSTI.GOV)

Samson, H.H.; Tolliver, G.A.; Haraguchi, M.

1991-03-11

Adult, male Long-Evans rats were initiated to lever press with 10% (v/v) ethanol reinforcement using the sucrose-fading technique. Following initiation and the development of stable ethanol self-administration behavior, bilateral cannula guides directed at the N.Accumbens were surgically implanted. Following recovery, the animals received microinjections once a week of either saline, 4, 10 or 20 ug/brain of dl-amphetamine sulfate dissolved in saline. Injections were 10 minutes prior to the daily 30min ethanol self-administration session.; At all doses tested, amphetamine had no significant effect upon the number of responses or ethanol. Reinforcements received during the session. However, a clear alteration in themore » pattern of responding was found at the 10 and 20 ug dose, with some animals showing effects at 4 ug. This alteration in response pattern with no effect upon total responding is different from prior work using systemic amphetamine injections, where both pattern and number of responses were affected. The data suggest that some but not all of the systemic effects could be related to amphetamine's actions on the N. Accumbens.« less

Central effects of ghrelin on the adrenal cortex: a morphological and hormonal study.

PubMed

Milosević, Verica Lj; Stevanović, Darko M; Nesić, Dejan M; Sosić-Jurjević, Branka T; Ajdzanović, Vladimir Z; Starcević, Vesna P; Severs, Walter B

2010-06-01

Ghrelin, a growth hormone secretagogue that exerts an important role in appetite and weight regulation, participates in the activation of the hypothalamo-pituitary-adrenal (HPA) axis. Male Wistar rats (5/group) received daily for 5 days, via an ICV (intracerebroventricular) cannula, 5 microl phosphate buffered saline with or without 1 microg of rat ghrelin. Two hours after the last injection, blood and adrenal glands were collected from decapitated rats for blood hormone analyses and histologic and morphometric processing. Ghrelin treatment resulted in increased (p<0.05) body weight (13%), absolute whole adrenal gland weight (18%) and whole adrenal gland volume (20%). The absolute volumes of the entire adrenal cortex, ZG, ZF, and ZR also increased (p<0.05) after ghrelin by 20%, 21%, 21% and 11%, respectively. Ghrelin-treated rats had elevated (p<0.05) blood concentrations of ACTH, aldosterone and corticosterone (68%, 32% and 67%, respectively). The data clearly provide both morphological and hormonal status that ghrelin acts centrally to exert a global stimulatory effect on the adrenal cortex. Clarifying of the ghrelin precise role in the multiple networks affecting the stress hormone release, besides its well known energy and metabolic unbalance effects, remains a very important research goal.

Safe swallowing and communicating for ventilated intensive care patients with tracheostoma: implementation of the Passy Muir speaking valve

PubMed

Fröhlich, Martin R; Boksberger, Heidi; Barfuss-Schneider, Claudia; Liem, Esther; Petry, Heidi

2017-01-01

Background: Between 4 to 45 % of intensive care patients suffer from prolonged ventilator dependence. Due to impeded weaning, verbal communication is impossible. The tracheal cannula affects breathing and swallowing. The Passy Muir speaking valve (PMV) allows patients on ventilators to speak. It counteracts pharyngeal as well as laryngeal desensitization and prevents an insufficient swallowing reflex. Aim and methods: To implement the PMV, we conducted a multiprofessional practice- and quality development project. The objective was to ensure safe swallowing and communicating for ventilated patients with tracheostoma. Results: Intensive care nurses, doctors and physiotherapists assessed patient safety as being high. In nine patients with 51 PMV applications, we observed three undesirable events in terms of dyspnea and oxygen desaturation. On one occasion, it was necessary to remove the PMV. Conclusion: A combination of mandatory training for the entire treatment team, presence of two professionals during PMV application, and a newly developed guiding document resulted in a high level of patient safety. By means of PMV, ventilated intensive care patients are able to communicate verbally and to swallow better. Complications can be identified early and solved effectively.

OCT Study of Mechanical Properties Associated with Trabecular Meshwork and Collector Channel Motion in Human Eyes

PubMed Central

Xin, Chen; Johnstone, Murray; Wang, Ningli; Wang, Ruikang K.

2016-01-01

We report the use of a high-resolution optical coherence tomography (OCT) imaging platform to identify and quantify pressure-dependent aqueous outflow system (AOS) tissue relationships and to infer mechanical stiffness through examination of tissue properties in ex vivo human eyes. Five enucleated human eyes are included in this study, with each eye prepared with four equal-sized quadrants, each encompassing 90 degrees of the limbal circumference. In radial limbal segments perfusion pressure within Schlemm’s canal (SC) is controlled by means of a perfusion cannula inserted into the canal lumen, while the other end of the cannula leads to a reservoir at a height that can control the pressure in the cannula. The OCT system images the sample with a spatial resolution of about 5 μm from the trabecular meshwork (TM) surface. Geometric parameters are quantified from the 2D OCT images acquired from the sample subjected to controlled changes in perfusion pressures; parameters include area and height of the lumen of SC, collector channel entrances (CCE) and intrascleral collector channels (ISCC). We show that 3D OCT imaging permits the identification of 3-D relationships of the SC, CCE and ISCC lumen dimensions. Collagen flaps or leaflets are found at CCE that are attached or hinged at only one end, whilst the flaps are connected to the TM by cylindrical structures spanning SC. Increasing static SC pressures resulted in SC lumen enlargement with corresponding enlargement of the CCE and ISCC lumen. Pressure-dependent SC lumen area and height changes are significant at the 0.01 levels for ANOVA, and at the 0.05 for both polynomial curves and Tukey paired comparisons. Dynamic measurements demonstrate a synchronous increase in SC, CCE and ISCC lumen height in response to pressure changes from 0 to 10, 30 or 50 mm Hg, respectively, and the response time is within the 50-millisecond range. From the measured SC volume and corresponding IOP values, we demonstrate that an elastance curve can be developed to infer the mechanical stiffness of the TM by means of quantifying pressure-dependent SC volume changes over a 2 mm radial region of SC. Our study finds pressure-dependent motion of the TM that corresponds to collagen leaflet configuration motion at CCE; the synchronous tissue motion also corresponds with synchrony of SC and CCE lumen dimension changes. PMID:27598990

Effects of fat and/or methionine hydroxy analog added to a molasses-urea-based supplement on ruminal and postruminal digestion and duodenal flow of nutrients in beef steers consuming low-quality lovegrass hay

USDA-ARS?s Scientific Manuscript database

Five crossbred beef steers (initial BW = 338.6 ± 7.8 kg) fitted with ruminal and duodenal cannulas were used in a 5 × 5 Latin square design experiment to evaluate the effects of methionine hydroxy analog (MHA) and/or yellow grease (fat) added to a molassesurea-based supplement on intake and characte...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sponseller, Patricia, E-mail: sponselp@uw.edu; Pelly, Nicole; Trister, Andrew

Radiation therapy for pediatric patients often includes the use of intravenous anesthesia with supplemental oxygen delivered via the nasal cannula. Here, we describe the use of an adaptive anesthesia technique for electron irradiation of the right naris in a preschool-aged patient treated under anesthesia. The need for an intranasal bolus plug precluded the use of standard oxygen supplementation. This novel technique required the multidisciplinary expertise of anesthesiologists, radiation therapists, medical dosimetrists, medical physicists, and radiation oncologists to ensure a safe and reproducible treatment course.

Experimental comparison of manually inflatable versus autoinflatable retrograde cardioplegia catheters.

PubMed

Menasché, P

1994-08-01

A pig model of cardiopulmonary bypass and cardioplegic arrest was used to compare leakage around manually inflatable and autoinflatable retrograde coronary sinus cardioplegia catheters. Warm and cold blood cardioplegia were alternately delivered through the catheter under study at both low (16 to 24 mm Hg) and high (30 to 40 mm Hg) perfusion pressures. During each experiment, the coronary sinus ostium was sealed around the shaft of the retrograde cannula so that all backflow occurring during cardioplegia delivery could be collected by a separate drainage catheter inserted directly into the coronary sinus approximately midway between the right atrium and the distal end of the balloon. Only two of the 52 manually inflatable cannulas leaked. The leakage in both cases was negligible (< 1% of the total retrograde cardioplegia flow). In contrast, leakage occurred with 57 of the 73 autoinflatable devices tested (p < 0.0001) and averaged 22% +/- 3% (mean +/- the standard error of the mean) of the total retrograde flow. The temperature of the cardioplegia solution had no effect on leakage. These results suggest that autoinflatable balloons inconsistently seal the coronary sinus during cardioplegia infusion, thereby decreasing the amount of flow that effectively reaches the myocardium. This should make surgeons cautious about using them with warm blood cardioplegia, which largely relies upon the delivery of sufficiently high retrograde nutritive flows for preventing cardioprotective aerobic arrest from becoming a life-threatening ischemic arrest.

Results of extracorporeal life support implementation in routine clinical practice: single center experience

PubMed Central

Biočina, Bojan; Petričević, Mate; Belina, Dražen; Gašparović, Hrvoje; Svetina, Lucija; Konosić, Sanja; White, Alexandra; Ivančan, Višnja; Kopjar, Tomislav; Miličić, Davor

2014-01-01

Aim To describe our experience in the clinical application of extracorporeal life support (ECLS) and analyze whether ECLS leads to acceptable clinical outcomes in patients with cardiac failure. Methods Data from clinical database of University Hospital Center Zagreb, Croatia, on 75 patients undergoing ECLS support from 2009 to 2014 due to cardiac failure were retrospectively analyzed. Outcomes were defined as procedural and clinical outcomes. ECLS as a primary procedure and ECLS as a postcardiotomy procedure due to inability to wean from cardiopulmonary bypass were analyzed. Results ECLS was used in 75 adult patients, and in 24 (32%) of those procedural success was noted. ECLS was implemented as a primary procedure in 36 patients and as a postcardiotomy procedure in 39 patients. Nine out of 39 (23.08%) patients had postcardiotomy ECLS after heart transplantation. Bleeding complications occurred in 30 (40%) patients, both in primary (11/36 patients) and postcardiotomy group (19/39 patients). ECLS was established by peripheral approach in 46 patients and by central cannulation in 27 patients. In 2 patients, combined cannulation was performed, with an inflow cannula placed into the right atrium and an outflow cannula placed into the femoral artery. Eleven patients treated with peripheral approach had ischemic complications. Conclusion ECLS is a useful tool in the treatment of patients with refractory cardiac failure and its results are encouraging in patients who otherwise have an unfavorable prognosis. PMID:25559831

Active silicone oil removal with a modified vacuum syringe.

PubMed

Bajaire, Boris J; Oudovitchenko, Elena; Salguero, Andrés E; Paipilla, Diego F

2012-01-01

At present, the number of clinical indications for the use of silicone oil (SO) has increased in intraocular surgery because of the advent of new techniques in vitreoretinal surgery, availability of better quality oils, and greater experience in its use. Consequently, the number of procedures for SO removal has increased, and support technologies for these procedures are always a concern. A simple active technique for SO removal based on a 5-mL standard syringe with an 18G cannula was developed. The oil is suctioned into the syringe by the pulling effect of a spring assembled along the axis of the piston. No abrupt change in the intraocular pressure is produced because of the oil viscosity and the reduced diameter of the cannula. A technique for SO removal that has been used successfully during the past 7 years is presented in this article. During the 7-year period, 234 SO removals were performed without any complication or device failure. Using the present method, the average time for SO removal was 4 minutes. The average extraction time with the technique is 4 minutes, which is in the range of other active techniques, and it is faster than passive methods that are performed between 8 and 9 minutes. The technique is in line with the advantages of more elaborated active methods without using complex technology. It is considered to be highly successful and easy to implement.

Computational analysis of aortic hemodynamics during total and partial extracorporeal membrane oxygenation and intra-aortic balloon pump support.

PubMed

Caruso, Maria Vittoria; Gramigna, Vera; Renzulli, Attilio; Fragomeni, Gionata

2016-01-01

The extracorporeal membrane oxygenation (ECMO) is a temporary, but prolonged circulatory support for cardiopulmonary failure. Clinical evidence suggests that pulsed flow is healthier than non pulsatile perfusion. The aim of this study was to computationally evaluate the effects of total and partial ECMO assistance and pulsed flow on hemodynamics in a patient-specific aorta model. The pulsatility was obtained by means of the intra-aortic balloon pump (IABP), and two different cases were investigated, considering a cardiac output (CO) of 5 L/min: Case A - total assistance - the whole flow delivered through the ECMO arterial cannula; Case B - partial assistance - flow delivered half through the cannula and half through the aorta. Computational fluid dynamic (CFD) analysis was carried out using the multiscale approach to couple the 3D aorta model with the lumped parameter model (resistance boundary condition). In case A pulsatility followed the balloon radius change, while in case B it was mostly influenced by the cardiac one. Furthermore, during total assistance, a blood stagnation occurred in the ascending aorta; in the case of partial assistance, the flow was orderly when the IABP was on and was chaotic when the balloon was off. Moreover, the mean arterial pressure (MAP) was higher in case B. The wall shear stress was worse in ascending aorta in case A. Partial support is hemodynamically advisable.

Hemodynamic energy generated by a combined centrifugal pump with an intra-aortic balloon pump.

PubMed

Lim, Choon Hak; Son, Ho Sung; Fang, Yung Hu; Lee, Jung Joo; Baik, Kwang Je; Kim, Kyung Hyun; Kim, Bum Soo; Lee, Hye Won; Sun, Kyung

2006-01-01

We examined the pulsatility generated by an intra-aortic balloon pump/centrifugal pump (IABP/CP) combination in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE). In five cardiac-arrested pigs, the outflow cannula of the CP was inserted into the ascending aorta, the inflow cannula in the right atrium. A 30-ml IABP was subsequently placed in the descending aorta. Extracorporeal circulation was maintained for 30 minutes using a pump flow of 75 ml/kg per minute by CP alone or by IABP/CP with pressure and flow measured in the right internal carotid artery. The IABP/CP combination converted the flow to pulsatile and increased pulse pressure significantly from 9.1 +/- 1.3 mm Hg to 54.9 +/- 6.1 mm Hg (p = 0.012). It also significantly increased the percent change from mean arterial pressure to EEP from 0.2 +/- 0.3% to 23.3 +/- 6.1% (p = 0.012) and SHE from 133.2 +/- 234.5 erg/cm to 20,219.8 +/- 5842.7 erg/cm3 (p = 0.012). However, no statistical difference was observed between CP and IABP/CP in terms of mean carotid artery pressure (p = NS). In a cardiac-arrested animal model, pulsatility generated by a IABP/CP combination may be effective in terms of energy equivalent pressure and surplus hemodynamic energy.

An alternative and inexpensive percutaneous access needle in pediatric patients.

PubMed

Penbegul, Necmettin; Soylemez, Haluk; Bozkurt, Yasar; Sancaktutar, Ahmet Ali; Bodakci, Mehmet Nuri; Hatipoglu, Namik Kemal; Atar, Murat; Yildirim, Kadir

2012-10-01

The most important factor that increases the cost of percutaneous surgery is the disposable instruments used for the surgery. In this study we present the advantages of using an intravenous cannula instead of a percutaneous access needle for renal access. Recently, percutaneous stone surgery has grown in use in pediatric cases and is considered a minimally invasive surgery. The most important step in this surgery is access to the renal collecting systems. Although fluoroscopy has been used frequently at this stage, the use of ultrasound has recently increased. During percutaneous accesses under all types of imaging techniques, disposable 11- to 15-cm-long 18-ga needles are used. In pediatric cases, these longer needles are difficult to use. Using disposable materials in percutaneous nephrolithotomy increases the cost of the procedure. Therefore, we asserted that percutaneous access especially in pediatric cases could be performed using a 16-ga intravenous cannula (angiocath). Indeed, percutaneous access was performed successfully, especially in pediatric preschool patients. Shorter needle length, easy skin entry, comfort of manipulation, clear visualization of the metal needle on ultrasound, and wide availability can be considered advantages of this method. The angiocath is also less expensive than a percutaneous access needle. Angiocath is inexpensive, easily available, and practical, and it is the shortest needle to perform percutaneous access in pediatric patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Pancreatic enzyme deficiency depends on dietary protein origin in milk-fed calves.

PubMed

Guilloteau, P; Plodari, M; Romé, V; Savary, G; Le Normand, L; Zabielski, R

2011-03-01

In young mammals, milk proteins and their substitutes are used in milk formula. Protein substitution modifies diet digestibility and pancreatic secretions. The aim of this study was to test if milk protein substitution could generate pancreatic deficiency in milk-fed calves. The effect of pancreatic juice on the digestibility of proteins was studied. Measurement of apparent fecal nutrient digestibility was used to estimate digestion. Ten calves (60 to 130 d old) were chronically fitted with pancreatic accessory duct cannulas and 2 duodenal cannulas to provide precise measurement, sampling, and reintroduction of pancreatic juice as well as additional infusions. Animals were fed milk formula based on skim milk powder or soybean concentrate. Level of deficiency depended on dietary protein origin. Twice as much protein or trypsin was required with a soybean concentrate diet than with a skim milk powder diet to obtain maximal nutrient digestibility. Pancreatic protein concentration in the juice can be used to differentiate between normal and deficient animals. Among these proteins, trypsin measurement is a good pancreatic deficiency marker. These results confirmed the major role of exocrine pancreatic secretions in producing optimal digestion in young calves. Furthermore, practical applications of these results can be applied for the young in other animal species and in humans. Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Rapid systematic review shows that using a high-flow nasal cannula is inferior to nasal continuous positive airway pressure as first-line support in preterm neonates.

PubMed

Conte, Francesca; Orfeo, Luigi; Gizzi, Camilla; Massenzi, Luca; Fasola, Salvatore

2018-05-11

We reviewed using a high-flow nasal cannula (HFNC) as first-line support for preterm neonates with, or at risk of, respiratory distress. This rapid systematic review covered biomedical databases up to June 2017. We included randomised controlled trials (RCTs) published in English. The reference lists of the studies and relevant reviews we included were also screened. We performed the study selection, data extraction, study quality assessment, meta-analysis and quality of evidence assessment following the Grading of Recommendations Assessment, Development and Evaluation system. Pooled results from six RCTs covering 1227 neonates showed moderate-quality evidence that HFNC was associated with a higher rate of failure than nasal continuous positive airway pressure (NCPAP) in preterm neonates of at least 28 weeks of gestation, with a risk ratio of 1.57. Low-quality evidence showed no significant differences between HFNC and NCPAP in the need for intubation and bronchopulmonary dysplasia rate. HFNC yielded a lower rate of nasal injury (risk ratio 0.50). When HFNC failed, intubation was avoided in some neonates by switching them to NCPAP. HFNC had higher failure rates than NCPAP when used as first-line support. Subsequently switching to NCPAP sometimes avoided intubation. Data on the most immature neonates were lacking. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Arthroscopic therapy of recurrent anterior luxation of the shoulder by capsular repair.

PubMed

Landsiedl, F

1992-01-01

Sixty-five cases of recurrent anterior unidirectional dislocation of the shoulder were treated by arthroscopic capsular repair. In this approach, the arthroscope is inserted through a posterior portal. Using mostly an anterior portal, a 5-mm hole is drilled across the neck of the glenoid, between the 3 and 4 o'clock positions. A 5-mm working cannula is passed from the posterior portal into the joint. Mostly through the anterior portal, four to six retention U-sutures are placed in the labrum, the middle and inferior glenohumeral ligament, and the subscapularis tendon. A 25-cm-long, 2.0-mm K-wire with an eye is used. The sutures are pulled out posteriorly through the cannula and tied on the fascia of the infraspinatus muscle. The goal of the procedure is to reattach the detached labrum-ligament complex (LLC) and achieve a capsulorrhaphy in a medial-lateral and superior-inferior direction. There were nine redislocations during a follow-up period of 24-60 months (average, 35.3 months). Reasons for redislocation were (a) fewer than four sutures; (b) no sutures of the LLC; (c) placement of the drill hole in the top third of the glenoid; (d) nontraumatic dislocation; (e) no Bankart or Hill-Sachs lesion; (f) transverse tear of the LLC; or (g) technical errors. Redislocation was more common in male patients.

The method of intraoperative analysis of structural and metabolic changes in the area of tumor resection

NASA Astrophysics Data System (ADS)

Savelieva, Tatiana A.; Loshchenov, Victor B.; Volkov, Vladimir V.; Linkov, Kirill G.; Goryainov, Sergey A.; Potapov, Alexander A.

2014-05-01

The method of intraoperative analysis of tumor markers such as structural changes, concentrations of 5- ALA induced protoporphyrin IX and hemoglobin in the area of tissue resection was developed. A device for performing this method is a neurosurgical aspiration cannulae coupled with the fiber optic probe. The configuration of fibers at the end of cannulae was developed according to the results of numerical modeling of light distribution in biological tissues. The optimal distance between the illuminating and receiving fiber was found for biologically relevant interval of optical properties. On this particular distance the detected diffuse reflectance depends on scattering coefficient almost linearly. Array of optical phantoms containing hemoglobin, protoporphyrin IX and fat emulsion (as scattering media) in various concentrations was prepared to verify the method. The recovery of hemoglobin and protoporphyrin IX concentrations in the scattering media with an error less than 10% has been demonstrated. The fat emulsion concentration estimation accuracy was less than 12%. The first clinical test was carried out during glioblastoma multiforme resection in Burdenko Neurosurgery Institute and confirmed that sensitivity of this method is enough to detect investigated tumor markers in vivo. This method will allow intraoperative analysis of the structural and metabolical tumor markers directly in the zone of destruction of tumor tissue, thereby increasing the degree of radical removal and preservation of healthy tissue.

A review of techniques of induced abortion.

PubMed

Hepburn, S

1981-04-01

Various techniques are available for inducing abortion. Evacuation of the uterus through the vagina is generally the preferred method in first trimester pregnancies. Dilation of the cervical canal by inserting rod dilators or laminaria tents allows the withdrawal of the fetus. Suction procedures (vacuum aspiration, uterine aspiration, or suction curettage) are possible since the decidua are separable from the basal layer of endometrium. This removal by force does not damage other maternal tissue. A cannula is introduced into the uterine cavity through the dilated cervix and its operator is then connected to a pump by way of a flexible tube which delivers negative pressure of about 600 mm of mercury. When the fetus is withdrawn, the uterus is felt to contract onto the cannula. The average time for this procedure is 5 minutes. Surgical curettage or dilatation and evacuation first dilates the cervical canal and then removes fetal parts and tissue from ovum forceps; a sharp curette does the rest. Anesthesia for these procedures may be general, local, or spinal. The techniques of menstrual regulation is used before pregnancy can be confirmed. However with the advent of the RIA test for the beta subunit of HCG this procedure is rarely indicated. Induction of premature labor is used in the later 1/2 of the second trimester and utilizes prostaglandins. Intraamniobor usually begins within 24 hours. Hysterotomy and hysterectomy are surgical procedures used in abortions.

Safety of lumbar spine radiofrequency procedures in the presence of posterior pedicle screws: technical report of a cadaver study.

PubMed

Gazelka, Halena M; Welch, Tasha L; Nassr, Ahmad; Lamer, Tim J

2015-05-01

To determine whether the thermal energy associated with lumbar spine radiofrequency neurotomy (RFN) performed near titanium and stainless steel pedicle screws is conducted to the pedicle screws or adjacent tissues, or both, thus introducing potential for thermal damage to those tissues. Cadaver study. Cadaver laboratory equipped with fluoroscopy, surgical spine implements, and radiofrequency generator. No live human subject; a fresh frozen (and thawed) cadaver torso was used for the study. Titanium and stainless steel pedicle screws were placed in the lumbar spine of a fresh frozen cadaver torso with real-time fluoroscopic guidance. Conventional RFN cannula placement was performed at the level of pedicle screws and a control (nonsurgically altered) lumbar level. Neurotomy was performed with conventional radiofrequency lesioning parameters. Temperatures were recorded at multiple sites through thermistor probes. Direct contact of the radiofrequency cannula with the pedicle screws during conventional RFN produced a substantial increase in temperature in the surrounding soft tissues. A small increase in temperature occurred at the same sites at the control level. Titanium and stainless steel pedicle screws are capable of sustaining large increases in temperature when the radiofrequency probe comes in contact with the screw. These results are suggestive that pedicle screws could serve as a possible source of tissue heating and thermal injury during RFN. Wiley Periodicals, Inc.

Extracorporeal life support: moving at the speed of light.

PubMed

Dalton, Heidi J

2011-09-01

Extracorporeal life support (ECLS), or extracorporeal membrane oxygenation (ECMO) as it is also known, has been used to support over 45,000 patients to date. Overall survival is 62%. After many years of no change in equipment and technology, there has been a recent flurry of new pumps, cannulas, and oxygenators available for ECLS use. While the impact of this new technology is not yet completely defined, initial results have found that these systems provide safe support with lower priming volumes and less bleeding complications. New cannulas are also available, some making it easier for venovenous support in patients, from infants through adults. The reported success of ECLS in patients with H1N1 during the 2009-2010 epidemic and the improved survival of patients randomized to the ECMO arm of a recently completed adult study of respiratory failure have also brought ECLS into the spotlight much more than other years. Whether these developments will usher in a new era of ECLS expansion to a wider range of patients will require close consideration and observation. Other areas that need to be further refined include anticoagulation management, treatment of bleeding complications, learning to "nurse" patients in an awake state, such as is done in some European (and a few United States) centers, and neurodevelopmental outcome on a long-term basis. 2011 Daedalus Enterprises

Cost-effectiveness analysis of the use of high-flow oxygen through nasal cannula in intensive care units in NHS England.

PubMed

Eaton Turner, Emily; Jenks, Michelle

2018-06-01

To estimate the cost-effectiveness of Nasal High Flow (NHF) in the intensive care unit (ICU) compared with standard oxygen or non-invasive ventilation (NIV) from a UK NHS perspective. Three cost-effectiveness models were developed to reflect scenarios of NHF use: first-line therapy (pre-intubation model); post-extubation in low-risk, and high-risk patients. All models used randomized control trial data on the incidence of intubation/re-intubation, events leading to intubation/re-intubation, mortality and complications. NHS reference costs were primarily used. Sensitivity analyses were conducted. When used as first-line therapy, Optiflow™ NHF gives an estimated cost-saving of £469 per patient compared with standard oxygen and £611 versus NIV. NHF cost-savings for high severity sub-group were £727 versus standard oxygen, and £1,011 versus NIV. For low-risk post-intubation patients, NHF generates estimated cost-saving of £156 versus standard oxygen. NHF decreases the number of re-intubations required in these scenarios. Results were robust in most sensitivity analyses. For high-risk post-intubation patients, NHF cost-savings were £104 versus NIV. NHF results in a non-significant increase in re-intubations required. However, reduction in respiratory failure offsets this. For patients in ICU who are at risk of intubation or re-intubation, NHF cannula is likely to be cost-saving.

[Cuff pressure control at the intersinve care unit: influence of nursing professionals' training].

PubMed

Velasco Sanz, T R; Ronda Delgado de la Fuente, M; Sánchez de la Ventana, A B; Reyes Merino Martínez, M

2015-01-01

To analyze proper control of endotracheal cuff pressure in an intensive care unit. The specific objective is to verify whether training of nursing professionals improves monitoring endotracheal cuff pressure. the study type is descriptive, observational and retrospective. All patients were admitted to the Critical Unit II of the Clínico San Carlos Hospital between May 2010-November 2011, requiring either a tracheal tube or tracheal cannula. Studied variables were: number of in range measures, number of intubated patients, or with tracheal cannula and register. Four cuts were made on all admitted patients admitted during the study period in order to measure endotracheal cuff pressure. Two cuts were performed before the professional nurses training and the other two cuts after a specific training with respect to endotracheal cuff pressure and Zero pneumonia. There were 74 measurements. The first cut obtained 40.74% of measures in range. In the second cut 61.90% of measures were identified in range. In the third cut, it was found that 85.7% of measures were in range and in the fourth court, it was noted the 89.47% of measures were in range. Monitoring of the endotracheal cuff pressure was inadequate before specific training of professionals. Nursing professionals training facilitates the correct measurement of the endotracheal cuff pressure, which improves patient safety. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Effects of vacuum suctioning and strategic drape tenting on oxygen concentration in a simulated surgical field.

PubMed

Kung, Theodore A; Kong, Sarah W; Aliu, Oluseyi; Azizi, Jahan; Kai, Salim; Cederna, Paul S

2016-02-01

To investigate the isolated and combined effects of vacuum suctioning and strategic drape tenting on oxygen concentration in an experimental setting. Experimental. Clinical simulation center of a university-affiliated hospital. Mannequin simulation of a patient undergoing facial surgery under sedation anesthesia. Supplemental oxygen was delivered via nasal cannula. Vacuum suctioning and strategic drape tenting. The experimental trials entailed measuring oxygen concentration around the nasal cannula continuously either in the presence or absence of a standard operating room vacuum suction system and strategic tenting of surgical drapes. The primary outcome was the time required for oxygen concentration to reach 21%. In the control group (without suction or strategic tenting), a mean time of 180 seconds elapsed until the measured oxygen concentration reached 21% after cessation of oxygen delivery. Use of a vacuum suction device alone (110 seconds; P < .01) or in combination with strategic tenting (110 seconds; P < .01) significantly reduced this time. No significant benefit was seen when tenting was used alone (160 seconds; P < .30). Use of a vacuum suction device during surgery will lower local oxygen concentration, and this in turn may decrease the risk of operating room fires. Although strategic tenting of surgical drapes has a theoretical benefit to decreasing the pooling of oxygen around the surgical site, further investigation is necessary before its routine use is recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

Early Feasibility Testing and Engineering Development of the Transapical Approach for the HeartWare MVAD Ventricular Assist System

PubMed Central

Tamez, Daniel; LaRose, Jeffrey A.; Shambaugh, Charles; Chorpenning, Katherine; Soucy, Kevin G; Sobieski, Michael A; Sherwood, Leslie; Giridharan, Guruprasad A; Monreal, Gretel; Koenig, Steven C; Slaughter, Mark S

2014-01-01

Implantation of ventricular assist devices (VADs) for treatment of end-stage heart failure (HF) falls decidedly short of clinical demand, which exceeds 100,000 HF patients per year. VAD implantation often requires major surgical intervention with associated risk of adverse events and long recovery periods. To address these limitations, HeartWare, Inc. (Miami Lakes, FL) has developed a platform of miniature ventricular devices with progressively reduced surgical invasiveness and innovative patient peripherals. One surgical implant concept is a transapical version of the miniaturized left ventricular assist device (MVAD). The HeartWare MVAD Pump® is a small, continuous flow, full-support device that has a displacement volume of 22mL. A new cannula configuration has been developed for transapical implantation, where the outflow cannula is positioned across the aortic valve. The two primary objectives for this feasibility study were to evaluate anatomic fit and surgical approach and efficacy of the transapical MVAD configuration. Anatomic fit and surgical approach were demonstrated using human cadavers (n=4). Efficacy was demonstrated in acute (n =2) and chronic (n = 1) bovine model experiments and assessed by improvements in hemodynamics, biocompatibility, flow dynamics, and histopathology. Potential advantages of the MVAD Pump include flow support in the same direction as the native ventricle, elimination of cardiopulmonary bypass, and minimally-invasive implantation. PMID:24399057

Ultrasound-Guided Percutaneous Nephrostomy Performed on Neonates and Infants Using a "14-4" (Trocar and Cannula) Technique.

PubMed

Bas, Ahmet; Gülşen, Fatih; Emre, Senol; Samanci, Cesur; Uzunlu, Osman; Cantasdemir, Murat; Emir, Haluk; Numan, Furuzan

2015-12-01

Percutaneous nephrostomy (PCN) catheters are placed under combined ultrasound and fluoroscopic guidance in the interventional radiology suite and present unique challenges in neonates and infants. The purpose of this study was to demonstrate feasibility of PCN using a "14-4" (trocar and cannula) technique on neonates and infants. Between September 2009 and June 2014, data for 27 kidneys from consecutive 22 neonates or infants who underwent PCN catheter placement using the "14-4" technique were retrospectively analyzed. The median age at the time of placement of the PCN catheters was 11 days (range 5-300 days). There were 18 males and 4 females. All procedures were performed in the interventional radiology suite but without using fluoroscopy. Unilateral PCN was performed on 17 out of 22 patients, while bilateral drainage was performed on five patients. The technical success rate was 100%. The median duration of PCN catheter was 75 days (range 10-138 days). Minor macroscopic hematuria not requiring blood transfusion was present in two of the patients in which the hematuria lasted in 2 days. Placement of PCN catheters using a "14-4" technique with ultrasound as the sole imaging modality is a technically feasible and desirable option for neonates or infants. The technique obviates the need for ionizing radiation and potentially could be performed in the ultrasound room or even at the bedside.

Duodenal infusions of palmitic, stearic or oleic acids differently affect mammary gland metabolism of fatty acids in lactating dairy cows.

PubMed

Enjalbert, F; Nicot, M C; Bayourthe, C; Moncoulon, R

1998-09-01

The effect of dietary lipids on the fatty acid (FA) profile of cows' milk fat is mainly dependent on digestive processes and mammary gland uptake and metabolism of FA. The objective of this study was to determine the separate effects of high arterial concentrations of 16:0, 18:0 and cis-18:1(n-9) on uptake, synthesis and 18:0 desaturation rate in the mammary gland of lactating dairy cows, via arterio-venous differences and mammary gland balance of FA. In a 4 x 4 Latin square, four lactating Holstein cows with cannula in the proximal duodenum were infused duodenally with a mixture providing daily 0 (C treatment) or 500 g FA with mainly 16:0 (P treatment), 18:0 (S treatment) or cis-18:1(n-9) (O treatment). Significantly higher arterial concentrations of infused FA in arterial plasma nonesterified FA and triglycerides (NETGFA) were observed with P and O treatments, but the effect of the S treatment was much lower. Arterio-venous differences of NETGFA increased with arterial concentrations. The number of synthesized FA in the mammary gland was not significantly affected by duodenal infusion of FA. Mean chain length was significantly reduced by P and O treatments, suggesting an effect of mammary gland uptake of long-chain FA on the termination process of mammary gland synthesis of FA. Across all treatments, 4:0 mammary gland balance increased linearly (r = 0.67, P = 0.004) with mammary gland FA uptake. Mammary gland desaturation of 18:0 to cis-18:1(n-9) averaged 52% and was not significantly affected by treatments, but was reduced by trans-18:1 mammary gland uptake. Uptake, synthesis and desaturation of FA by the mammary gland of dairy cows are affected by arterial concentrations of 16:0, 18:0 and cis-18:1(n-9).

Ab interno management of blocked Ahmed valve in the posterior segment.

PubMed

Odrich, Steven; Wald, Kenneth; Sperber, Laurence

2013-01-01

To report a case of late failure of a posterior segment placed Ahmed valve in a uveitic eye with a corneal graft and a minimally invasive, ab interno approach in restoring valve function, pressure control, and preservation of vision. Case report. A 25 gauge trans-conjunctival 3-port pars plana vitrectomy was performed to inspect and clean the ostium of the Ahmed valve of any vitreous debris. The Ahmed valve was not disturbed externally and conjunctival dissection was not performed. A 27-gauge blunt cannula was introduced through the vitrector site and used to cannulate the tube and flush it with balanced salt solution. A bleb was immediately re-established and all instruments were removed requiring no sutures. Intraocular pressure returned to target levels and a filtration bleb was re-established. Corneal graft clarity was restored with resolution of preoperative microcystic edema. Postoperative inflammation was minimal and vision was restored. A nonfunctioning tube shunt residing in the vitreous cavity may be revised ab interno without disturbing the shunt placement or the conjunctiva under which it resides to re-establish filtration.

Characterization of Carbon Dioxide Washout Measurement Techniques in the Mark-III Space Suit

NASA Technical Reports Server (NTRS)

Norcross, J.; Bekdash, O.; Meginnis, I.

2016-01-01

Providing adequate carbon dioxide (CO2) washout is essential to the reduction of risk in performing suited operations. Long term CO2 exposure can lead to symptoms such as headache, lethargy, dizziness, and in severe cases can lead to unconsciousness and death. Thus maintaining adequate CO2 washout in both ground testing and during in flight EVAs is a requirement of current and future suit designs. It is necessary to understand the inspired CO2 of suit wearers such that future requirements for space suits appropriately address the risk of inadequate washout. Testing conducted by the EVA Physiology Laboratory at the NASA Johnson Space Center aimed to characterize a method for noninvasively measuring inspired oronasal CO2 under pressurized suited conditions in order to better inform requirements definition and verification techniques for future CO2 washout limits in space suits. Prior work conducted by the EPL examined several different wearable, respirator style, masks that could be used to sample air from the vicinity surround the nose and mouth of a suited test subject. Previously published studies utilized these masks, some being commercial products and some novel designs, to monitor CO2 under various exercise and flow conditions with mixed results for repeatability and/or consistency between subjects. Based on a meta-analysis of those studies it was decided to test a nasal cannula as it is a commercially available device that is placed directly in the flow path of the user as they breathe. A nasal cannula was used to sample air inhaled by the test subjects during both rest and exercise conditions. Eight subjects were tasked with walking on a treadmill or operating an arm ergometer to reach target metabolic rates of 1000, 2000, and 3000 BTU/hr. Suit pressure was maintained at 4.3 psid for all tests, with supply flow rates of 6, 4, and 2 actual cubic feet per minute depending on the test condition. Each test configuration was conducted twice with subjects breathing either through their nose only, or however they felt comfortable. By restricting breathing through a single orifice, we are able to more accurately define exactly what flow stream the sampled CO2 is taken from. Oronasal CO2 was monitored using real time infrared gas analyzers fed via sample tubes connected to the nasal cannula within the suit. Two additional sampling tubes were placed at the head and chin of the test subject, in an effort to capture CO2 concentrations across the entire flow stream of the Mark-III vent system (flow path is head to neck). Metabolic rate was calculated via the exhaust CO2 concentration and used to adjust subject workload on either the treadmill or arm ergometer until the target was reached. Forward work will aim to characterize the historically accepted minimum ppCO2 in suit during EVA by repeating this study in the Extravehicular Mobility Unit (EMU) space suit. This will help to define washout requirements for future suits, be they NASA (e.g. Z-2) or Commercial Crew designed. Additionally it is important to determine the functional consequences of CO2 exposure during EVA. Severe CO2 symptoms are a result of very high concentration, acute exposures. While long term, low concentration exposures have been shown to result in slight cognitive decline, symptoms resolve upon quickly returning to nominal concentrations and it remains unknown the impact that minor deficits in cognitive performance can have on EVA performance.

A previous history of repeated amphetamine exposure modifies brain angiotensin II AT1 receptor functionality.

PubMed

Casarsa, B S; Marinzalda, M Á; Marchese, N A; Paz, M C; Vivas, L; Baiardi, G; Bregonzio, C

2015-10-29

Previous results from our laboratory showed that angiotensin II AT1 receptors (AT1-R) are involved in the neuroadaptative changes induced by amphetamine. The aim of the present work was to study functional and neurochemical responses to angiotensin II (ANG II) mediated by AT1-R activation in animals previously exposed to amphetamine. For this purpose male Wistar rats (250-320 g) were treated with amphetamine (2.5mg/kg/day intraperitoneal) or saline for 5 days and implanted with intracerebroventricular (i.c.v.) cannulae. Seven days after the last amphetamine administration the animals received ANG II (400 pmol) i.c.v. One group was tested in a free choice paradigm for sodium (2% NaCl) and water intake and sacrificed for Fos immunoreactivity (Fos-IR) determinations. In a second group of rats, urine and plasma samples were collected for electrolytes and plasma renin activity determination and then they were sacrificed for Fos-IR determination in Oxytocinergic neurons (Fos-OT-IR). Repeated amphetamine exposure (a) prevented the increase in sodium intake and Fos-IR cells in caudate-putamen and accumbens nucleus induced by ANG II i.c.v. (b) potentiated urinary sodium excretion and Fos-OT-IR in hypothalamus and (c) increased the inhibitory response in plasma renin activity, in response to ANG II i.c.v. Our results indicate a possible functional desensitisation of AT1-R in response to ANG II, induced by repeated amphetamine exposure. This functional AT1-R desensitisation allows to unmask the effects of ANG II i.c.v. mediated by oxytocin. We conclude that the long lasting changes in brain AT1-R functionality should be considered among the psychostimulant-induced neuroadaptations. Published by Elsevier Ltd.

Measuring Intracranial Pressure and Correlation with Severity of Blast Traumatic Brain Injury

DTIC Science & Technology

2013-01-01

additional care was taken to ensure the removal of air bubbles. Saline solution was placed in the can- nula through a syringe and petroleum jelly was added...system and the limbs. J. Royal Naval Medical Service 86, 27–31. Irwin, R.J., Lerner, M.R., Bealer, J.F., Brackett, D.J., and Tuggle, D.W. (1997...filled with a sterile saline solu- tion. The cannula cap was filled with petroleum jelly and the fiber optic pressure sensor (FOP-MIV, Fiso Inc.) was

Effects of Simulated Pathophysiology on the Performance of a Decision Support Medical Monitoring System for Early Detection of Hemodynamic Decompensation in Humans

DTIC Science & Technology

2015-10-01

Arterial oxygen saturation was monitored 130 using a finger pulse oximeter and end-tidal CO2 (ETCO2) was collected from a nasal cannula 131 (Cardiocap/5...Johnson et al, J Appl Physiol 2014 PMID 24876357. 5 Keywords Trauma, coagulation, central venous pressure, stroke volume, pulse pressure...Johnson BD, Curry TB, Convertino VA, & Joyner MJ. The association between pulse pressure and stroke volume during lower body negative pressure and

The Relationship Between Intrinsic and Extrinsic Factors and Central Venous Catheter Infections in the Acutely Ill Patient

DTIC Science & Technology

1991-01-01

central venous catheter is inserted into the bloodstream, a fibrin sheath forms around the cannula which attracts bacteria . Bacteria can either migrate from...to the fibrin sheath. After colonization of the fibrin sheath, the bacteria replicate and are released into the bloodstream when symptoms may develop...culture." Rose et al. (1988, p. 511) defined catheter site infection as occurring when "cultures at the exit site are identical to bacteria found on

Long-Term Bioeffects of 435-MHz Radiofrequency Radiation on Selected Blood-Borne Endpoints in Cannulated Rats. Volume 4. Plasma Catecholamines.

DTIC Science & Technology

1987-08-01

out. To use each animal as its own control , arterial blood was sampled by means of chronically implanted aortic cannulas 112,13,14]. This simple...APPENDIX B STATISTICAL METHODOLOGY 37 APPENDIX B STATISTICAL METHODOLOGY The balanced design of this experiment (requiring that 25 animals from each...protoccl in that, in numerous cases, samples were collected at odd intervals (invalidating the orthogonality of the design ) and the number of samples’taken

Influence of Route and Pattern of Exposure on the Pharmacokinetics and Hepatotoxicity of Carbon Tetrachloride

DTIC Science & Technology

1990-05-30

metabolize the chemical is limited [16]. Also, in high doses, CC14 can cause liver injury and thereby inhibit its own metabolism I23] If ingested CC...to clarify whether the liver is actually at greater risk of injury upon oral exposure to CC!4 . As cumulative uptaL. (Le, the systemically absorbed...the unanesthetized animals by means of an indwelling arterial cannula and analyzed for CC14 by headspace gas chromatography. Blood and liver samples

Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals.

PubMed

Milutinović, Dragana; Andrijević, Ilija; Ličina, Milijana; Andrijević, Ljiljana

2015-01-01

This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis. A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals' confidence level in their own ability to perform first and last venipuncture. The average score on the knowledge test was higher in nurses' than in laboratory technicians (8.11±1.7, and 7.4±1.5, respectively). The difference in average scores was statistically significant (P=0.035) and Cohen's d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P=0.551). Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample.

Influence of Kaolinite Clay Supplementation on Growth Performance and Digestive Function in Finishing Calf-fed Holstein Steers

PubMed Central

Ortiz, José; Montaño, Martín; Plascencia, Alejandro; Salinas, Jaime; Torrentera, Noemí; Zinn, Richard A.

2016-01-01

Two experiments were conducted to examine the influence of kaolinite clay supplementation (0%, 1%, or 2% diet dry matter [DM] basis) on characteristics of digestion (Trial 1) and growth performance (Trial 2) in calf-fed Holstein steers fed a finishing diet. In Trial 1, 6 Holstein steers (539±15 kg) with ruminal and duodenal cannulas were used to evaluate treatment effects on characteristics of digestion. Kaolinite clay supplementation decreased total tract DM digestion (linear effect, p<0.01) without effects (p≥0.10) on site and extent of digestion of organic matter, neutral detergent fiber, starch and N, or ruminal microbial efficiency. There were no treatment effects on ruminal pH, volatile fatty acids molar proportions or estimated methane production. In Trial 2, 108 Holstein steers (132.4±5.6 kg) were used in a 308-d study to evaluate growth performance and carcass characteristics. There were no treatment effects (p>0.10) on average daily gain (ADG) and gain efficiency (ADG/dry matter intake). Kaolinite supplementation tended (linear effect, p = 0.08) to increase dietary net energy (NE) during the initial 112-d period. However, the overall (308-d) effect of supplementation dietary NE was not appreciable (p>0.20). However, due to the inertness of kaolinite, itself, the ratio of observed-to-expected dietary NE increased with kaolinite supplementation. This effect was more pronounced (linear effect, p 0.03) during the initial 224 d of the study. Overall (308 d), kaolinite supplementation tended to increase (linear effect, p = 0.07) dietary NE by 3% over expected. Kaolinite supplementation did not affect carcass weight, yield grade, longissimus area, kidney, pelvic and heart fat, and quality grade, but decreased (linear effect, p = 0.01) dressing percentage. It is concluded that kaolinite supplementation up to 2% of diet DM may enhance energetic efficiency of calf-fed Holstein steers in a manner independent of changes in characteristics of ruminal and total tract digestion. PMID:27165016

Double dissociation in the neural substrates of acute opiate dependence as measured by withdrawal-potentiated startle.

PubMed

Harris, A C; Atkinson, D M; Aase, D M; Gewirtz, J C

2006-01-01

The basolateral amygdala and portions of the "extended" amygdala (i.e. central nucleus of the amygdala, bed nucleus of the stria terminalis and shell of the nucleus accumbens) have been implicated in the aversive aspects of withdrawal from chronic opiate administration. Given that similar withdrawal signs are observed following a single opiate exposure, these structures may also play a role in "acute opiate dependence." In the current study, drug-naïve rats underwent naloxone-precipitated withdrawal from acute morphine (10 mg/kg) exposure on two successive days. On either the first or second day of testing, the basolateral amygdala, central nucleus of the amygdala, bed nucleus of the stria terminalis, or nucleus accumbens was temporarily inactivated immediately prior to naloxone injection by microinfusion of the glutamatergic alpha-amino-3-hydroxy-5-methyl-4-isoxazole proprionic acid receptor antagonist 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo-benzo(f)quinoxaline-7-sulfonamide (3 microg/0.5 microl). On the first day, inactivation of the basolateral amygdala, central nucleus of the amygdala, or bed nucleus of the stria terminalis, but not the nucleus accumbens blocked withdrawal-potentiated startle, a behavioral measure of the anxiogenic effects of withdrawal. On the second day, inactivation of the nucleus accumbens, but not the basolateral amygdala, central nucleus of the amygdala, or bed nucleus of the stria terminalis disrupted the withdrawal effect. Effects of structural inactivations on withdrawal-potentiated startle were not influenced by differences in withdrawal severity on the two days of testing. A fear-potentiated startle procedure provided functional confirmation of correct cannulae placement in basolateral amygdale- and central nucleus of the amygdala-implanted animals. Our findings indicate a double dissociation in the neural substrates of withdrawal-potentiated startle following a first versus second morphine exposure, and may reflect a reorganization of the neural circuitry underlying the expression of withdrawal-induced negative affect during the earliest stages of opiate dependence.

Multi-unit activity suppression and sensorimotor deficits after endothelin-1-induced middle cerebral artery occlusion in conscious rats.

PubMed

Moyanova, Slavianka; Kirov, Roumen; Kortenska, Lidia

2003-08-15

Conscious Wistar rats with stereotaxically and unilaterally implanted cannula just above the middle cerebral artery (MCA) were injected with the powerful vasoconstrictor peptide endothelin-1 (ET1, 60 pmol in 3 microl). The purpose was to examine the long-term (from the 1st to the 14th day) changes in neuronal bioelectrical activity together with sensorimotor deficits after ET1-induced MCA occlusion (MCAO). Extracellular multi-unit activity (MUA) recorded from the ipsilateral fronto-parietal cortical area (supplied by MCA) and sensorimotor behavior (one postural reflex test and six limb placing tests) were examined. A significant suppression of the multi-unit activity was observed until the 14th day post-ET1. The rats exhibited significant unilateral sensorimotor deficits with a maximum at the 3-7 days after ET1 and a spontaneous partial recovery by days 11-14. A significant correlation was found between the suppression of the multi-unit activity and the sensorimotor deficits between the 3rd and the 10th day post-ET1. The results suggest that studying the bioelectrical activity in combination with the behavioral sensorimotor functions may be of use to assess the functional disturbances associated with focal cerebral ischemia and would help to examine the therapeutic benefits of various cerebroprotective treatments before initiating human clinical trials.

Aortoiliac aneurysm with congenital right pelvic kidney.

PubMed

Date, Kazuma; Okada, Shuuichi; Ezure, Masahiko; Takihara, Hitomi; Okonogi, Shuuichi; Hasegawa, Yutaka; Sato, Yasushi; Kaneko, Tatsuo

2015-05-01

The association of congenital pelvic kidney with abdominal aortoiliac aneurysm is an extremely rare clinical finding. Previous reports have described various methods of aneurysm repair with successful preservation of the function of pelvic kidney. However, to our knowledge, reconstruction of more than two renal arteries has not been established. We report a case of abdominal aortic aneurysm complicated by congenital right pelvic kidney in a 72-year-old man. Computed tomography (CT) revealed an abdominal aortic aneurysm with a maximum diameter of 54 mm and a right common iliac aneurysm of 45 mm. In addition, he had a congenital right pelvic kidney and CT angiography identified three right pelvic renal arteries. The upper artery originated from the bifurcation of the terminal aorta and the lower two originated from the right common iliac artery. Three-dimensional CT was helpful for the accurate planning of the operation. Open surgical repair of the aortoiliac aneurysm with a Dacron bifurcated graft replacement was decided and reimplantation of all three right pelvic kidney arteries to the right limb of the graft was also performed. For renal preservation, the right pelvic kidney arteries were perfused with cold Ringer's lactate using a rapid infusion pump and coronary perfusion cannula. The patient's postoperative course was uneventful, and worsening of renal function was not observed. The perfusion of renal arteries with cold Ringer's solution was thought to be a simple and appropriate procedure for renal protection.

Fat grafting to the nose: personal experience with 36 patients.

PubMed

Monreal, Juan

2011-10-01

Clinicians are facing an increasing trend toward nonsurgical nose reshaping using synthetic injectables, mainly for patients who refuse standard rhinoplasties. Autologous fat grafting is a safer and convenient alternative to permanent or semipermanent injectables due to better results as well as fewer and milder side effects. The author reports his experience with fat grafting to the nose using his personal technique for 36 consecutive patients. The experience covers primary treatments of noses not treated by surgery, treatment of post rhinoplasty deformities, and combination fat grafting and rhinoplasties. The technique used by the author for fat grafting to the nose does not differ significantly from that used for other body or face areas. It is based in the atraumatic extraction of fat fragments using a multi-orifice cannula and injection of these fragments using 1.4- to 1.6-mm cannulas or needles. In combining rhinoplasties with fat grafting, fat grafts are used in the same location instead of a prosthesis or cartilage grafts. The initial analysis of postoperative results showed a good to high level of patient satisfaction, particularly in primary cases, with virtually no complications or severe side effects. Some easily corrected side effects probably were learning curve dependent. Autologous fat grafting is an effective and reliable technique for aesthetic and reconstructive nose reshaping for patients who refuse surgical treatments. Although optimal results can be achieved with this technique, they are not comparable with those obtained by surgical rhinoplasties, and this is an important issue to discuss with the prospective patient.

Anesthetic management in a patient with Kindler's syndrome

PubMed Central

Solanki, Sohan Lal; Jain, Amit; Bhukal, Ishwar; Samanta, Sukhen

2011-01-01

A 35-year-old male with pan-anterior urethral stricture was scheduled to undergo perineal urethrostomy. He was a known case of Kindler's syndrome since infancy. He was having a history of blister formation, extensive poikiloderma and progressive cutaneous atrophy since childhood. He had a tendency of trauma-induced blisters with clear or hemorrhagic contents that healed with scarring. The fingers were sclerodermiform with dystrophic nails and inability to completely clench the fist. Airway examination revealed thyromental distance of 7 cm with limited neck extension, limited mouth opening and mallampatti class III with a fixed large tongue. He was reported as grade IV Cormack and Lehane laryngoscopic on previous anesthesia exposure. We described the anesthetic management of such case on guidelines for epidermolysis bullosa. In the operating room, an 18-G cannula was secured in the right upper limb using Coban™ Wrap. The T-piece of the cannula was than inserted into the slit and the tape was wrapped around the extremity. The ECG electrodes were placed on the limbs and fixed with Coban™. Noninvasive blood pressure cuff was applied over the wrap after wrapping the arm with Webril® cotton. Oral fiberoptic tracheal intubation was done after lubricating the laryngoscope generously with a water-based lubricant with 7-mm endotracheal tube. Surgery proceeded without any complication. After reversing the residual neuromuscular block, trachea was extubated once the patient became awake. He was kept in the postanesthesia care unit for 2 hours and then shifted to urology ward. PMID:22144935

Short-Term Intraocular Pressure Rise during Locally Induced Force by Ophthalmologic Surgery Applications.

PubMed

Koelbl, Philipp Simon; Werner, Jens Ulrich; Enders, Christian; Lingenfelder, Christian; Koch, Frank H J; Hessling, Martin

2018-05-31

Surgical or diagnostic procedures are often accompanied by a short-term increase in intraocular pressure (IOP). A short-term increase in IOP can occur during refractive procedures, vitreoretinal surgery, transillumination, photocoagulation, or cryocoagulation. A porcine eye model was chosen (n = 89) to compile comparable study data and to de termine correlations between the force induced and the resulting intraocular pressure while excluding the effect of surgeons. The IOP was measured in the anterior chamber. IOP changes were induced by applying an external force and measured when using a cannula, trocar, and cryocoagulation (n = 32), and correlations between force and resulting IOP were assessed (n = 57). A correlation was noted between the force induced and the IOP increase, which showed a linear dependency. The insertion of a 29-G cannula caused a mean ΔIOP value of 49.1 ± 2.9 mm Hg and an external force of 0.76 N, and that of a 23-G trocar 344.4 ± 5.9 mm Hg and 6.09 N, respectively. The rise in IOP during a simulated cryocoagulation reached values between 57.3 ± 14.8 mm Hg (cryoprobe tip diameter: 0.9 mm) and 130.3 ± 2.9 mm Hg (cryoprobe tip diameter: 7.0 mm). The values of the forces applied can be converted into the resulting IOP based on the specific action. Surgical or diagnostic procedures should, therefore, be evaluated with regard to preexisting pathologies, such as glaucoma. © 2018 S. Karger AG, Basel.

Site and extent of starch degradation in the dairy cow - a comparison between in vivo, in situ and in vitro measurements.

PubMed

Hindle, V A; Vuuren van, A M; Klop, A; Mathijssen-Kamman, A A; van Gelder, A H; Cone, J W

2005-01-01

Prediction of the supply of glycogenic precursors to dairy cows and the site of degradation of wheat, maize and potato starch (PS) were determined in an in vivo experiment and the results were compared with data obtained from experiments involving in situ nylon bag and in vitro gas production techniques. In a Latin square design experiment four lactating dairy cows fitted with a rumen cannula and T-piece cannulae in the duodenum and terminal ileum, received either a low-starch control diet or diets in which sugar beet pulp in the concentrate mixture had been replaced by wheat, maize or PS. Starch from the different sources was almost completely degraded in the total gastrointestinal tract. For all starches, the rumen was the main site of degradation in vivo. No digestion of PS in the small intestine was observed. In situ results suggested that 14% of wheat starch (WS), 47% of maize starch and 34% of PS escaped rumen fermentation. According to the gas production technique WS ferments quickest and potato slowest. PS had a low degradability during the first 8 (gas production) to 11 (in situ) h. However, according to both in vitro and in vivo measurements rumen degradability of PS was high. The results suggest that in situ and in vitro techniques should be performed in animals that have adapted to starch source to provide a more accurate simulation of the in vivo situation.

Does high-flow nasal cannula oxygen improve outcome in acute hypoxemic respiratory failure? A systematic review and meta-analysis.

PubMed

Lin, Si-Ming; Liu, Kai-Xiong; Lin, Zhi-Hong; Lin, Pei-Hong

2017-10-01

To evaluate the efficacy of high-flow nasal cannula (HFNC) in the rate of intubation and mortality for patients with acute hypoxemic respiratory failure. We searched Pubmed, EMBASE, and the Cochrane Library for relevant studies. Two reviewers extracted data and reviewed the quality of the studies independently. The primary outcome was the rate of intubation; secondary outcome was mortality in the hospital. Study-level data were pooled using a random-effects model when I2 was >50% or a fixed-effects model when I2 was <50%. Eight randomized controlled studies with a total of 1,818patients were considered. Pooled analysis showed that no statistically significant difference was found between groups regarding the rate of intubation (odds ratio [OR] = 0.79; 95% confidence interval [CI]: 0.60-1.04; P = 0.09; I2 = 36%) and no statistically significant difference was found between groups regarding hospital mortality (OR = 0.89; 95% CI: 0.62-127; P = 0.51; I2 = 47%). The use of HFNC showed a trend toward reduction in the intubation rate, which did not meet statistical significance, in patients with acute respiratory failure compared with conventional oxygen therapy (COT) and noninvasive ventilation (NIV). Moreover no difference in mortality. So, Large, well-designed, randomized, multi-center trials are needed to confirm the effects of HFNC in acute hypoxemic respiratory failure patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Initial experience with endoscopic side cutting aspiration system in pure neuroendoscopic excision of large intraventricular tumors.

PubMed

Mohanty, Aaron; Thompson, Bobbye Jo; Patterson, Joel

2013-11-01

Conventionally, neuroendoscopic excision of intraventricular tumors has been difficult and time consuming because of lack of an effective decompression system that can be used through the working channel of the endoscope. The authors report their initial experience in purely endoscopic excision of large intraventricular tumors with the minimally invasive NICO Myriad system. The NICO Myriad is a side cutting soft tissue aspiration system that uses an inner reciprocating cannula and an outer stationary sheath with a side port. During decompression, applied suction approximates the tumor into the lumen of the outer sheath, with the inner cannula excising the tissue by oscillation of the cutting edge. The tumor is then removed by aspiration through the inner sheath. Three patients with large intraventricular tumors were operated by a purely endoscopic approach using a GAAB rigid endoscope and the NICO Myriad system. Of these, two had intraventricular craniopharyngiomas and one had a lateral ventricular subependymoma. The tumor size varied between 1.9 and 4.5 cm in the largest diameter. A relatively firm and solid tumor was encountered in two and a multicystic tumor with thick adherent walls in one. The tumor could be subtotally removed in one and near totally in two. There were no long-term complications. The NICO Myriad is a highly effective tumor decompression system that can be effectively used in a purely endoscopic approach to intraventricular lesions. Copyright © 2013 Elsevier Inc. All rights reserved.

Effect of Normobaric versus Hypobaric Oxygenation on Gaseous Microemboli Removal in a Diffusion Membrane Oxygenator: An In Vitro Comparison

PubMed Central

Schuldes, Matthew; Riley, Jeffrey B.; Francis, Stephen G.; Clingan, Sean

2016-01-01

Abstract: Gaseous microemboli (GME) are an abnormal physiological occurrence during cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO). Several studies have correlated negative sequelae with exposure to increased amounts of GME. Hypobaric oxygenation is effective at eliminating GME in hollow-fiber microporous membrane oxygenators. However, hollow-fiber diffusion membrane oxygenators, which are commonly used for ECMO, have yet to be validated. The purpose of this study was to determine if hypobaric oxygenation, compared against normobaric oxygenation, can reduce introduced GME when used on diffusion membrane oxygenators. Comparison of a sealed Quadrox-iD with hypobaric sweep gas (.67 atm) vs. an unmodified Quadrox-iD with normal atmospheric sweep gas (1 atm) in terms of GME transmission during continuous air introduction (50 mL/min) in a recirculating in vitro circuit, over a range of flow rates (3.5, 5 L/min) and crystalloid prime temperatures (37°C, 28°C, and 18°C). GME were measured using three EDAC Doppler probes positioned pre-oxygenator, post-oxygenator, and at the arterial cannula. Hypobaric oxygenation vs. normobaric oxygenation significantly reduced hollow-fiber diffusion membrane oxygenator GME transmission at all combination of pump flows and temperatures. There was further significant reduction in GME count between the oxygenator outlet and at the arterial cannula. Hypobaric oxygenation used on hollow-fiber diffusion membrane oxygenators can further reduce GME compared to normobaric oxygenation. This technique may be a safe approach to eliminate GME during ECMO. PMID:27729706

μ-Opioid modulation in the rostral solitary nucleus and reticular formation alters taste reactivity: evidence for a suppressive effect on consummatory behavior.

PubMed

Kinzeler, Nicole R; Travers, Susan P

2011-09-01

The neural control of feeding involves many neuromodulators, including the endogenous opioids that bind μ-opioid receptors (MORs). Injections of the MOR agonist, Damgo, into limbic and hypothalamic forebrain sites increase intake, particularly of palatable foods. Indeed, forebrain Damgo injections increase sucrose-elicited licking but reduce aversive responding (gaping) to quinine, suggesting that MOR activation may enhance taste palatability. A μ-opioid influence on taste reactivity has not been assessed in the brain stem. However, MORs are present in the first-order taste relay, the rostral nucleus of the solitary tract (rNST), and in the immediately subjacent reticular formation (RF), a region known to be essential for consummatory responses. Thus, to evaluate the consequences of rNST/dorsal RF Damgo in this region, we implanted rats with intraoral cannulas, electromyographic electrodes, and brain cannulas aimed at the ventral border of the rNST. Licking and gaping elicited with sucrose, water, and quinine were assessed before and after intramedullary Damgo and saline infusions. Damgo slowed the rate, increased the amplitude, and decreased the size of fluid-induced lick and gape bouts. In addition, the neutral stimulus water, which typically elicits licks, began to evoke gapes. Thus, the current results demonstrate that μ-opioid activation in the rNST/dorsal RF exerts complex effects on oromotor responding that contrast with forebrain effects and are more indicative of a suppressive, rather than a facilitatory effect on ingestion.

Umbilical cannulation optimizes circuit flows in premature lambs supported by the EXTra-uterine Environment for Neonatal Development (EXTEND).

PubMed

Hornick, Matthew A; Davey, Marcus G; Partridge, Emily A; Mejaddam, Ali Y; McGovern, Patrick E; Olive, Aliza M; Hwang, Grace; Kim, Jenny; Castillo, Orlando; Young, Kathleen; Han, Jiancheng; Zhao, Sheng; Connelly, James T; Dysart, Kevin C; Rychik, Jack; Peranteau, William H; Flake, Alan W

2018-05-01

Bronchopulmonary dysplasia is a disease of extreme prematurity that occurs when the immature lung is exposed to gas ventilation. We designed a novel 'artificial womb' system for supporting extreme premature lambs (called EXTEND) that obviates gas ventilation by providing oxygen via a pumpless arteriovenous circuit with the lamb submerged in sterile artificial amniotic fluid. In the present study, we compare different arteriovenous cannulation strategies on EXTEND, including carotid artery/jugular vein (CA/JV), carotid artery/umbilical vein (CA/UV) and umbilical artery/umbilical vein (UA/UV). Compared to CA/JV and CA/UV cannulation, UA/UV cannulation provided significantly higher, physiological blood flows to the oxygenator, minimized flow interruptions and supported significantly longer circuit runs (up to 4 weeks). Physiological circuit blood flow in UA/UV lambs made possible normal levels of oxygen delivery, which is a critical step toward the clinical application of artificial womb technology. EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system that promotes physiological development by maintaining the premature lamb in a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit. During the development of EXTEND, different cannulation strategies evolved with the aim of improving circuit flow. The present study examines how different cannulation strategies affect EXTEND circuit haemodynamics in extreme premature lambs. Seventeen premature lambs were cannulated at gestational ages 105-117 days (term 145-150 days) and supported on EXTEND for up to 4 weeks. Experimental groups were distinguished by cannulation strategy: carotid artery outflow and jugular vein inflow (CA/JV; n = 4), carotid artery outflow and umbilical vein inflow (CA/UV; n = 5) and double umbilical artery outflow and umbilical vein inflow (UA/UV; n = 8). Circuit flows and pressures were measured continuously. As we transitioned from CA/JV to CA/UV to UA/UV cannulation, mean duration of circuit run and weight-adjusted circuit flows increased (P < 0.001) and the frequency of flow interruptions declined (P < 0.05). Umbilical vessels generally accommodated larger-bore cannulas, and cannula calibre was directly correlated with circuit pressures and indirectly correlated with flow:pressure ratio (a measure of post-membrane resistance). We conclude that UA/UV cannulation in fetal lambs on EXTEND optimizes circuit flow dynamics and flow stability and also supports circuit flows that closely approximate normal placental flow. © 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.

Diet-Dependent Modular Dynamic Interactions of the Equine Cecal Microbiota

PubMed Central

Kristoffersen, Camilla; Jensen, Rasmus B.; Avershina, Ekaterina; Austbø, Dag; Tauson, Anne-Helene; Rudi, Knut

2016-01-01

Knowledge on dynamic interactions in microbiota is pivotal for understanding the role of bacteria in the gut. We herein present comprehensive dynamic models of the horse cecal microbiota, which include short-chained fatty acids, carbohydrate metabolic networks, and taxonomy. Dynamic models were derived from time-series data in a crossover experiment in which four cecum-cannulated horses were fed a starch-rich diet of hay supplemented with barley (starch intake 2 g kg−1 body weight per day) and a fiber-rich diet of only hay. Cecal contents were sampled via the cannula each h for 24 h for both diets. We observed marked differences in the microbial dynamic interaction patterns for Fibrobacter succinogenes, Lachnospiraceae, Streptococcus, Treponema, Anaerostipes, and Anaerovibrio between the two diet groups. Fluctuations and microbiota interactions were the most pronounced for the starch rich diet, with Streptococcus spp. and Anaerovibrio spp. showing the largest fluctuations. Shotgun metagenome sequencing revealed that diet differences may be explained by modular switches in metabolic cross-feeding between microbial consortia in which fermentation is linked to sugar alcohols and amino sugars for the starch-rich diet and monosaccharides for the fiber-rich diet. In conclusion, diet may not only affect the composition of the cecal microbiota, but also dynamic interactions and metabolic cross-feeding. PMID:27773914

Diet-Dependent Modular Dynamic Interactions of the Equine Cecal Microbiota.

PubMed

Kristoffersen, Camilla; Jensen, Rasmus B; Avershina, Ekaterina; Austbø, Dag; Tauson, Anne-Helene; Rudi, Knut

2016-12-23

Knowledge on dynamic interactions in microbiota is pivotal for understanding the role of bacteria in the gut. We herein present comprehensive dynamic models of the horse cecal microbiota, which include short-chained fatty acids, carbohydrate metabolic networks, and taxonomy. Dynamic models were derived from time-series data in a crossover experiment in which four cecum-cannulated horses were fed a starch-rich diet of hay supplemented with barley (starch intake 2 g kg -1 body weight per day) and a fiber-rich diet of only hay. Cecal contents were sampled via the cannula each h for 24 h for both diets. We observed marked differences in the microbial dynamic interaction patterns for Fibrobacter succinogenes, Lachnospiraceae, Streptococcus, Treponema, Anaerostipes, and Anaerovibrio between the two diet groups. Fluctuations and microbiota interactions were the most pronounced for the starch rich diet, with Streptococcus spp. and Anaerovibrio spp. showing the largest fluctuations. Shotgun metagenome sequencing revealed that diet differences may be explained by modular switches in metabolic cross-feeding between microbial consortia in which fermentation is linked to sugar alcohols and amino sugars for the starch-rich diet and monosaccharides for the fiber-rich diet. In conclusion, diet may not only affect the composition of the cecal microbiota, but also dynamic interactions and metabolic cross-feeding.

Photodynamic therapy to destroy pneumonia associated microorganisms using external irradiation source

NASA Astrophysics Data System (ADS)

Bassi, Rosane; Myakawa, Walter; Navarro, Ricardo S.; Baptista, Alessandra; Ribeiro, Martha Simões; Nunez, Silvia Cristina

2018-02-01

An endotracheal tube (ETT) is required for the management of critically ill, mechanically ventilated patients. Ventilatorassociated pneumonia (VAP) affects patients hospitalized in intensive care units; its risk of occurrence is 1% to up 3% for each day of mechanical ventilation. The polymicrobial nature of VAP is established with mixed bacterial-fungal biofilms colonizing the ETT. The microbial interaction enhances the microbial pathogenesis contributing to high indexes of morbidity/mortality. Antimicrobial Photodynamic Therapy (aPDT) could be a suitable therapy for decontamination of oral cavity and ETT at the same time, but the use of a fiber optics inside the ETT seems to not be appropriated since a cannula for secretion aspiration has to be introduced into the ETT to keep it's lumen. The aim of this study is to proof the concept that an external light source from a LED is capable of reach all areas of the ETT. We use a commercial ETT, 60μM methylene blue (MB), and a 660nm diode laser and calculated the transmission coefficient of light in different situations as only tube, tube with biofilm and biofilm+MB. The results prove that is possible to transmit light through the tube even in the presence of MB and biofilm although a high attenuation of about 60% was measured depending on the tested condition.

AAV viral vector delivery to the brain by shape-conforming MR-guided infusions.

PubMed

Bankiewicz, Krystof S; Sudhakar, Vivek; Samaranch, Lluis; San Sebastian, Waldy; Bringas, John; Forsayeth, John

2016-10-28

Gene transfer technology offers great promise as a potential therapeutic approach to the brain but has to be viewed as a very complex technology. Success of ongoing clinical gene therapy trials depends on many factors such as selection of the correct genetic and anatomical target in the brain. In addition, selection of the viral vector capable of transfer of therapeutic gene into target cells, along with long-term expression that avoids immunotoxicity has to be established. As with any drug development strategy, delivery of gene therapy has to be consistent and predictable in each study subject. Failed drug and vector delivery will lead to failed clinical trials. In this article, we describe our experience with AAV viral vector delivery system, that allows us to optimize and monitor in real time viral vector administration into affected regions of the brain. In addition to discussing MRI-guided technology for administration of AAV vectors we have developed and now employ in current clinical trials, we also describe ways in which infusion cannula design and stereotactic trajectory may be used to maximize the anatomical coverage by using fluid backflow. This innovative approach enables more precise coverage by fitting the shape of the infusion to the shape of the anatomical target. Copyright © 2016 Elsevier B.V. All rights reserved.

Infralimbic cortex Rho-kinase inhibition causes antidepressant-like activity in rats.

PubMed

Inan, Salim Yalcin; Soner, Burak Cem; Sahin, Ayse Saide

2015-03-03

Depression is one of the most common psychiatric disorders in the world; however, its mechanisms remain unclear. Recently, a new signal-transduction pathway, namely Rho/Rho-kinase signalling, has been suggested to be involved in diverse cellular events in the central nervous system; such as epilepsy, anxiety-related behaviors, regulation of dendritic and axonal morphology, antinociception, subarachnoid haemorrhage, spinal cord injury and amyotrophic lateral sclerosis. However there is no evidence showing the involvement of Rho-kinase pathway in depression. In addition, the infralimbic cortex, rodent equivalent to subgenual cingulate cortex has been shown to be responsible for emotional responses. Thus, in the present study, intracranial guide cannulae were stereotaxically implanted bilaterally into the infralimbic cortex, and the effects of repeated microinjections of a Rho-kinase (ROCK) inhibitor Y-27632 (10 nmol) were investigated in rats. Y-27632 significantly decreased immobility time and increased swimming and climbing behaviors when compared to fluoxetine (10 μg) and saline groups in the forced swim test. In addition, Y-27632 treatment did not affect spontaneous locomotor activity and forelimb use in the open-field and cylinder tests respectively; but it enhanced limb placing accuracy in the ladder rung walking test. Our results suggest that Y-27632 could be a potentially active antidepressant agent. Copyright © 2014 Elsevier Inc. All rights reserved.

Lateral Parabrachial Nucleus Serotonergic Mechanisms and Salt Appetite Induced by Sodium Depletion

NASA Technical Reports Server (NTRS)

Menani, Jose Vanderlei; DeLuca, Laurival Antonio, Jr.; Johnson, Alan Kim

1998-01-01

This study investigated the effects of bilateral injections of a serotonin (5-HT) receptor agonist into the lateral parabrachial nucleus on the intake of NaCl and water induced by 24-h water deprivation or by sodium depletion followed by 24 h of sodium deprivation (injection of the diuretic furosemide plus 24 h of d sodium-deficient diet). Rats had stainless steel cannulas implanted bilaterally into the LPBN. Bilateral LPBN injections of the serotonergic 5-HT(1/2) receptor antagonist methysergide (4 micro-g/200 nl at each site) increased hypertonic NaCl intake when tested 24 h after sodium depletion and after 24 h of water deprivation. Water intake also increased after bilateral injections of methysergide into the LPBN. In contrast, the intake of a palatable solution (0.06 M sucrose) under body fluid-replete conditions was not changed after bilateral LPBN methysergide injections. The results show that serotonergic mechanisms in the LPBN modulate water and sodium intake induced by volume depletion and sodium loss. The finding that sucrose intake was not affected by LPBN serotonergic blockade suggests that the effects of the methysergide treatment on the intakes of water and NaCl are not due to a mechanism producing a nonspecific enhancement of all ingestive behaviors.

Neurotensin modulates the composition of pancreatic exocrine secretions in chickens.

PubMed

DeGolier, T F; Place, A R; Duke, G E; Carraway, R E

The effects of neurotensin on pancreatic exocrine secretion were examined in fasted, conscious White Leghorn hens. A cannula was surgically implanted in the central duct serving the ventral lobe of the pancreas in order to collect pure pancreatic juice. Following recovery, neurotensin was infused intravenously at 3.6 or 10.8 pmol/kg*min. The volume and pH of the pancreatic secretions were recorded and total pancreatic protein concentration, amylase, lipase, trypsin, and chymotrypsin activity were measured every 30 min for 2 hr and compared to secretions following the infusion of 0.9% saline. Our results demonstrated that neurotensin did not affect the pH nor the pancreatic juice protein concentration, but did increase secretion rate following neurotensin infusion at 3.6 pmol/kg*min. Amylase activity was significantly depressed during neurotensin infusions, while lipase (both pancreatic and carboxylester lipase) activity was significantly elevated. The ratio of amylase to lipase activity was especially depressed by neurotensin infusion at 10.8 pmol/kg*min. Insufficient secretory activity prevented a balanced statistical analysis of chymotrypsin activity, but from a pooled analysis, neurotensin had no effect on protease activity in the pancreatic juice. These results support our current research indicating that neurotensin may be a hormonal regulator of postprandial lipid digestion in chickens.

Supraspinal inhibitory effects of chimeric peptide MCRT on gastrointestinal motility in mice.

PubMed

He, Chunbo; Li, Hailan; Zhang, Jing; Kang, Yanping; Jia, Fang; Dong, Shouliang; Zhou, Lanxia

2017-09-01

Chimeric peptide MCRT, based on morphiceptin and PFRTic-NH 2 , was a bifunctional ligand of μ- and δ-opioid receptors (MOR-DOR) and produced potent analgesia in tail-withdrawal test. The study focused on the supraspinal effects of morphiceptin, PFRTic-NH 2 and MCRT on gastrointestinal motility. Moreover, opioid receptor antagonists, naloxone (non-selective), cyprodime (MOR selective) and naltrindole (DOR selective) were utilized to explore the mechanisms. Intracerebroventricular administration was achieved via the implanted cannula. Gastric emptying and intestinal transit were measured to evaluate gastrointestinal motility. (1) At supraspinal level, morphiceptin, PFRTic-NH 2 and MCRT significantly decreased gastric emptying and intestinal transit; (2) MCRT at 1 nmol/mouse, far higher than its analgesic dose (ED 50  = 29.8 pmol/mouse), failed to regulate the gastrointestinal motility; (3) MCRT-induced gastrointestinal dysfunction could be completely blocked by naloxone and naltrindole, but not affected by cyprodime. (1) Morphiceptin and PFRTic-NH 2 played important roles in the regulation of gastrointestinal motility; (2) MCRT possessed higher bioactivity of pain relief than gastrointestinal regulation, suggesting its promising analgesic property; (3) MCRT-induced motility disorders were sensitive to DOR but not to MOR blockade, indicating the pain-relieving specificity of speculated MOR subtype or splice variant or MOR-DOR heterodimer. © 2017 Royal Pharmaceutical Society.

Insulin Infusion Sets: A Critical Reappraisal.

PubMed

Heinemann, Lutz

2016-05-01

An insulin infusion set (IIS) is a key component of insulin pumps. In daily practice issues with the IIS appear to be as relevant for a successful insulin therapy as the pumps themselves. The insulin is applied to the subcutaneous tissue via a Teflon(®) (Dupont, Wilmington, DE) or steel cannula. There are intensive discussions about the impact the choice of material for insulin application has on insulin pharmacokinetics. In this review, this factor and others that are known to have an impact on the successful usage of IIS are discussed.

The Isolated Perfused Rat Liver and its use in the Study of Chemical Kinetics: Quality and Performance Parameters

DTIC Science & Technology

1999-04-01

atrium , the inferior vena cava was closed with a silk ligature and the liver was carefully excised. 2.4 Liver...withdraw needle. 5.5.10 Secure tip of cannula with ligature and connect medium at lowest flow rate (5 mL/min). 5.5.11 Cut inferior vena cava below the...heart. 5.5.14 Cannulate the superior vena cava via an incision in the right atrium , secure with ligature. 5.5.15 Close ligature around inferior vena cava

Activation of the cannabinoid system in the nucleus accumbens affects effort-based decision making.

PubMed

Fatahi, Zahra; Haghparast, Abbas

2018-02-01

Effort-based decision making addresses how we make an action choice based on an integration of action and goal values. The nucleus accumbens (NAc) is implicated in allowing an animal to overcome effort constraints to obtain greater benefits, and it has been previously shown that cannabis derivatives may affect such processes. Therefore, in this study, we intend to evaluate the involvement of the cannabinoid system in the entire NAc on effort-based decision making. Rats were trained in a T-maze cost-benefit decision making the task in which they could choose either to climb a barrier to obtain a large reward in one arm or run into the other arm without a barrier to obtaining a small reward. Following training, the animals were bilaterally implanted with guide cannulae in the NAc. On test day, rats received cannabinoid agonist (Win 55,212-2; 2, 10 and 50μM) and/or antagonist (AM251; 45μM), afterward percentage of large reward choice and latency of reward attainment were investigated. Results revealed that the administration of cannabinoid agonist led to decrease of large reward choice percentage such that the animals preferred to receive a small reward with low effort instead of receiving a large reward with high effort. The administration of antagonist solely did not affect effort-based decision making, but did attenuate the Win 55,212-2-induced impairments in effort allocation. In agonist-treated animals, the latency of reward collection increased. Moreover, when the effort was equated on both arms, the animals returned to choosing large reward showing that obtained results were not caused by spatial memory impairment. Our finding suggested that activation of the cannabinoid system in the NAc impaired effort-based decision making and led to rats were less willing to invest the physical effort to gain large reward. Copyright © 2017 Elsevier Inc. All rights reserved.

Predicted Hemodynamic Benefits Of Counterpulsation Therapy Using A Superficial Surgical Approach

PubMed Central

Giridharan, Guruprasad A.; Pantalos, George M.; Litwak, Kenneth N.; Spence, Paul A.; Koenig, Steven C.

2010-01-01

A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0–50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure–volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients. PMID:16436889

Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome.

PubMed

Akkanti, Bindu; Rajagopal, Keshava; Patel, Kirti P; Aravind, Sangeeta; Nunez-Centanu, Emmanuel; Hussain, Rahat; Shabari, Farshad Raissi; Hofstetter, Wayne L; Vaporciyan, Ara A; Banjac, Igor S; Kar, Biswajit; Gregoric, Igor D; Loyalka, Pranav

2017-06-01

Extracorporeal carbon dioxide removal (ECCO 2 R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO 2 R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO 2 R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.

Microinfusion of nefazodone into the basolateral nucleus of the amygdala enhances defensive behavior induced by NMDA stimulation of the inferior colliculus.

PubMed

Maisonnette, S; Villela, C; Carotti, A P; Landeira-Fernandez, J

2000-01-01

The inferior colliculus is notably associated with defensive behavior. Electrical or pharmacological stimulation of the inferior colliculus induces aversive reactions such as running and jumping. Lesion of the basolateral nucleus of the amygdala decreases the threshold of aversive reactions induced by electrical stimulation of the inferior colliculus. The present work examined the influence of microinjections of nefazodone, a serotonin (5-HT(2)) antagonist, into the basolateral nucleus of amygdala on aversive reactions induced by N-methyl-D-aspartate (NMDA) microinjected into the inferior colliculus. Rats implanted with cannulae in the inferior colliculus and in the basolateral nucleus of the amygdala were submitted to the open-field test where defensive behaviors were observed. Results indicated that microinjection of nefazodone into the basolateral nucleus of the amygdala increases aversive responses induced by NMDA injections into the inferior colliculus. This result suggests that the inferior colliculus and the basolateral nucleus of the amygdala have a functional relationship on the neural circuitry of defensive behavior. Moreover, 5-HT(2) receptors located at the basolateral nucleus of the amygdala seem to play an inhibitory role on defensive behaviors induced by inferior colliculus stimulation.

Single Center Experience with the AngioVac Aspiration System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Salsamendi, Jason, E-mail: jsalsamendi@med.miami.edu; Doshi, Mehul, E-mail: mdoshi@med.miami.edu; Bhatia, Shivank, E-mail: sbhatia1@med.miami.edu

2015-08-15

PurposeThe AngioVac catheter system is a mechanical suction device designed for removal of intravascular material using extracorporeal veno-venous bypass circuit. The purpose of this study is to present the outcomes in patients treated with the AngioVac aspiration system and to discuss its efficacy in different vascular beds.Materials and MethodsA retrospectively review was performed of seven patients treated with AngioVac between October 2013 and December 2014. In 6/7 cases, the AngioVac cannula was inserted percutaneously and the patient was placed on veno-venous bypass. In one of the cases, the cannula was inserted directly into the Fontan circuit after sternotomy and themore » patient was maintained on cardiopulmonary bypass. Thrombus location included iliocaval (2), SVC (1), pulmonary arteries (1), Fontan circuit and Glenn shunt with pulmonary artery extension (1), right atrium (1), and IVC with renal vein extension (1).ResultsThe majority of thrombus (50–95 %) was removed in 5/7 cases, and partial thrombus removal (<50 %) was confirmed in 2/7 cases. Mean follow-up was 205 days (range 64–403 days). All patients were alive at latest follow-up. Minor complications included three neck hematomas in two total patients. No major complications occurred.ConclusionAngioVac is a useful tool for acute thrombus removal in the large vessels. The setup and substantial cost may limit its application in straightforward cases. More studies are needed to establish the utility of AngioVac in treatment of intravascular and intracardiac material.« less

Noninvasive Assessment of Left Ventricular Assist Devices with Cardiovascular Computed Tomography and Impact on Management

PubMed Central

Raman, Subha V.; Sahu, Anurag; Merchant, Ali Z.; Louis, Louis B.; Firstenberg, Michael S.; Sun, Benjamin

2009-01-01

Background Left ventricular assist devices (LVADs) provide a bridge to recovery or heart transplantation, but require serial assessment. Echocardiographic approaches may be limited by device artifact and acoustic window. Cardiovascular computed tomography (CCT) provides noninvasive imaging of LVADs, yet no study has evaluated CCT’s impact on clinical care. We evaluated the diagnostic findings and clinical impact of CCT for noninvasive assessment of patients with LVADs. Methods CCT examinations performed between 2005 and 2008 in patients with LVADs were identified. Acquisitions were completed on the identical 64 detector-row scanner with intravenous contrast administration; electrocardiographic gating was used in patients with pulsatile devices, while peripheral pulse gating was used in patients with continuous-flow devices. Comparison was made between CCT results and 30-day outcomes, including echocardiographic and intraoperative findings. Results Thirty-two CCT examinations from 28 patients were reviewed. Indications included evaluation of low cardiac output symptoms, assessment of cannula position, low flow reading on the LVAD, and surgical planning. CCT identified critical findings in 6 patients including thrombosis and inlet cannula malposition, all confirmed intraoperatively; one case of intra-LVAD thrombus was missed by CCT. Using intraoperative findings as the gold standard, CCT’s sensitivity was 85% and specificity was 100%. Echocardiographic LVAD evaluation did not correlate with findings on CCT (kappa = −0.29, 95% CI −0.73−0.13). Conclusions This preliminary observational cohort study indicates that noninvasive imaging using CCT of LVADs is feasible and accurate. CCT warrants consideration in the initial evaluation of symptomatic patients with LVADs. PMID:19782594

Comparisons and Limitations of Current Definitions of Bronchopulmonary Dysplasia for the Prematurity and Respiratory Outcomes Program.

PubMed

Poindexter, Brenda B; Feng, Rui; Schmidt, Barbara; Aschner, Judy L; Ballard, Roberta A; Hamvas, Aaron; Reynolds, Anne Marie; Shaw, Pamela A; Jobe, Alan H

2015-12-01

Bronchopulmonary dysplasia is the most common morbidity of prematurity, but the validity and utility of commonly used definitions have been questioned. To compare three commonly used definitions of bronchopulmonary dysplasia in a contemporary prospective, multicenter observational cohort of extremely preterm infants. At 36 weeks postmenstrual age, the following definitions of bronchopulmonary dysplasia were applied to surviving infants with and without imputation: need for supplemental oxygen (Shennan definition), National Institutes of Health Workshop definition, and "physiologic" definition after a room-air challenge. Of 765 survivors assessed at 36 weeks, bronchopulmonary dysplasia was diagnosed in 40.8, 58.6, and 32.0% of infants, respectively, with the Shennan, workshop and physiologic definitions. The number of unclassified infants was lowest with the workshop definition (2.1%) and highest with the physiologic definition (16.1%). After assigning infants discharged home in room air before 36 weeks as no bronchopulmonary dysplasia, the modified Shennan definition compared favorably to the workshop definition, with 2.9% unclassified infants. Newer management strategies with nasal cannula flows up to 4 L/min or more and 0.21 FiO2 at 36 weeks obscured classification of bronchopulmonary dysplasia status in 12.4% of infants. Existing definitions of bronchopulmonary dysplasia differ with respect to ease of data collection and number of unclassifiable cases. Contemporary changes in management of infants, such as use of high-flow nasal cannula, limit application of existing definitions and may result in misclassification. A contemporary definition of bronchopulmonary dysplasia that correlates with respiratory morbidity in childhood is needed. Clinical trial registered with www.clinicaltrials.gov (NCT01435187).

Ruminal motility of stocker cattle grazed on winter wheat pasture.

PubMed

Horn, G W; Frost, D F

1982-10-01

A 2-yr study was conducted to determine whether bloat of stocker cattle grazing winter wheat pasture is a primary bloat or a secondary bloat as a result of reduced ruminal motility. Amplitude (mm Hg) and frequency of ruminal contractions (contractions/min) of steers were measured before and after the steers were placed on wheat pasture, and at about weekly intervals during the pasture grazing periods. Implantable pressure transducers and water-filled balloon cannulas were used to measure ruminal motility. During the first year, amplitude of contractions increased (P less than .005) during grazing of wheat pasture (i.e., 20.5 vs 6.7 and 21.6 vs 12.9, respectively, for steers with implanted pressure transducers and water-filled balloon cannulas). Frequency of ruminal contractions of steers on wheat pasture was not decreased (P greater than .05). In the second year, amplitudes of ruminal contractions of steers on wheat pasture ranged from 11.0 to 33.5, and were either similar or greater (P less than .05) than the mean for the pre- and post-wheat pasture period (16.5). Frequencies of ruminal contractions that ranged from 1.66 to 1.80 were observed on four dates during the pasture grazing period, and were decreased (P less than .05) as compared with the mean for the pre- and post-wheat pasture period (2.43). However, the reduced frequencies were not accompanied by reduced (P greater than .05) amplitude x frequency of contractions. The data indicate that ruminal motility is not decreased in stocker cattle grazing winter wheat pasture.

Elevated intracranial pressure causes optic nerve and retinal ganglion cell degeneration in mice.

PubMed

Nusbaum, Derek M; Wu, Samuel M; Frankfort, Benjamin J

2015-07-01

The purpose of this study was to develop a novel experimental system for the modulation and measurement of intracranial pressure (ICP), and to use this system to assess the impact of elevated ICP on the optic nerve and retinal ganglion cells (RGCs) in CD1 mice. This system involved surgical implantation of an infusion cannula and a radiowave based pressure monitoring probe through the skull and into the subarachnoid space. The infusion cannula was used to increase ICP, which was measured by the probe and transmitted to a nearby receiver. The system provided robust and consistent ICP waveforms, was well tolerated, and was stable over time. ICP was elevated to approximately 30 mmHg for one week, after which we assessed changes in optic nerve structure with transmission electron microscopy in cross section and RGC numbers with antibody staining in retinal flat mounts. ICP elevation resulted in optic nerve axonal loss and disorganization, as well as RGC soma loss. We conclude that the controlled manipulation of ICP in active, awake mice is possible, despite their small size. Furthermore, ICP elevation results in visual system phenotypes of optic nerve and RGC degeneration, suggesting that this model can be used to study the impact of ICP on the visual system. Potentially, this model can also be used to study the relationship between ICP and IOP, as well diseases impacted by ICP variation such as glaucoma, idiopathic intracranial hypertension, and the spaceflight-related visual impairment intracranial pressure syndrome. Copyright © 2015 Elsevier Ltd. All rights reserved.

Feasibility of an endotracheal tube-mounted camera for percutaneous dilatational tracheostomy.

PubMed

Grensemann, J; Eichler, L; Hopf, S; Jarczak, D; Simon, M; Kluge, S

2017-07-01

Percutaneous dilatational tracheostomy (PDT) in critically ill patients is often led by optical guidance with a bronchoscope. This is not without its disadvantages. Therefore, we aimed to study the feasibility of a recently introduced endotracheal tube-mounted camera (VivaSight™-SL, ET View, Misgav, Israel) in the guidance of PDT. We studied 10 critically ill patients who received PDT with a VivaSight-SL tube that was inserted prior to tracheostomy for optical guidance. Visualization of the tracheal structures (i.e., identification and monitoring of the thyroid, cricoid, and tracheal cartilage and the posterior wall) and the quality of ventilation (before puncture and during the tracheostomy) were rated on four-point Likert scales. Respiratory variables were recorded, and blood gases were sampled before the interventions, before the puncture and before the insertion of the tracheal cannula. Visualization of the tracheal landmarks was rated as 'very good' or 'good' in all but one case. Monitoring during the puncture and dilatation was also rated as 'very good' or 'good' in all but one. In the cases that were rated 'difficult', the visualization and monitoring of the posterior wall of the trachea were the main concerns. No changes in the respiratory variables or blood gases occurred between the puncture and the insertion of the tracheal cannula. Percutaneous dilatational tracheostomy with optical guidance from a tube-mounted camera is feasible. Further studies comparing the camera tube with bronchoscopy as the standard approach should be performed. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Effects of Chromium Picolinate on Food Intake and Satiety

PubMed Central

Morrison, Christopher D.; Cefalu, William T.; Martin, Corby K.; Coulon, Sandra; Geiselman, Paula; Han, Hongmei; White, Christy L.; Williamson, Donald A.

2008-01-01

Abstract Background Chromium picolinate (CrPic) has been shown to attenuate weight gain, but the mechanism underlying this effect is unknown. Methods We assessed the effect of CrPic in modulating food intake in healthy, overweight, adult women who reported craving carbohydrates (Study 1) and performed confirmatory studies in Sprague-Dawley rats (Study 2). Study 1 utilized a double-blind placebo-controlled design and randomly assigned 42 overweight adult women with carbohydrate cravings to receive 1,000 μg of chromium as CrPic or placebo for 8 weeks. Food intake at breakfast, lunch, and dinner was directly measured at baseline, week 1, and week 8. For Study 2, Sprague-Dawley rats were fasted for 24 h and subsequently injected intraperitoneally with 0, 1, 10, or 50 μg/kg CrPic. Subsequently, rats were implanted with an indwelling third ventricular cannula. Following recovery, 0, 0.4, 4, or 40 ng of CrPic was injected directly into the brain via the intracerebroventricular cannula, and spontaneous 24-h food intake was measured. Results Study 1 demonstrated that CrPic, as compared to placebo, reduced food intake (P < 0.0001), hunger levels (P < 0.05), and fat cravings (P < 0.0001) and tended to decrease body weight (P = 0.08). In study 2, intraperitoneal administration resulted in a subtle decrease in food intake at only the highest dose (P = 0.03). However, when administered centrally, CrPic dose-dependently decreased food intake (P < 0.05). Conclusions These data suggest CrPic has a role in food intake regulation, which may be mediated by a direct effect on the brain. PMID:18715218

Morphometric analysis of the working zone for endoscopic lumbar discectomy.

PubMed

Min, Jun-Hong; Kang, Shin-Hyuk; Lee, Jang-Bo; Cho, Tai-Hyoung; Suh, Jung-Keun; Rhyu, Im-Joo

2005-04-01

Our study's purpose was to analyze the working zone for the current practice of endoscopic discectomy at the lateral exit zone of the intervertebral foramen (IVF) and to define a safe point for clinical practice. One hundred eighty-six nerve roots of the lumbar IVFs of cadaveric spines were studied. Upon lateral inspection, we measured the distance from the nerve root to the most dorsolateral margin of the disc and to the lateral edge of the superior articular process of the vertebra below at the plane of the superior endplate of the vertebra below. The angle between the root and the plane of the disc was also measured. The results showed that the mean distance from the nerve root to the most dorsolateral margin of the disc was 3.4 +/- 2.7 mm (range 0.0-10.8 mm), the mean distance from the nerve root to the lateral edge of the superior articular process of the vertebra below was 11.6 +/- 4.6 mm (range 4.1-24.3 mm), and the mean angle between the nerve root and the plane of the disc was 79.1 degrees +/- 7.6 degrees (range 56.0-90.0 degrees ). The values of the base of the working zone have a wide distribution. Blind puncture of annulus by the working cannula or obturator may be dangerous. The safer procedure would be the direct viewing of the annulus by endoscopy before annulotomy; the working cannula should be inserted into the foramen as close as possible to the facet joint.

Are high flow nasal cannulae noisier than bubble CPAP for preterm infants?

PubMed

Roberts, C T; Dawson, J A; Alquoka, E; Carew, P J; Donath, S M; Davis, P G; Manley, B J

2014-07-01

Noise exposure in the neonatal intensive care unit is believed to be a risk factor for hearing loss in preterm neonates. Continuous positive airway pressure (CPAP) devices exceed recommended noise levels. High flow nasal cannulae (HFNC) are an increasingly popular alternative to CPAP for treating preterm infants, but there are no in vivo studies assessing noise production by HFNC. To study whether HFNC are noisier than bubble CPAP (BCPAP) for preterm infants. An observational study of preterm infants receiving HFNC or BCPAP. Noise levels within the external auditory meatus (EAM) were measured using a microphone probe tube connected to a calibrated digital dosimeter. Noise was measured across a range of frequencies and reported as decibels A-weighted (dBA). A total of 21 HFNC and 13 BCPAP noise measurements were performed in 21 infants. HFNC gas flows were 2-5 L/min, and BCPAP gas flows were 6-10 L/min with set pressures of 5-7 cm of water. There was no evidence of a difference in average noise levels measured at the EAM: mean difference (95% CI) of -1.6 (-4.0 to 0.9) dBA for HFNC compared to BCPAP. At low frequency (500 Hz), HFNC was mean (95% CI) 3.0 (0.3 to 5.7) dBA quieter than BCPAP. Noise increased with increasing BCPAP gas flow (p=0.007), but not with increasing set pressure. There was a trend to noise increasing with increasing HFNC gas flows. At the gas flows studied, HFNC are not noisier than BCPAP for preterm infants.

Blindness following cosmetic injections of the face.

PubMed

Lazzeri, Davide; Agostini, Tommaso; Figus, Michele; Nardi, Marco; Pantaloni, Marcello; Lazzeri, Stefano

2012-04-01

Complications following facial cosmetic injections have recently heightened awareness of the possibility of iatrogenic blindness. The authors conducted a systematic review of the available literature to provide the best evidence for the prevention and treatment of this serious eye injury. The authors included in the study only the cases in which blindness was a direct consequence of a cosmetic injection procedure of the face. Twenty-nine articles describing 32 patients were identified. In 15 patients, blindness occurred after injections of adipose tissue; in the other 17, it followed injections of various materials, including corticosteroids, paraffin, silicone oil, bovine collagen, polymethylmethacrylate, hyaluronic acid, and calcium hydroxyapatite. Some precautions may minimize the risk of embolization of filler into the ophthalmic artery following facial cosmetic injections. Intravascular placement of the needle or cannula should be demonstrated by aspiration before injection and should be further prevented by application of local vasoconstrictor. Needles, syringes, and cannulas of small size should be preferred to larger ones and be replaced with blunt flexible needles and microcannulas when possible. Low-pressure injections with the release of the least amount of substance possible should be considered safer than bolus injections. The total volume of filler injected during the entire treatment session should be limited, and injections into pretraumatized tissues should be avoided. Actually, no safe, feasible, and reliable treatment exists for iatrogenic retinal embolism. Nonetheless, therapy should theoretically be directed to lowering intraocular pressure to dislodge the embolus into more peripheral vessels of the retinal circulation, increasing retinal perfusion and oxygen delivery to hypoxic tissues. Risk, V.

The optical "Veress-needle"--initial puncture with a minioptic.

PubMed

Schaller, G; Kuenkel, M; Manegold, B C

1995-02-01

Laparoscopic access is a necessary part of minimally invasive surgery. The double blind puncture with Veress-needle and trocar can cause lethal complications such as bowel injury, bleeding and gas-embolisation. Some authors have reported alternative techniques for laparoscopic abdominal access. Because no blind procedure can absolutely prevent injury, permanent visual control of perforated tissue layers as in open surgery should be achieved to prevent possible injury at an early stage. Previously described procedures could not fulfil all requirements to comply with this ideal, i.e. permanent visual control of abdominal wall penetration prior to establishment of pneumoperitoneum and trocar insertion without further possible damage. We designed a 2 mm fibreglass optic 250 mm in length that is inserted into a suitable cannula. Special construction allows rinsing through the cannula to clear the vision and to open spaces in the puncture track by water dissection. After incision of the skin, all layers of the abdominal wall can be visualised, including blood vessels and internal surfaces. Once the abdominal cavity is reached, the needle tip is retracted and a two-step dilation allows the trocar to be introduced via the puncture track. Only then does insufflation begin. The fibreglass optic-equipped safety needle was used for visually controlled access in 184 laparoscopic surgical procedures. After a period of training, all layers of the abdominal wall could be recognised exactly. In two patients with dense adhesions, perforation of the small bowel was diagnosed immediately by endoscopic viewing. The small injury needed no treatment, and the intended procedure was completed laparoscopically.(ABSTRACT TRUNCATED AT 250 WORDS)

Vascular extravasation of contrast medium in radiological examinations: University of California San Diego Health System Experience.

PubMed

Niv, Galia; Costa, Matthew; Kicak, Patricia; Richman, Katherine

2014-06-01

Extravasation is a well-recognized complication estimated to be between 0.1% and 0.9% of contrast medium administrations. According to the UC San Diego (UCSD) health system policy, all contrast medium extravasation (CME) reports are reviewed by the department of Risk Management, and the appropriate action is taken. Despite this strategy, a decrease in the incidence of CME could not be demonstrated. The aims of this study were to determine the frequency, management, and outcome of CME in UC San Diego patients and to assess the knowledge regarding CME among radiology technologists based on policy and guidelines. The secondary aim was to assess the manual ability of the radiology technologists in the performance of the procedure. The study has 2 parts; the first was retrospective, including data collection and interpretation of all radiology procedures using intravenous contrast medium injection between January 1, 2010, and September 30, 2011, and the second was prospective, including proactive observations and knowledge questionnaire. There were 83 (0.48%) cases of CME of 17,200 patients, 54 women (0.64%) and 29 men (0.33%), P = 0.005. The patients with CME were older, and their cannula was inserted in other departments than Radiology Department, P < 0.000. There was a gap between the high theoretical knowledge that was found in the knowledge questionnaire and its implementation that was demonstrated in the proactive observation. Our data demonstrate that sex, age, and where the cannula was inserted are predictive factors for CME. We believe that CME could be prevented by proper educational program and establishment of efficient strategy.

High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Children with Respiratory Distress.

PubMed

Sitthikarnkha, Punthila; Samransamruajkit, Rujipat; Prapphal, Nuanchan; Deerojanawong, Jitladda; Sritippayawan, Suchada

2018-05-01

The aim of this study is to determine the clinical efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy in children presented with respiratory distress. This was a randomized controlled study. Infants and children aged between 1 month to 5 years who were admitted to our tertiary referral center for respiratory distress (July 1, 2014 to March 31, 2015) and met the inclusion criteria were recruited. Infants and children hospitalized with respiratory distress were randomized into two groups of interventions. All clinical data, for example, respiratory score, pulse rate, and respiratory rate were recorded. The results were subsequently analyzed. A total of 98 respiratory distress children were enrolled during the study period. Only 4 children (8.2%) failed in HFNC therapy, compared with 10 children (20.4%) in conventional oxygen therapy group ( P = 0.09). After adjusted for body weight, underlying diseases, and respiratory distress score, there was an 85% reduction in the odds of treatment failure in HFNC therapy group (adjusted odds ratio 0.15, 95% confidence interval 0.03-0.66, P = 0.01). Most children in HFNC therapy group had significant improvement in clinical respiratory score, heart rate, and respiratory rate at 240, 360, and 120 min compared with conventional oxygen therapy ( P = 0.03, 0.04, and 0.03). HFNC therapy revealed a potential clinical advantage in management children hospitalized with respiratory distress compared with conventional respiratory therapy. The early use of HFNC in children with moderate-to-severe respiratory distress may prevent endotracheal tube intubation. TCTR 20170222007.

Adverse reactions of α2-adrenoceptor agonists in cats reported in 2003-2013 in Finland.

PubMed

Raekallio, Marja R; Virtanen, Marika; Happonen, Irmeli; Vainio, Outi M

2017-07-01

To describe suspected adverse drug reactions in cats associated with use of α 2 -adrenoceptor agonists. Retrospective study. A total of 90 cats. Data were collected from reports on adverse reactions to veterinary medicines sent to the Finnish Medicines Agency during 2003-2013. All reports of suspected adverse reactions associated with use of α 2 -adrenoceptor agonists in cats were included. Probable pulmonary oedema was diagnosed based on post mortem or radiological examination, or presence of frothy or excess fluid from the nostrils or trachea. If only dyspnoea and crackles on auscultation were reported, possible pulmonary oedema was presumed. Pulmonary oedema was suspected in 61 cases. Of these cats, 37 were categorised as probable and 24 as possible pulmonary oedema. The first clinical signs had been noted between 1 minute and 2 days (median, 15 minutes) after α 2 -adrenoceptor agonist administration. Many cats probably had no intravenous overhydration when the first clinical signs were detected, as either they presumably had no intravenous cannula or the signs appeared before, during or immediately after cannulation. Of the 61 cats, 43 survived, 14 died and for four the outcome was not clearly stated. Pulmonary oedema is a perilous condition that may appear within minutes of an intramuscular administration of sedative or anaesthetic agent in cats. The symptoms were not caused by intravenous overhydration, at least in cats having no venous cannula when the first clinical signs were detected. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Humidified high flow nasal cannulae: current practice in Australasian nurseries, a survey.

PubMed

Hough, Judith L; Shearman, Andrew D; Jardine, Luke A; Davies, Mark W

2012-02-01

Humidified High Flow Nasal Cannula (HHFNC) has been increasingly adopted as a new means of respiratory support throughout the world. However, evidence to support its safety and efficacy is limited. The aim of the present survey was to determine current practices regarding the usage of HHFNC by neonatologists in Australia and New Zealand. Surveys were sent to all 167 neonatologists identified by the list of centres in the Australia and New Zealand Neonatal Network. A total of 157 surveys were sent to valid email addresses: 111 (71%) responded of which 105 (67%) had completed the questionnaire. HHFNC is used in 17 (63%) of neonatal intensive care units in Australia and New Zealand. It is most commonly used to reduce nasal trauma (91%) and provide continuous positive airways pressure (62%). The main perceived benefits of HHFNC were the easier application and care of the infant (86%), and improved tolerance by the baby (84%). Rain out leading to fluid instillation into the upper airway (59%) was the most common problem. This survey has provided a snapshot of the practice of HHFNC usage in Australia and New Zealand in 2010 and has revealed that HHFNC use is widespread and that clinical practices are diverse. The majority of neonatologists acknowledge that there is limited evidence to support its efficacy and safety, and would be happy to participate in clinical trials to address how best to deliver HHFNC. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Needle localization using a moving stylet/catheter in ultrasound-guided regional anesthesia: a feasibility study

NASA Astrophysics Data System (ADS)

Beigi, Parmida; Rohling, Robert

2014-03-01

Despite the wide range and long history of ultrasound guided needle insertions, an unresolved issue in many cases is clear needle visibility. A well-known ad hoc technique to detect the needle is to move the stylet and look for changes in the needle appearance. We present a new method to automatically locate a moving stylet/catheter within a stationary cannula using motion detection. We then use this information to detect the needle trajectory and the tip. The differences between the current frame and the previous frame are detected and localized, to minimize the influence of tissue global motions. A polynomial fit based on the detected needle axis determines the estimated stylet shaft trajectory, and the extent of the differences along the needle axis represents the tip. Over a few periodic movements of the stylet including its full insertion into the cannula to the tip, a combination of polynomial fits determines the needle trajectory and the last detected point represents the needle tip. Experiments are conducted in water bath and bovine muscle tissue for several stylet/catheter materials. Results show that a plastic stylet has the best needle shaft and tip localization accuracy in the water bath with RMSE = 0:16 mm and RMSE = 0:51 mm, respectively. In the bovine tissue, the needle tip was best localized with the plastic catheter with RMSE = 0:33 mm. The stylet tip localization was most accurate with the steel stylet, with RMSE = 2:81 mm and the shaft was best localized with the plastic catheter, with RMSE = 0:32 mm.

Transvaginal Pelvic Floor Muscle Injection Technique: A Cadaver Study.

PubMed

Gupta, Priyanka; Ehlert, Michael; Sirls, Larry T; Peters, Kenneth

Women with pelvic floor dysfunction can have tender areas on vaginal examination, which can be treated with trigger-point injections. There are no publications to evaluate the accuracy of pelvic floor muscle injections. Trigger-point injections were performed on 2 fresh cadaveric pelvises using a curved nasal cannula guide and 7-in spinal needle. This was performed using our standard template of 2 sets of injections at the 1-, 3-, and 5-o'clock positions distally and proximally. The first pelvis was dissected to examine dye penetration. Based on these results, we modified our technique and repeated the injections on the second cadaver. We dissected the second pelvis and compared our findings. The 1-o'clock proximal and distal injections stained the obturator internus and externus near the insertion at the ischiopubic ramus. The 3-o'clock injections stained the midbody of the pubococcygeus and puborectalis. The distal 5-o'clock position was too deep and stained the fat of the ischiorectal space. The proximal 5-o'clock injection stained the area of the pudendal nerve. Our goal at the distal 5-o'clock position was to infuse the iliococcygeus muscle, so we shortened the needle depth from 2 to 1 cm beyond the cannula tip. In our second dissection, the distal 5-o'clock injection again stained only the fat of the ischiorectal space. This is the first study to characterize the distribution of pelvic floor muscle injections in a cadaver model and confirms the ability to deliver medications effectively to the pelvic floor muscles.

Acute Central Neuropeptide Y Administration Increases Food Intake but Does Not Affect Hepatic Very Low-Density Lipoprotein (Vldl) Production in Mice

PubMed Central

Havekes, Louis M.; Romijn, Johannes A.; Rensen, Patrick C. N.

2013-01-01

Objective Central neuropeptide Y (NPY) administration stimulates food intake in rodents. In addition, acute modulation of central NPY signaling increases hepatic production of very low-density lipoprotein (VLDL)-triglyceride (TG) in rats. As hypertriglyceridemia is an important risk factor for atherosclerosis, for which well-established mouse models are available, we set out to validate the effect of NPY on hepatic VLDL-TG production in mice, to ultimately investigate whether NPY, by increasing VLDL production, contributes to the development of atherosclerosis. Research Design and Methods Male C57Bl/6J mice received an intracerebroventricular (i.c.v.) cannula into the lateral (LV) or third (3V) ventricle of the brain. One week later, after a 4 h fast, the animals received an intravenous (i.v.) injection of Tran35S (100 µCi) followed by tyloxapol (500 mg/kg body weight; BW), enabling the study of hepatic VLDL-apoB and VLDL-TG production, respectively. Immediately after the i.v. injection of tyloxapol, the animals received either an i.c.v. injection of NPY (0.2 mg/kg BW in artificial cerebrospinal fluid; aCSF), synthetic Y1 receptor antagonist GR231118 (0.5 mg/kg BW in aCSF) or vehicle (aCSF), or an i.v. injection of PYY3–36 (0.5 mg/kg BW in PBS) or vehicle (PBS). Results Administration of NPY into both the LV and 3V increased food intake within one hour after injection (+164%, p<0.001 and +367%, p<0.001, respectively). NPY administration neither in the LV nor in the 3V affected hepatic VLDL-TG or VLDL-apoB production. Likewise, antagonizing central NPY signaling by either PYY3–36 or GR231118 administration did not affect hepatic VLDL production. Conclusion In mice, as opposed to rats, acute central administration of NPY increases food intake without affecting hepatic VLDL production. These results are of great significance when extrapolating findings on the central regulation of hepatic VLDL production between species. PMID:23460782

Does Simultaneous Liposuction Adversely Affect the Outcome of Thread Lifts? A Preliminary Result.

PubMed

Lee, Yong Woo; Park, Tae Hwan

2018-04-11

Along with advances in thread lift techniques and materials, ancillary procedures such as fat grafting, liposuction, or filler injections have been performed simultaneously. Some surgeons think that these ancillary procedures might affect the aesthetic outcomes of thread lifting possibly due to inadvertent injury to threads or loosening of soft tissue via passing the cannula in the surgical plane of the thread lifts. The purpose of the current study is to determine the effect of such ancillary procedures on the outcome of thread lifts in the human and cadaveric setting. We used human abdominal tissue after abdominoplasty and cadaveric faces. In the abdominal tissue, liposuction parallel to the parallel axis was performed in one area for 5 min. We counted 30 passes when liposuction was performed in one direction. This was repeated as we changed the direction of passages. The plane of thread lifts (dermal vs subcutaneous) and angle between liposuction and thread lifts (parallel vs perpendicular) were differentiated in this abdominal tissue study group. Then, we performed parallel or perpendicular thread lifts using a small slit incision. Using a tensiometer, the maximum holding strength was measured when pulling the thread out of the skin as much as possible. We also used faces of cadavers to prove whether the finding in human abdominal tissue is really valid with corresponding techniques. Our pilot study using abdominal tissue showed that liposuction after thread lifts adversely affects it regardless of the vector of thread lifts. In the cadaveric study, however, liposuction prior to thread lifting does not significantly affect the holding strength of thread lifts. Liposuction or fat grafting in the appropriate layer would not be a hurdle to safely performing simultaneous thread lifts if the target lift tissue is intra-SMAS or just above the SMAS layer. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals

PubMed Central

Milutinović, Dragana; Andrijević, Ilija; Ličina, Milijana; Andrijević, Ljiljana

2015-01-01

Introduction This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis. Materials and methods A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals’ confidence level in their own ability to perform first and last venipuncture. Results The average score on the knowledge test was higher in nurses’ than in laboratory technicians (8.11 ± 1.7, and 7.4 ± 1.5, respectively). The difference in average scores was statistically significant (P = 0.035) and Cohen’s d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P = 0.551). Conclusion Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample. PMID:26527124

Investigation of effects of 60-Hz electric and magnetic fields on operant and social behavior and on the neuroendocrine system of nonhuman primates: Neuroendocrine portion of Experiment IV

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rogers, W.R.; Rhodes, J.W.

1992-08-31

This quarterly report covers the neuroendocrine Portion of Experiment IV. Serum melatonin concentration was measured in individual baboons, each implanted with a chronically indwelling venous cannula. As in Experiment III the system of six automatic blood samplers was used to achieve undisturbed, 24 hr per day, simultaneous blood sampling from six individual subjects. The objective of the neuroendocrine portion of Experiment IV was to determine if 30 kV/m electric and 1.0 G magnetic field (E/MF) exposure produced a 50% decline in nocturnal serum melatonin concentration. Other groups of subjects were tested concurrently during Experiment IV to assess E/MF effects onmore » group social and individual operant behavior. The results of these experiments will be covered respectively in the next two quarterly reports. The results of Experiment IV, as was the case with the result of Experiments III and IIIA, provide little or no evidence that E/MF exposure, under the conditions of these experiments, affects nocturnal serum melatonin concentrations of nonhuman primates. Together the negative results of Experiments III, IIA and IV indicate that day-time exposure of primates to slow-onset/offset, regularly-scheduled E/MF does not produce melatonin suppression, strongly suggesting that such exposure would not affect human melatonin either. However, before concluding that E/MF exposure in general has no effect on primate melatonin, nightime exposure needs to be examined, and the possibility, suggested by the Pilot Experiment, that fast onset/offset, irregularly-scheduled E/MF can completely suppress melatonin needs to be investigated.« less

Investigation of effects of 60-Hz electric and magnetic fields on operant and social behavior and on the neuroendocrine system of nonhuman primates: Neuroendocrine portion of Experiment IV. Quarterly report No. 38

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rogers, W.R.; Rhodes, J.W.

1992-08-31

This quarterly report covers the neuroendocrine Portion of Experiment IV. Serum melatonin concentration was measured in individual baboons, each implanted with a chronically indwelling venous cannula. As in Experiment III the system of six automatic blood samplers was used to achieve undisturbed, 24 hr per day, simultaneous blood sampling from six individual subjects. The objective of the neuroendocrine portion of Experiment IV was to determine if 30 kV/m electric and 1.0 G magnetic field (E/MF) exposure produced a 50% decline in nocturnal serum melatonin concentration. Other groups of subjects were tested concurrently during Experiment IV to assess E/MF effects onmore » group social and individual operant behavior. The results of these experiments will be covered respectively in the next two quarterly reports. The results of Experiment IV, as was the case with the result of Experiments III and IIIA, provide little or no evidence that E/MF exposure, under the conditions of these experiments, affects nocturnal serum melatonin concentrations of nonhuman primates. Together the negative results of Experiments III, IIA and IV indicate that day-time exposure of primates to slow-onset/offset, regularly-scheduled E/MF does not produce melatonin suppression, strongly suggesting that such exposure would not affect human melatonin either. However, before concluding that E/MF exposure in general has no effect on primate melatonin, nightime exposure needs to be examined, and the possibility, suggested by the Pilot Experiment, that fast onset/offset, irregularly-scheduled E/MF can completely suppress melatonin needs to be investigated.« less

Antinociception after both peripheral and intrathecal injection of oxotremorine is modulated by spinal nitric oxide.

PubMed

Machelska, H; Pavone, F; Capone, F; Przewłocka, B

1999-03-01

The present study investigated the role of spinal nitric oxide (NO) in the antinociception induced by intraperitoneal (i.p.) and intrathecal (i.th.) injection of oxotremorine. The experiments were carried out on male Wistar rats, which had cannulas chronically implanted in the lumbar enlargement of the spinal cord. Antinociceptive effects were evaluated using a tail-flick and a paw pressure test. To raise the spinal NO level, the rats received the NO donor, 3-morpholino-sydnonimine (SIN-1, 10 and 100 microg/5 microl); to lower the NO level, the inhibitor of NO synthase, N-nitro-L-arginine methyl ester (L-NAME, 50 and 400 microg/5 microl), was administered. Both those substances were injected i.th. Systemic injections of oxotremorine (0.02 and 0.1 mg/kg) produced a significant increase in the thermal nociceptive threshold, while the mechanical threshold was affected only by the higher dose (0.1 mg/kg) of the muscarinic agonist. I.th. injections of oxotremorine (0.1 ng, 1 ng, 1 microg/5 microl) produced significant antinociception in both those tests. I.th. administration of SIN-1 in doses which themselves did not affect the nociceptive threshold antagonized both the peripheral and central oxotremorine antinociception. I.th. administration of L-NAME (50 and 400 microg/5 microl) did not change the nociceptive threshold, but dose-dependently potentiated the effects of oxotremorine injected i.p. in both tests; however, the effect of i.th. administration of oxotremorine was potentiated only in the tail-flick test. Our results demonstrate that irrespective of the way of its injection, the antinociceptive effect of oxotremorine is modulated by activity of the spinal NO. Moreover, our results further support the hypothesis that NO present in the spinal cord exerts pronociceptive effects.

Technical note: A device for obtaining time-integrated samples of ruminal fluid

USGS Publications Warehouse

Corley, R. N.; Murphy, M.R.; Lucena, J.; Panno, S.V.

1999-01-01

A device was adapted to allow for time-integrated sampling of fluid from the rumen via a cannula. The sampler consisted of a cup-shaped ceramic filter positioned in the ventral rumen of a cannulated cow and attached to a tube through which fluid entering the filter was removed continuously using a peristaltic pump. Rate of ruminal fluid removal using the device was monitored over two 36-h periods (at 6-h intervals) and was not affected (P > .05) by time, indicating that the system was not susceptible to clogging during this period. Two cows having ad libitum access to a totally mixed ration were used in a split-block design to evaluate the utility of the system for obtaining time-integrated samples of ruminal fluid. Ruminal fluid VFA concentration and pattern in samples collected in two replicated 8-h periods by the time-integrated sampler (at 1-h intervals) were compared with composite samples collected using a conventional suction-strainer device (at 30-min intervals). Each 8-h collection period started 2 h before or 6 h after feeding. Results indicated that total VFA concentration was not affected (P > .05) by the sampling method. Volatile fatty acid patterns were likewise unaffected (P > .05) except that acetate was 2.5% higher (P < .05) in samples collected 2 h before feeding and valerate was 5% higher (P < .05) in samples collected 6 h after feeding by the suction-strainer device. Although significant, these differences were not considered physiologically important. We concluded that use of the ceramic filter improved the sampling of ruminal fluid by simplifying the technique and allowing time-integrated samples to be obtained.

Mathematical modeling of laser lipolysis

PubMed Central

Mordon, Serge R; Wassmer, Benjamin; Reynaud, Jean Pascal; Zemmouri, Jaouad

2008-01-01

Background and Objectives Liposuction continues to be one of the most popular procedures performed in cosmetic surgery. As the public's demand for body contouring continues, laser lipolysis has been proposed to improve results, minimize risk, optimize patient comfort, and reduce the recovery period. Mathematical modeling of laser lipolysis could provide a better understanding of the laser lipolysis process and could determine the optimal dosage as a function of fat volume to be removed. Study design/Materials and Methods An Optical-Thermal-Damage Model was formulated using finite-element modeling software (Femlab 3.1, Comsol Inc). The general model simulated light distribution using the diffusion approximation of the transport theory, temperature rise using the bioheat equation and laser-induced injury using the Arrhenius damage model. Biological tissue was represented by two homogenous regions (dermis and fat layer) with a nonlinear air-tissue boundary condition including free convection. Video recordings were used to gain a better understanding of the back and forth movement of the cannula during laser lipolysis in order to consider them in our mathematical model. Infrared video recordings were also performed in order to compare the actual surface temperatures to our calculations. The reduction in fat volume was determined as a function of the total applied energy and subsequently compared to clinical data reported in the literature. Results In patients, when using cooled tumescent anesthesia, 1064 nm Nd:YAG laser or 980 nm diode laser: (6 W, back and forth motion: 100 mm/s) give similar skin surface temperature (max: 41°C). These measurements are in accordance with those obtained by mathematical modeling performed with a 1 mm cannula inserted inside the hypodermis layer at 0.8 cm below the surface. Similarly, the fat volume reduction observed in patients at 6-month follow up can be determined by mathematical modeling. This fat reduction depends on the applied energy, typically 5 cm3 for 3000 J. At last, skin retraction was observed in patients at 6-month follow up. This observation can be easily explained by mathematical modeling showing that the temperature increase inside the lower dermis is sufficient (48–50°C) to induce skin tightening Discussion and Conclusion Laser lipolysis can be described by a theoretical model. Fat volume reduction observed in patients is in accordance with model calculations. Due to heat diffusion, temperature elevation is also produced inside the lower reticular dermis. This interesting observation can explain remodeling of the collagenous tissue, with clinically evident skin tightening. In conclusion, while the heat generated by interstitial laser irradiation provides stimulate lipolysis of the fat cells, the collagen and elastin are also stimulated resulting in a tightening in the skin. This mathematical model should serve as a useful tool to simulate and better understand the mechanism of action of the laser lipolysis PMID:18312643

Arthroscopic partial wrist fusion.

PubMed

Ho, Pak-Cheong

2008-12-01

The wide intraarticular exposure of the wrist joint under arthroscopic view provides an excellent ground for various forms of partial wrist fusion. Combining with percutaneous fixation technique, arthroscopic partial wrist fusion can potentially generate the best possible functional outcome by preserving the maximal motion pertained with each type of partial wrist fusion because the effect of extraarticular adhesion associated with open surgery can be minimized. From November 1997 to May 2008, the author had performed 12 cases of arthroscopic partial wrist fusion, including scaphotrapeziotrapezoid fusion in 3, scaphoidectomy and 4-corner fusion in 4, radioscapholunate fusion in 3, radiolunate fusion in 1, and lunotriquetral fusion in 1 case. Through the radiocarpal or midcarpal joint, the corresponding articular surfaces were denuded of cartilage using arthroscopic burr and curette. Carpal bones involved in the fusion process were then transfixed with K wires percutaneously after alignment corrected and confirmed under fluoroscopic control. Autogenous cancellous bone graft or bone substitute were inserted and impacted to the fusion site through cannula under direct arthroscopic view. Final fixation could be by multiple K wires or cannulated screw system. Early mobilization was encouraged. Surgical complications were minor, including pin tract infection, skin burn, and delay union in 1 case. Uneventful radiologic union was obtained in 9 cases, stable fibrous union in 2, and nonunion in 1. The average follow-up period was 70 months. Symptom was resolved or improved, and functional motion was gained in all cases. All surgical scars were almost invisible, and aesthetic outcome was excellent.

Brain functional network changes following Prelimbic area inactivation in a spatial memory extinction task.

PubMed

Méndez-Couz, Marta; Conejo, Nélida M; Vallejo, Guillermo; Arias, Jorge L

2015-01-01

Several studies suggest a prefrontal cortex involvement during the acquisition and consolidation of spatial memory, suggesting an active modulating role at late stages of acquisition processes. Recently, we have reported that the prelimbic and infralimbic areas of the prefrontal cortex, among other structures, are also specifically involved in the late phases of spatial memory extinction. This study aimed to evaluate whether the inactivation of the prelimbic area of the prefrontal cortex impaired spatial memory extinction. For this purpose, male Wistar rats were implanted bilaterally with cannulae into the prelimbic region of the prefrontal cortex. Animals were trained during 5 consecutive days in a hidden platform task and tested for reference spatial memory immediately after the last training session. One day after completing the training task, bilateral infusion of the GABAA receptor agonist Muscimol was performed before the extinction protocol was carried out. Additionally, cytochrome c oxidase histochemistry was applied to map the metabolic brain activity related to the spatial memory extinction under prelimbic cortex inactivation. Results show that animals acquired the reference memory task in the water maze, and the extinction task was successfully completed without significant impairment. However, analysis of the functional brain networks involved by cytochrome oxidase activity interregional correlations showed changes in brain networks between the group treated with Muscimol as compared to the saline-treated group, supporting the involvement of the mammillary bodies at a the late stage in the memory extinction process. Copyright © 2015 Elsevier B.V. All rights reserved.

Role of gap junctional coupling in astrocytic networks in the determination of global ischaemia-induced oxidative stress and hippocampal damage.

PubMed

Perez Velazquez, Jose L; Kokarovtseva, Larisa; Sarbaziha, Raheleh; Jeyapalan, Zina; Leshchenko, Yevgen

2006-01-01

While there is evidence that gap junctions play important roles in the determination of cell injuries, there is not much known about mechanisms by which gap junctional communication may exert these functions. Using a global model of transient ischaemia in rats, we found that pretreatment with the gap junctional blockers carbenoxolone, 18alpha-glycyrrhetinic acid and endothelin, applied via cannulae implanted into the hippocampus in one hemisphere, resulted in decreased numbers of TUNEL-positive neurons, as compared with the contralateral hippocampus that received saline injection. Post-treatment with carbenoxolone for up to 30 min after the stroke injury still resulted in decreased cell death, but post-treatment at 90 min after the ischaemic insult did not result in differences in cell death. However, quinine, an inhibitor of Cx36-mediated gap junctional coupling, did not result in appreciable neuroprotection. Searching for a possible mechanism for the observed protective effects, possible actions of the gap junctional blockers in the electrical activity of the hippocampus during the ischaemic insult were assessed using intracerebral recordings, with no differences observed between the saline-injected and the contralateral drug-injected hippocampus. However, a significant reduction in lipid peroxides, a measure of free radical formation, in the hippocampus treated with carbenoxolone, revealed that the actions of gap junctional coupling during injuries may be causally related to oxidative stress. These observations suggest that coupling in glial networks may be functionally important in determining neuronal vulnerability to oxidative injuries.

Our experience with a new instrument for laparoscopic gallbladder extraction, the "Bergetrokar".

PubMed

Höferlin, A; Höhle, K D

1993-01-01

Laparoscopic cholecystectomy has become a standardized technique within the last years. However, the extraction of the stone-filled gallbladder often becomes a time-consuming and difficult part of the operation. We have developed a new instrument for quick and safe extraction of the stone-filled gallbladder. The instrument, called "Bergetrokar", is a trocar cannula with a trumpet valve and cone-shaped tip which can be spread. The application of this device is simple. After using the "Bergetrokar" in about 180 cases we have not observed any perforation of the gallbladder or loss of stones. Extraction times were reduced.

Robert H. Goetz: the surgeon who performed the first successful clinical coronary artery bypass operation.

PubMed

Konstantinov, I E

2000-06-01

Robert H. Goetz performed the first successful clinical coronary artery bypass operation on May 2, 1960. He used a nonsuture technique to connect the right internal thoracic artery to the coronary artery by means of a modified Payr's cannula made of tantalum. The patency of the anastomosis was demonstrated angiographically and the patient remained free of angina pectoris for 1 year. It was an important and brave step forward, a step that was far ahead of its time. Unfortunately, his pioneering work was not appreciated and fell into oblivion.

Technical aspects and clinical implications of high frequency jet ventilation with a solenoid valve.

PubMed

Carlon, G C; Miodownik, S; Ray, C; Kahn, R C

1981-01-01

High frequency jet ventilation (HFJV) is an incompletely studied technique of mechanical respiratory support. The authors have built a ventilator based on a solenoid valve, that allows independent selection of respiratory rate and inspiratory/expiratory ratio. The ventilator can be synchronized to the heart rate. Humidification is provided by warm saline dripped in front of the injector nozzle, so that the jet stream itself acts as a nebulizer. Tube diameter, length, and deformability are fundamental determinants of inspiratory flow rate and wave form. Cannula kinking and inadequate humidification were the most significant sources of complications.

Micromachined needles and lancets with design adjustable bevel angles

NASA Astrophysics Data System (ADS)

Sparks, Douglas; Hubbard, Timothy

2004-08-01

A new method of micromachining hollow needles and two-dimensional needle arrays from single crystal silicon is described. The process involves a combination of fusion bonding, photolithography and anisotropic plasma etching. The cannula produced with this process can have design adjustable bevel angles, wall thickness and channel dimensions. A subset of processing steps can be employed to produce silicon blades and lancets with design adjustable bevel angles and shaft dimensions. Applications for this technology include painless drug infusion, blood diagnosis, glucose monitoring, cellular injection and the manufacture of microkeratomes for ocular, vascular and neural microsurgery.

[The antitussive effect of theophylline].

PubMed

Nemceková, E; Nosál'ová, G; Rybár, A

1994-08-01

Theophylline belongs to a group of medicaments used in asthma therapy. It yields an antiinflammatory effect, reduces allergic reactions, and in respiratory airways it improves the mucociliary clearance and eminently dilates smooth muscles. Therefore, the main aim of our interest is its effect on the cough reflex. Cough was evoked by mechanical irritation of the airways in cats with chronic tracheal cannula. It has been discovered that theophylline, when dosed 10 mg per kg of body weight i.p. achieved a more intensive effect than dextromethorphane, namely in evaluation of cough parameters, but it had a lower suppressive effect than codeine. (Fig. 3, Ref. 13.)

Effects of intra-fourth ventricle injection of crocin on capsaicin-induced orofacial pain in rats.

PubMed

Tamaddonfard, Esmaeal; Tamaddonfard, Sina; Pourbaba, Salar

2015-01-01

Crocin, a constituent of saffron and yellow gardenia, possesses anti-nociceptive effects. In the present study, we investigated the effects of intra-fourth ventricle injection of crocin in a rat model of orofacial pain. The contribution of opioid system was assessed using intra-fourth ventricle injection of naloxone, an opioid receptor antagonist. A guide cannula was implanted into the fourth ventricle of brain in anesthetized rats. Orofacial pain was induced by subcutaneous (s.c.) injection of capsaicin (1.5 µg/20 µl) into the right vibrissa pad. The time spent face rubbing/grooming was recorded for a period of 20 min. Locomotor activity was measured using an open-field test. Intra-fourth ventricle injection of crocin (10 and 40 µg/rat) and morphine (10 and 40 µg/rat) and their co-administration (2.5 and 10 µg/rat of each) suppressed capsaicin-induced orofacial pain. The analgesic effect induced by 10 µg/rat of morphine, but not crocin (10 µg/rat), was prevented by 20 µg/rat of naloxone pretreatment. The above-mentioned chemical compounds did not affect locomotor activity. The results of this study showed that the injection of crocin into the cerebral fourth ventricle attenuates capsaicin-induced orofacial pain in rats. The anti-nociceptive effect of crocin was not attributed to the central opioid receptors.

Aldosterone induces rapid sodium intake by a nongenomic mechanism in the nucleus tractus solitarius.

PubMed

Qiao, Hu; Hu, Bo; Zhou, Hong; Yan, Jianqun; Jia, Ru; Lu, Bo; Sun, Bo; Luo, Xiao; Fan, Yuanyuan; Wang, Nan

2016-12-09

The purpose of this study was to determine whether aldosterone has a rapid action in the nucleus tractus solitarius (NTS) that increases sodium intake, and to examine whether this effect of aldosterone, if present, is mediated by G protein-coupled estrogen receptor (GPER). Adult male Sprague-Dawley rats with a stainless-steel cannula in the NTS were used. Aldosterone was injected into the NTS at the doses of 1, 5, 10 and 20 ng 0.1 μl -1 . A rapid dose-related increase of 0.3 M NaCl intake was induced within 30 min and this increase was not suppressed by the mineralocorticoid receptor (MR) antagonist spironolactone (10 ng 0.1 μl -1 ). Water intake was not affected by aldosterone. The GPER agonist G-1 produced a parallel and significant increase in sodium intake, while pre-treatment with GPER antagonist G15 (10 ng 0.1 μl -1 ) blocked the G-1 or aldosterone-induced rapid sodium intake. In addition, sodium intake induced by sodium depletion or low-sodium diet fell within 30 min after injection into the NTS of the MR antagonist spironolactone, while G15 had no effect. Our results confirm previous reports, and support the hypothesis that aldosterone evokes rapid sodium intake through a non-genomic mechanism involving GPER in NTS.

Effects of monosodium glutamate (umami taste) with and without guanosine 5'-monophosphate on rat autonomic responses to meals.

PubMed

Steffens, A B; Leuvenink, H; Scheurink, A J

1994-07-01

Monosodium glutamate (MSG) is used as a food additive to improve the taste of food. The effect of MSG on sweet taste is enhanced by guanosine 5'-monophosphate (GMP). Because increased palatability is known to increase the vagally mediated preabsorptive insulin response (PIR), we hypothesized that MSG and GMP will enhance the PIR. To study this, male Wistar rats were provided with permanent cannulas for venous blood sampling and intragastric drug administration. The MSG and GMP were either added to a test meal or infused into the stomach during a test meal. Blood samples were taken to measure concentrations of glucose, insulin, epinephrine (E), and norepinephrine (NE). Addition of 56 mg MSG to a control meal markedly reduced both phases of the meal-induced increase in plasma insulin and had no effects on blood glucose and plasma E and NE responses. Infusion of 56 mg MSG into the stomach at the onset of food intake reduced the PIR with no effect on glucose, E, NE, or the second phase insulin release. Addition of 2 mg MSG in combination with GMP to the test meal or gastric administration of these drugs did not affect the changes in any of the blood components measured. It is concluded that addition of a high dose of MSG to a test meal leads to a reduction in the vagal response to food.

Daily patterns of secretion of neurohypophysial hormones in man: effect of age.

PubMed

Forsling, M L; Montgomery, H; Halpin, D; Windle, R J; Treacher, D F

1998-05-01

The neurohypophysial hormone vasopressin contributes to control of urine output and, while urine flow shows a clear daily rhythm, there has been debate as to whether this is true of neurohypophysial hormones. A study was performed on fifteen adult males, with a mean age of 25 years, over a 24 h period, nine blood samples being taken at regular intervals for the determination of neurohypophysial hormones and indices of fluid balance. Samples were taken via an indwelling cannula so that sleep was undisturbed. A daily variation in the plasma concentrations of oxytocin and vasopressin was demonstrated with concentrations reaching a nadir in the late afternoon. Concentrations of both hormones peaked at 02.00 h. Vasopressin concentrations were inversely correlated with packed cell volume, indicating that the altered hormone release was affecting fluid retention. Consistent with this was the observation that the relationship of plasma osmolality to vasopressin depended on the time of day. To determine the effect of ageing, a similar study was performed on nine healthy elderly subjects with a mean age of 70 years. The nocturnal peak of vasopressin was markedly attenuated, while oxytocin release was similar to that in the younger group. These observations confirm the existence of a daily rhythm in the plasma concentrations of neurohypophysial hormones and indicate that the amplitude of the vasopressin change decreases with age.

Hippocampal protein kinase D1 is necessary for DHPG-induced learning and memory impairments in rats

PubMed Central

Groveman, Bradley R.; Carrier, Nicole; Qiao, Haifa; Fang, Xiao-Qian; Wang, Hui; Xin, Wenkuan; Jiang, Xing-Hong; Salter, Michael W.; Ding, Xin-Sheng; Kabbaj, Mohamed

2018-01-01

Background Understanding molecular mechanisms underlying the induction of learning and memory impairments remains a challenge. Recent investigations have shown that the activation of group I mGluRs (mGluR1 and mGluR5) in cultured hippocampal neurons by application of (S)-3,5-Dihydroxyphenylglycine (DHPG) causes the regulated internalization of N-methyl-D-aspartate receptors (NMDARs), which subsequently activates protein kinase D1 (PKD1). Through phosphorylating the C-terminals of the NMDAR GluN2 subunits, PKD1 down-regulates the activity of remaining (non-internalized) surface NMDARs. The knockdown of PKD1 does not affect the DHPG-induced inhibition of AMPA receptor-mediated miniature excitatory post-synaptic currents (mEPSCs) but prevents the DHPG-induced inhibition of NMDAR-mediated mEPSCs in vitro. Thus, we investigated the in vivo effects of bilateral infusions of DHPG into the hippocampal CA1 area of rats in the Morris water maze (MWM) and the novel object discrimination (NOD) tests. Methods A total of 300 adult male Sprague Dawley rats (250–280 g) were used for behavioral tests. One hundred ninety four were used in MWM test and the other 106 rats in the NOD test. Following one week of habituation to the vivarium, rats were bilaterally implanted under deep anesthesia with cannulas aimed at the CA1 area of the hippocampus (CA1 coordinates in mm from Bregma: AP -3.14; lateral +/-2; DV -3.0). Through implanted cannulas artificial cerebrospinal fluid (ACSF), the group1 mGluR antagonist 6-Methyl-2-(phenylethynyl)pyridine (MPEP), the dynamin-dependent internalization inhibitor Dynasore, or the PKD1 inhibitor CID755673 were infused into the bilateral hippocampal CA1 areas (2 μL per side, over 5 min). The effects of these infusions and the effects of PKD1 knockdown were examined in MWM or NOD test. Results DHPG infusion increased the latency to reach the platform in the MWM test and reduced the preference for the novel object in the NOD task. We found that the DHPG effects were dose-dependent and could be maintained for up to 2 days. Notably, these effects could be prevented by pre-infusion of the group1 mGluR antagonist MPEP, the dynamin-dependent internalization inhibitor Dynasore, the PKD1 inhibitor CID755673, or by PKD1 knockdown in the hippocampal CA1 area. Conclusion Altogether, these findings provide direct evidence that PKD1-mediated signaling may play a critical role in the induction of learning and memory impairments by DHPG infusion into the hippocampal CA1 area. PMID:29614089

Propionate supplementation improves nitrogen use by reducing urea flux in sheep.

PubMed

Agarwal, U; Hu, Q; Bequette, B J

2015-10-01

Feeding and postruminal infusion of propionate is known to increase N retention in ruminants. Our aim was to determine the role of rumen propionate on urea N recycling and gluconeogenesis in growing sheep. In Exp. 1, wether sheep ( = 6; 32.5 ± 3.57 kg BW) fitted with a rumen cannula were fed to 1.8 × ME requirement a concentrate-type ration (172 g CP/kg DM and 10.4 MJ ME/kg DM) and continuously infused into the rumen with isoenergetic (10% of dietary ME intake) solutions of either sodium acetate (control) or sodium propionate for 9-d periods in a crossover design. In Exp. 2, a different group of wether sheep ( = 5; 33.6 ± 3.70 kg BW) fitted with a rumen cannula were fed, on an isonitrogenous basis, either a control (151 g CP/kg DM and 8.4 MJ ME/kg DM) or sodium propionate-supplemented (139 g CP/kg DM and 8.9 MJ ME/kg DM) diet at 2-h intervals. [N] urea was continuously infused intravenously for the last 5 d of each period, and total urine was collected by vacuum and feces were collected by a harness bag. Over the last 12 h, [C]glucose was continuously infused intravenously and hourly blood samples were collected during the last 5 h. Propionate treatments increased ( < 0.001) the proportion of rumen propionate in both experiments. In Exp. 1, N retention was not affected by propionate infusion as compared with isoenergetic acetate. There was no effect on urea entry (synthesis) rate (UER) in Exp. 1; however, sodium propionate infusion tended ( < 0.1) to increase urinary urea elimination (UUE). In Exp. 2, feeding propionate increased ( < 0.01) N retention by 0.8 g N/d. In addition, UER was reduced by approximately 2 g urea N/d, leading to a reduction ( < 0.05) in UUE (7.0 vs. 6.2 g urea N/d). Between the 2 experiments, the proportion of UER recycled to the gut was greater with the forage-type diet in Exp. 2 (approximately 60%) compared with the concentrate-type diet in Exp. 1 (approximately 40%), although urea N fluxes across the gut remained unchanged in both experiments. In Exp. 1, glucose entry and gluconeogenesis were greater ( < 0.05) and plasma glucose tended ( < 0.1) to be greater with sodium propionate infusion than with sodium acetate infusion, but there was no difference in Cori cycling. In Exp. 2, glucose entry, gluconeogenesis, Cori cycling, and plasma glucose increased ( < 0.05) with dietary propionate. Our studies indicate that propionate inclusion in feed, but not continuous infusion in to the rumen, improves N utilization in growing sheep. The propionate effect is likely mediated by providing additional precursors for gluconeogenesis.

Efficient Nose-to-Lung (N2L) Aerosol Delivery with a Dry Powder Inhaler

PubMed Central

Golshahi, Laleh; Behara, Srinivas R.B.; Tian, Geng; Farkas, Dale R.; Hindle, Michael

2015-01-01

Abstract Purpose: Delivering aerosols to the lungs through the nasal route has a number of advantages, but its use has been limited by high depositional loss in the extrathoracic airways. The objective of this study was to evaluate the nose-to-lung (N2L) delivery of excipient enhanced growth (EEG) formulation aerosols generated with a new inline dry powder inhaler (DPI). The device was also adapted to enable aerosol delivery to a patient simultaneously receiving respiratory support from high flow nasal cannula (HFNC) therapy. Methods: The inhaler delivered the antibiotic ciprofloxacin, which was formulated as submicrometer combination particles containing a hygroscopic excipient prepared by spray-drying. Nose-to-lung delivery was assessed using in vitro and computational fluid dynamics (CFD) methods in an airway model that continued through the upper tracheobronchial region. Results: The best performing device contained a 2.3 mm flow control orifice and a 3D rod array with a 3-4-3 rod pattern. Based on in vitro experiments, the emitted dose from the streamlined nasal cannula had a fine particle fraction <5 μm of 95.9% and mass median aerodynamic diameter of 1.4 μm, which was considered ideal for nose-to-lung EEG delivery. With the 2.3-343 device, condensational growth in the airways increased the aerosol size to 2.5–2.7 μm and extrathoracic deposition was <10%. CFD results closely matched the in vitro experiments and predicted that nasal deposition was <2%. Conclusions: The developed DPI produced high efficiency aerosolization with significant size increase of the aerosol within the airways that can be used to enable nose-to-lung delivery and aerosol administration during HFNC therapy. PMID:25192072

Numerical simulation of left ventricular assist device implantations: comparing the ascending and the descending aorta cannulations.

PubMed

Bonnemain, Jean; Malossi, A Cristiano I; Lesinigo, Matteo; Deparis, Simone; Quarteroni, Alfio; von Segesser, Ludwig K

2013-10-01

In this work we present numerical simulations of continuous flow left ventricle assist device implantation with the aim of comparing difference in flow rates and pressure patterns depending on the location of the anastomosis and the rotational speed of the device. Despite the fact that the descending aorta anastomosis approach is less invasive, since it does not require a sternotomy and a cardiopulmonary bypass, its benefits are still controversial. Moreover, the device rotational speed should be correctly chosen to avoid anomalous flow rates and pressure distribution in specific location of the cardiovascular tree. With the aim of assessing the differences between these two approaches and device rotational speed in terms of flow rate and pressure waveforms, we set up numerical simulations of network of one-dimensional models where we account for the presence of an outflow cannula anastomosed to different locations of the aorta. Then, we use the resulting network to compare the results of the two different cannulations for several stages of heart failure and different rotational speed of the device. The inflow boundary data for the heart and the cannulas are obtained from a lumped parameters model of the entire circulatory system with an assist device, which is validated with clinical data. The results show that ascending and descending aorta cannulations lead to similar waveforms and mean flow rate in all the considered cases. Moreover, regardless of the anastomosis region, the rotational speed of the device has an important impact on wave profiles; this effect is more pronounced at high RPM. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

Life after Roe v. Wade.

PubMed

Bauerlein, M

1992-01-01

With the possibility that the US Supreme Court will overturn or "substantially erode" Roe v. Wade, interest has focused on two alternative abortion techniques: RU-486, the French "abortion pill," and "menstrual extraction," a self-taught procedure performed up to the 8th week of pregnancy. RU-486 is legally available in only a few countries. In France, a woman signs a lengthy consent form and waits a week under French abortion law before receiving 3 200-milligram tablets of RU-486. RU-486 causes an extended, heavy, and somewhat painful menstruation by blocking receptors for progesterone, which prevents the uterine lining from growing; the lining sloughs off, carrying the embryo with it. 2 days later she returns to the clinic and receives an injection or vaginal suppository of prostaglandin to stimulate uterine contractions and increase the effectiveness of RU-486 from 85% to 95%. A week later, she returns for a checkup. RU-486 is a popular choice; complications compare favorable with standard vacuum-aspiration abortions. Proponents argue for RU-486 in the US for research in areas from AIDS to breast cancer. However, the US Food and Drug Administration has an import alert on the drug, prohibiting its entry into the US. Despite the simplicity of this drug, it still fails to guarantee access for private, easily accessible, inexpensive alternatives to traditional abortion services. Although home-performed abortions are illegal in most places, menstrual extraction allows a woman complete control of her body at home via a sterilized cannula attached to as plastic tube that feeds through a hole in a rubber stopper into a jar; 2nd hole holds a tube with a syringe. The cannula is inserted into the uterus, as helper creates suction with the syringes, and observes the uterine contents flush through the clear tubing and into the jar.

Antegrade sclerotherapy in adolescent varicocele patients.

PubMed

Keene, D J B; Cervellione, R M

2017-06-01

In the 1970s, Tauber described the antegrade sclerotherapy technique to treat varicoceles, and reported a 10% recurrence rate. The present study aimed to evaluate paediatric success rates and the effect of modifications to the surgical technique. A prospective study was performed of all adolescent patients undergoing antegrade sclerotherapy surgery. Each patient had an idiopathic varicocele with spontaneous venous reflux on Doppler examination, and underwent cannulation of a pampiniform plexus vein via a scrotal incision under general anaesthetic. Aethoxysklerol ® 3% (2 ml/kg) maximum 3 ml was injected into the pampiniform plexus vein under fluoroscopic monitoring. Success was assessed by clinical examination and Doppler ultrasound 3, 6 and 9 months after surgery. Data were presented as median (interquartile range). Patients were split into three groups: Group A - liquid sclerotherapy with Y connector; Group B - liquid sclerotherapy direct to cannula; and Group C - foam sclerotherapy direct to cannula. Fisher's exact test was used to compare the success rates in each group. A total of 91 patients underwent antegrade sclerotherapy. The median age was 14.8 years (range 13.7-15.5). Eleven persistent varicoceles occurred and were diagnosed by Doppler ultrasound. The success rate of surgery was 58% in Group A, 90% in Group B and 96% in Group C. Success was significantly higher in Group B and Group C compared with Group A. No testicular atrophy occurred; two wound infections, two haematomas and one hydrocele were recorded (Table). Introduction of antegrade sclerotherapy in the adolescent population resulted in a safe and cost-effective method for the management of adolescent varicocele. Several modifications to the technique have been introduced to achieve a high success rate (96%) with minimal complications. Published by Elsevier Ltd.

Comparison of pulsatile with nonpulsatile mechanical support in a porcine model of profound cardiogenic shock.

PubMed

Drakos, Stavros G; Charitos, Christos E; Ntalianis, Argirios; Terrovitis, John V; Siafakas, Kostas X; Dolou, Paraskevi; Pierrakos, Charalampos; Charitos, Efstratios; Karelas, John; Nanas, John N

2005-01-01

The aim of this study was to examine whether pulsatility by intraaortic balloon counterpulsation (IABP) is an important adjunct to the treatment of profound cardiogenic shock (CS) with a widely used, nonpulsatile centrifugal pump (CP). In each of 18 anesthetized, open chest pigs, the outflow cannula of the CP was inserted in the aortic arch through the right external carotid artery, and the inflow cannula of the CP was placed in the left atrium. A 40 cc IABP was subsequently placed in the descending aorta through the left external carotid artery. CS was induced by occlusion of coronary arteries and the infusion of propranolol and crystalloid fluid. Mean aortic pressure, pulse pressure, aortic end diastolic pressure, left ventricular end diastolic pressure, right atrial pressure, and heart rate were monitored. Cardiac output and left anterior descending artery flow were measured with a transit time ultrasound flowmeter. During profound CS, life sustaining hemodynamics were maintained only with the support of the assist devices. Hemodynamic support with the CP was associated with a nearly nonpulsatile flow and a pulse pressure of 7 +/- 4 mm Hg, which increased to 33 +/- 10 mm Hg (p = 0.000) after combining the CP with the IABP. Compared with the hemodynamic support offered by the CP alone, addition of the IABP increased mean aortic pressure from 40 +/- 15 to 50 +/- 16 mm Hg (p = 0.000), cardiac output from 810 +/- 194 to 1,200 +/- 234 ml/min (p = 0.003), and left anterior descending artery flow from 26 +/- 10 to 39 +/- 14 ml/min (p = 0.001). In profound CS, mechanical support provided by a continuous flow CP is enhanced by the added pulsatility of the IABP.

Total vascular resistance and blood flow frequency during left ventricular assistance using a vibrating flow pump.

PubMed

Kobayashi, S; Owada, N; Yambe, T; Nitta, S; Fukuju, T; Hongoh, T; Hashimoto, H

1999-08-01

A vibrating flow pump (VFP) can generate high frequency oscillated blood flow within 10-30 Hz by the oscillation of its central tube. A totally implantable artificial heart using a VFP is being developed as a unique type of blood pump. In this study, left ventricular (LV) assist circulation was performed using a VFP. The total vascular resistance and driving frequency of the VFP were estimated from their relationship. The effect of oscillation on the vascular system was studied by the frequency analysis method and vascular impedance. Adult goats were anesthetized by halothane using an inhaler and a left fourth thoracotomy was performed. The inflow cannula was inserted into the left ventricle, and the outflow cannula was sutured to the descending aorta. The VFP and a centrifugal pump were set in parallel for alternation and comparison. The driving frequency of the VFP was changed and included 15, 20, 25, and 30 Hz. The hemodynamic parameters were continuously recorded during experiments by a digital audio tape (DAT) data recorder. The internal pressure of the left ventricular cavity and aortic pressure were monitored by the pressure manometers continuously. One hundred percent LV assistance was judged by the separation of LV and aortic pressure. The total vascular resistance was decreased by the start of operation of each pump. The decrease during flow using the VFP was not as large as that using a centrifugal pump (CP). The arterial input impedance during oscillated blood flow by the VFP showed a slow curve appearance. It was similar to the frequency characteristics curve of natural heart beats within the lower frequencies. The study of arterial impedance may be important for the estimation of the reflection of the pulsatile wave from the arterial branch, among other things.

Effects of the combination of metyrapone and oxazepam on cocaine-induced increases in corticosterone in the medial prefrontal cortex and nucleus accumbens.

PubMed

Keller, Courtney M; Breaux, Kelly N; Goeders, Nicholas E

2017-03-01

We have previously demonstrated that a combination of drugs (i.e., metyrapone and oxazepam) known to attenuate HPA-axis activity effectively decreases cocaine self-administration and cue reactivity in rats. However, we did not find changes in plasma corticosterone that matched the behavioral effects we observed, indicating that a different mechanism of action must be involved. Therefore, we hypothesized that the combination of metyrapone and oxazepam attenuates cocaine taking and seeking by decreasing cocaine-induced increases in corticosterone in the brain. Male rats were implanted with guide cannulae targeting the medial prefrontal cortex or nucleus accumbens. After the rats recovered from surgery, the microdialysis session was conducted. Rats were housed in the experimental chamber and the dialysis probes inserted into the guide cannulae the night before the session. The following day, dialysate samples were collected over a five-hour session. Baseline samples were collected for the first two hours, every 20min. Samples were then collected following administration of cocaine (15mg/kg, ip). Before injections of cocaine, rats were pretreated with either vehicle or the combination of metyrapone (50mg/kg, ip) and oxazepam (10mg/kg, ip). The administration of cocaine resulted in an increase in corticosterone in the medial prefrontal cortex following vehicle pretreatment, which was not observed in the nucleus accumbens. This cocaine-induced increase in corticosterone was attenuated by metyrapone/oxazepam. Reducing cocaine-induced increases in corticosterone in the medial prefrontal cortex might represent a novel mechanism through which the combination of metyrapone/oxazepam produces its behavioral effects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Comparison of the effectiveness of high flow nasal oxygen cannula vs. standard non-rebreather oxygen face mask in post-extubation intensive care unit patients.

PubMed

Brotfain, Evgeni; Zlotnik, Alexander; Schwartz, Andrei; Frenkel, Amit; Koyfman, Leonid; Gruenbaum, Shaun E; Klein, Moti

2014-11-01

Optimal oxygen supply is the cornerstone of the management of critically ill patients after extubation, especially in patients at high risk for extubation failure. In recent years, high flow oxygen system devices have offered an appropriate alternative to standard oxygen therapy devices such as conventional face masks and nasal prongs. To assess the clinical effects of high flow nasal cannula (HFNC) compared with standard oxygen face masks in Intensive Care Unit (ICU) patients after extubation. We retrospectively analyzed 67 consecutive ventilated critical care patients in the ICU over a period of 1 year. The patients were allocated to two treatment groups: HFNC (34 patients, group 1) and non-rebreathing oxygen face mask (NRB) (33 patients, group 2). Vital respiratory and hemodynamic parameters were assessed prior to extubation and 6 hours after extubation. The primary clinical outcomes measured were improvement in oxygenation, ventilation-free days, re-intubation, ICU length of stay, and mortality. The two groups demonstrated similar hemodynamic patterns before and after extubation. The respiratory rate was slightly elevated in both groups after extubation with no differences observed between groups. There were no statistically significant clinical differences in PaCO2. However, the use of HFNC resulted in improved PaO2/FiO2 post-extubation (P < 0.05). There were more ventilator-free days in the HFNC group (P< 0.05) and fewer patients required reintubation (1 vs. 6). There were no differences in ICU length of stay or mortality. This study demonstrated better oxygenation for patients treated with HFNC compared with NRB after extubation. HFNC may be more effective than standard oxygen supply devices for oxygenation in the post-extubation period.

Effects of time of day and monensin on the size distribution of particles in digestive tract sites of heifers fed corn silage.

PubMed

Deswysen, A G; Pond, K R; Rivera-Villarreal, E; Ellis, W C

1989-07-01

Effects of time of day and dietary monensin in the distribution of size of digesta particles in different digestive tract sites and their intersite relationships were examined in six heifers (290 kg BW) with ruminal, duodenal and ileal cannulas given ad libitum access to corn silage, with or without 100 mg monensin.head-1.d-1, in a two-period crossover design. Ingestive masticate and digesta of corn silage were collected via esophageal, ruminal or intestinal cannulas. The distribution of particulate matter retained on sieves with apertures larger than 20 microm was determined by wet-sieving. The cumulative distribution of particulate matter on a series of sieves was regressed on retaining sieve aperture to estimate the sieve aperture that would retain 50% weight of the particulate matter (median retaining aperture, MRA). The MRA of masticate was 6,494 microm. The MRA of digesta particles decreased (P less than .05) from ventral rumen (1,847 microm) to dorsal rumen (1,797 microm) to duodenum (346 microm), but increased to the rectum (359 microm). The MRA was lower (P = .044) for the monensin treatment only in feces. The MRA of particulate matter in the dorsal and ventral rumen, duodenum and rectum all changed (P less than .05) over 24 h. An inverse pattern between the MRA of ruminal and duodenal digesta occurred, presumably the result of a nycterohemeral pattern of eating and ruminating activity. Across sampling times, an inverse relationship existed between MRA of ventral rumen and duodenal digesta. This relationship suggests that a ruminal digesta raft composed of larger particles (immediately following major meals) is more effective than a raft of smaller particles (prior to such meals) in preventing flux of large particles to the duodenum.

Skin Rejuvenation and Volume Enhancement with the Micro Superficial Enhanced Fluid Fat Injection (M-SEFFI) for Skin Aging of the Periocular and Perioral Regions.

PubMed

Gennai, Alessandro; Zambelli, Alessandra; Repaci, Erica; Quarto, Rodolfo; Baldelli, Ilaria; Fraternali, Giulio; Bernardini, Francesco P

2017-01-01

Adipose-derived stromal and stem cells (ADSC) in autologous fat promises regenerative advantages, and injected into the dermal and subdermal layers, enhances rejuvenation and volume. However, extremely superficial fat injection with current techniques is limited. Efficacy and viability evaluation of fat harvested with extremely small side port (0.3 mm) cannulae without further tissue manipulation for the correction of aging/thin skin in the periocular and perioral regions. Micro-superficial enhanced fluid fat injection (M-SEFFI) harvests adipose tissue with a multi-perforated cannula (0.3 mm), and autologous platelet rich plasma (PRP) is added. The tissue is injected into the dermal region of the periocular and perioral zones. Efficacy and viability were evaluated by histological and cell culture analysis. Clinical assessment included retrospective evaluation according to 1 = no effect, 2 = fair effect, 3 = good effect, 4 = excellent effect. Between June 2014 and July 2015, 65 patients (7 men; mean age 49.7 years) were treated with M-SEFFI. No intraoperative complications or visible lumpiness were recorded. Analysis demonstrated mature, viable adipocytes with a strong stromal component. Following PRP addition, there was a greater proliferation noted in the M-SEFFI compared to the SEFFI (0.5 mm). Mean follow-up was 4.1 months. Clinical assessment by surgeons and patients at 1 month was 3.52 and 3.74, and 6 months 3.06 and 2.6 respectively. M-SEFFI is effective and viable for lump free skin rejuvenation and volume enhancement, through the extraction of smoother ADSC rich, autologous fat tissue that does not require further tissue manipulation, to correct skin aging. 4 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

New minimally invasive discectomy technique through the interlaminar space using a percutaneous endoscope.

PubMed

Dezawa, A; Sairyo, K

2011-05-01

The serial dilating technique used to access herniated discs at the L5-S1 space using percutaneous endoscopic discectomy (PED) via an 8 mm skin incision can possibly injure the S1 nerve root. In this paper, we describe in detail a new surgical procedure to safely access the disc and to avoid the nerve root damage. This small-incision endoscopic technique, small-incision microendoscopic discectomy (sMED), mimics microendoscopic discectomy and applies PED. The sMED approach is similar to the well-established microendoscopic discectomy technique. To secure the surgical field, a duckbill-type PED cannula is used. Following laminotomy of L5 using a high-speed drill, the ligamentum flavum is partially removed using the Kerrison rongeur. Using the curved nerve root retractor, the S1 nerve root is gradually and gently moved caudally. Following the compete retraction of the S1 nerve root to the caudal side of the herniated nucleus pulposus (HNP), the nerve root is retracted safely medially and caudally using the bill side of the duckbill PED cannula. Next, using the HNP rongeur for PED, the HNP is removed piece by piece until the nerve root is decompressed. A total of 30 patients with HNP at the L5-S1 level underwent sMED. In all cases, HNP was successfully removed and patients showed improvement following surgery. Only one patient complained of moderate radiculopathy at the final visit. No complications were encountered. We introduced a minimally invasive technique to safely remove HNP at the L5-S1 level. sMED is possibly the least invasive technique for HNP removal at the L5-S1 level. © 2011 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Blackwell Publishing Asia Pty Ltd.

Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery.

PubMed

Suga, Kikuko; Kobayashi, Yoshiro; Ochiai, Ryoichi

2017-08-01

The aim of this study was to reveal the mechanism of improved arterial oxygenation by measuring the changes in oxygenation before and after initiation of left heart bypass (LHB) during one-lung ventilation (OLV) for thoracic aortic surgery. Prospective, observational study. Single-institution, private hospital. The study comprised 50 patients who underwent aortic surgery via a left thoracotomy approach with LHB circulatory support. Patients were ventilated using pure oxygen during OLV, and the ventilator setting was left unchanged during the measurement period. The measurement of partial pressure of arterial oxygen (PaO 2 ) was made at the following 4 time points: 2 minutes after heparin infusion (point 1 [P1]), 2 minutes after inflow cannula insertion through the left pulmonary vein (P2), immediately before LHB initiation (P3), and 10 minutes after LHB initiation (P4). The mean±standard deviation (mmHg) of PaO 2 measurements at the P1, P2, P3, and P4 time points were 244±121, 250±123, 419±122, and 430±109, respectively, with significant increases between P1 and P3, P1 and P4, P2 and P3, and P2 and P4 (p<0.0001, respectively). No significant increase in PaO 2 was seen between P1 and P2 or between P3 and P4. The improved arterial oxygenation during OLV in patients who underwent thoracic aortic surgery using LHB can be attributed to the insertion of an inflow cannula via the left pulmonary vein into the left atrium before LHB. Copyright © 2017 Elsevier Inc. All rights reserved.

Delays during the administration of acetylcysteine for the treatment of paracetamol overdose

PubMed Central

Bailey, George P.; Najafi, Javad; Elamin, Muhammad E. M. O.; Waring, W. Stephen; Thomas, Simon H. L.; Archer, John R. H.; Wood, David M.

2016-01-01

Background The licensed intravenous acetylcysteine regimen for treating paracetamol overdose in most countries uses three separate infusions over 21 h. This complex regimen, requiring different infusion concentrations and rates, has been associated with administration errors. The aim of the present study was to assess the extent of administration delays occurring during this acetylcysteine regimen. Method A 6‐month retrospective observational study was conducted at three English teaching hospitals with clinical toxicology services from October 2014. Patients aged 16 years and over, treated with intravenous acetylcysteine for paracetamol overdose, were included. The start times for infusions were recorded and the delays compared with the prescribed infusion times were calculated. Anaphylactoid reactions, intravenous cannula problems, overdose intent and smoking status were recorded to assess their contribution to delays. Results From 263 cases identified, 198 met the study inclusion criteria. The median time between the start of infusions 1 and 3 was delayed from the intended 5 h by a median (interquartile range) of 90 (50–163) min, with 135 (68%) cases delayed by more than 1 h. Significantly longer delays were observed in patients with anaphylactoid reactions [median delay 267 (217–413) min, n = 8] and accidental/supratherapeutic overdose [median delay 170 (95–260) min, n = 29]. There were no significant differences between smokers and nonsmokers, or for patients with intravenous cannula problems. Conclusion Long delays were identified during the three‐infusion acetylcysteine regimen for the treatment of paracetamol overdose. These were of clinical significance and could lead to periods of subtherapeutic plasma acetylcysteine concentrations and potentially avoidable hepatotoxicity, as well as delaying hospital discharge. PMID:27412926

Delays during the administration of acetylcysteine for the treatment of paracetamol overdose.

PubMed

Bailey, George P; Najafi, Javad; Elamin, Muhammad E M O; Waring, W Stephen; Thomas, Simon H L; Archer, John R H; Wood, David M; Dargan, Paul I

2016-11-01

The licensed intravenous acetylcysteine regimen for treating paracetamol overdose in most countries uses three separate infusions over 21 h. This complex regimen, requiring different infusion concentrations and rates, has been associated with administration errors. The aim of the present study was to assess the extent of administration delays occurring during this acetylcysteine regimen. A 6-month retrospective observational study was conducted at three English teaching hospitals with clinical toxicology services from October 2014. Patients aged 16 years and over, treated with intravenous acetylcysteine for paracetamol overdose, were included. The start times for infusions were recorded and the delays compared with the prescribed infusion times were calculated. Anaphylactoid reactions, intravenous cannula problems, overdose intent and smoking status were recorded to assess their contribution to delays. From 263 cases identified, 198 met the study inclusion criteria. The median time between the start of infusions 1 and 3 was delayed from the intended 5 h by a median (interquartile range) of 90 (50-163) min, with 135 (68%) cases delayed by more than 1 h. Significantly longer delays were observed in patients with anaphylactoid reactions [median delay 267 (217-413) min, n = 8] and accidental/supratherapeutic overdose [median delay 170 (95-260) min, n = 29]. There were no significant differences between smokers and nonsmokers, or for patients with intravenous cannula problems. Long delays were identified during the three-infusion acetylcysteine regimen for the treatment of paracetamol overdose. These were of clinical significance and could lead to periods of subtherapeutic plasma acetylcysteine concentrations and potentially avoidable hepatotoxicity, as well as delaying hospital discharge. © 2016 The British Pharmacological Society.

Effect of palliative oxygen versus medical (room) air in relieving breathlessness in patients with refractory dyspnea: a double-blind randomized controlled trial

PubMed Central

Abernethy, Amy P.; McDonald, Christine F.; Frith, Peter A.; Clark, Katherine; Herndon, James E.; Marcello, Jennifer; Young, Iven H.; Bull, Janet; Wilcock, Andrew; Booth, Sara; Wheeler, Jane L.; Tulsky, James A.; Crockett, Alan J.; Currow, David C.

2010-01-01

Background Palliative oxygen therapy is widely used for dyspnea in individuals with life-limiting illness ineligible for long-term oxygen therapy. Methods This international double-blind randomized controlled trial evaluatedeffectiveness of oxygen vs. medical (room) air for relieving breathlessness in patients with life-limiting illness, refractory dyspnea, and PaO2>55 mm Hg. Participants were recruited from outpatient clinics at 9 sites (Australia, United States, England). Participants received oxygen or medical air via concentrator through nasal cannulae at 2 liters/minute for 7 days. The primary outcome measure was breathlessness (0-10 numerical rating scale [NRS]), measured twice daily. Findings Participants (N=239) were: mean age, 73 (standard deviation [SD] 10); 62% male; mean PaO2, 77 mm Hg (SD 12); mean morning dyspnea, 4.5 on NRS (SD 2.2); chronic obstructive pulmonary disease, 64%; cancer, 16%. Oxygen was not significantly superior to medical air for relief of breathlessness. Over the 7-day period, after provision of medical gas, mean morning and evening dyspnea decreased by -0.8 (95% confidence interval [CI]: -1.1, -0.5) and -0.4 (CI: -0.7, 0.1), respectively (p<0.001), regardless of intervention. Baseline dyspnea predicted improvement with medical gas; participants with moderate (4-6 NRS) and severe (7-10 NRS) baseline dyspnea had average decreases in morning dyspnea of -0.7 (CI: -1.1, -0.4) and -2.4 (CI: -3.0, -1.8), respectively. Interpretation There is no additional symptomatic benefit of oxygen over room air delivered by nasal cannulae for relieving refractory dyspnea related to life-limiting illness in patients with PaO2>55 mm Hg. Dyspnea intensity decreased in both study arms, temporally related to provision of medical gas. PMID:20816546

Long-term effects of oxygen-enriched high-flow nasal cannula treatment in COPD patients with chronic hypoxemic respiratory failure.

PubMed

Storgaard, Line Hust; Hockey, Hans-Ulrich; Laursen, Birgitte Schantz; Weinreich, Ulla Møller

This study investigated the long-term effects of humidified high-flow nasal cannula (HFNC) in COPD patients with chronic hypoxemic respiratory failure treated with long-term oxygen therapy (LTOT). A total of 200 patients were randomized into usual care ± HFNC. At inclusion, acute exacerbation of COPD (AECOPD) and hospital admissions 1 year before inclusion, modified Medical Research Council (mMRC) score, St George's Respiratory Questionnaire (SGRQ), forced expiratory volume in 1 second (FEV 1 ), 6-minute walk test (6MWT) and arterial carbon dioxide (PaCO 2 ) were recorded. Patients completed phone interviews at 1, 3 and 9 months assessing mMRC score and AECOPD since the last contact. At on-site visits (6 and 12 months), mMRC, number of AECOPD since last contact and SGRQ were registered and FEV 1 , FEV 1 %, PaCO 2 and, at 12 months, 6MWT were reassessed. Hospital admissions during the study period were obtained from hospital records. Hours of the use of HFNC were retrieved from the high-flow device. The average daily use of HFNC was 6 hours/day. The HFNC group had a lower AECOPD rate (3.12 versus 4.95/patient/year, p <0.001). Modeled hospital admission rates were 0.79 versus 1.39/patient/year for 12- versus 1-month use of HFNC, respectively ( p <0.001). The HFNC group had improved mMRC scores from 3 months onward ( p <0.001) and improved SGRQ at 6 and 12 months ( p =0.002, p =0.033) and PaCO 2 ( p =0.005) and 6MWT ( p =0.005) at 12 months. There was no difference in all-cause mortality. HFNC treatment reduced AECOPD, hospital admissions and symptoms in COPD patients with hypoxic failure.

Failure strength of a new meniscus arrow repair technique: biomechanical comparison with horizontal suture.

PubMed

Albrecht-Olsen, P; Lind, T; Kristensen, G; Falkenberg, B

1997-04-01

A new method for arthroscopic all-inside repair of vertical meniscus lesions by use of a biodegradable fixation device ("meniscus arrow") has been developed, including a set of cannulas for easy insertion via standard arthroscopic portals. The technique is described. A study to test the fixation properties was performed in the laboratory. Twenty-four fresh frozen bovine medial menisci were defreezed and divided into three groups. In all menisci an artificial vertical lesion was created with a scalpel 3mm from the peripheral rim. Repair in group I was done with a single horizontal Maxon-O suture using an Acufex double-barrel cannula (Acufex Meniscal Stitcher; Acufex Microsurgical, Norwood, MA). A knot was tied on the capsular side. Repair in group II was made with one 13 mm Biofix Meniscus arrow (Bioscience Ltd, Tampere, Finland). In group III repair was performed like in group II but the menisci were incubated in isotonic saline at 21 degrees C for 24 hours before testing. Menisci in group I and II were tested within 3 hours after defreezing. Prior to testing total separation of central and peripheral part of meniscus was performed. Thus only the repair site was tested. Pull-out tests to failure were made in a computer-based Nene M5 testing machine with a cross-head speed of 5 mm/min. Median failure load in group I: 49 N (range 43 to 77 N), in group II: 53 N (range 42 to 65 N) and in group III: 54 N (range 35 to 74 N). No statistically significant differences in failure load was found between the groups. Thus initial failure strength for arrow-repaired bovine menisci is comparable to that of a horizontal suture.

Periodic Extraction of Interstitial Fluid from the Site of Subcutaneous Insulin Infusion for the Measurement of Glucose: A Novel Single-Port Technique for the Treatment of Type 1 Diabetes Patients

PubMed Central

Lindpointner, Stefan; Korsatko, Stefan; Tutkur, Dina; Bodenlenz, Manfred; Pieber, Thomas R.

2013-01-01

Abstract Background Treatment of type 1 diabetes patients could be simplified if the site of subcutaneous insulin infusion could also be used for the measurement of glucose. This study aimed to assess the agreement between blood glucose concentrations and glucose levels in the interstitial fluid (ISF) that is extracted from the insulin infusion site during periodic short-term interruptions of continuous subcutaneous insulin infusion (CSII). Subjects and Methods A perforated cannula (24 gauge) was inserted into subcutaneous adipose tissue of C-peptide-negative type 1 diabetes subjects (n=13) and used alternately to infuse rapid-acting insulin (100 U/mL) and to extract ISF glucose during a fasting period and after ingestion of a standard oral glucose load (75 g). Results Although periodically interrupted for extracting glucose (every hour for approximately 10 min), insulin infusion with the cannula was adequate to achieve euglycemia during fasting and to restore euglycemia after glucose ingestion. Furthermore, the ISF-derived estimates of plasma glucose levels agreed well with plasma glucose concentrations. Correlation coefficient and median absolute relative difference values were found to be 0.95 and 8.0%, respectively. Error grid analysis showed 99.0% of all ISF glucose values within clinically acceptable Zones A and B (83.5% Zone A, 15.5% Zone B). Conclusions Results show that ISF glucose concentrations measured at the insulin infusion site during periodic short-term interruptions of CSII closely reflect blood glucose levels, thus suggesting that glucose monitoring and insulin delivery may be performed alternately at the same tissue site. A single-port device of this type could be used to simplify and improve glucose management in diabetes. PMID:23126579

A novel curvature-controllable steerable needle for percutaneous intervention.

PubMed

Bui, Van Khuyen; Park, Sukho; Park, Jong-Oh; Ko, Seong Young

2016-08-01

Over the last few decades, flexible steerable robotic needles for percutaneous intervention have been the subject of significant interest. However, there still remain issues related to (a) steering the needle's direction with less damage to surrounding tissues and (b) increasing the needle's maximum curvature for better controllability. One widely used approach is to control the fixed-angled bevel-tip needle using a "duty-cycle" algorithm. While this algorithm has shown its applicability, it can potentially damage surrounding tissue, which has prevented the widespread adoption of this technology. This situation has motivated the development of a new steerable flexible needle that can change its curvature without axial rotation, while at the same time producing a larger curvature. In this article, we propose a novel curvature-controllable steerable needle. The proposed robotic needle consists of two parts: a cannula and a stylet with a bevel-tip. The curvature of the needle's path is controlled by a control offset, defined by the offset between the bevel-tip and the cannula. As a result, the necessity of rotating the whole needle's body is decreased. The duty-cycle algorithm is utilized to a limited degree to obtain a larger radius of curvature, which is similar to a straight path. The first prototype of 0.46 mm (outer diameter) was fabricated and tested with both in vitro gelatin phantom and ex vivo cow liver tissue. The maximum curvatures measured 0.008 mm(-1) in 6 wt% gelatin phantom, 0.0139 mm(-1) in 10 wt% gelatin phantom, and 0.0038 mm(-1) in cow liver. The experimental results show a linear relationship between the curvature and the control offset, which can be utilized for future implementation of this control algorithm. © IMechE 2016.

Novel temporary left ventricular assist system with hydrodynamically levitated bearing pump for bridge to decision: initial preclinical assessment in a goat model.

PubMed

Kishimoto, Satoru; Takewa, Yoshiaki; Tsukiya, Tomonori; Mizuno, Toshihide; Date, Kazuma; Sumikura, Hirohito; Fujii, Yutaka; Ohnuma, Kentaro; Togo, Konomi; Katagiri, Nobumasa; Naito, Noritsugu; Kishimoto, Yuichiro; Nakamura, Yoshinobu; Nishimura, Motonobu; Tatsumi, Eisuke

2018-03-01

The management of heart failure patients presenting in a moribund state remains challenging, despite significant advances in the field of ventricular assist systems. Bridge to decision involves using temporary devices to stabilize the hemodynamic state of such patients while further assessment is performed and a decision can be made regarding patient management. We developed a new temporary left ventricular assist system employing a disposable centrifugal pump with a hydrodynamically levitated bearing. We used three adult goats (body weight, 58-68 kg) to investigate the 30-day performance and hemocompatibility of the newly developed left ventricular assist system, which included the pump, inflow and outflow cannulas, the extracorporeal circuit, and connectors. Hemodynamic, hematologic, and blood chemistry measurements were investigated as well as end-organ effect on necropsy. All goats survived for 30 days in good general condition. The blood pump was operated at a rotational speed of 3000-4500 rpm and a mean pump flow of 3.2 ± 0.6 L min. Excess hemolysis, observed in one goat, was due to the inadequate increase in pump rotational speed in response to drainage insufficiency caused by continuous contact of the inflow cannula tip with the left ventricular septal wall in the early days after surgery. At necropsy, no thrombus was noted in the pump, and no damage caused by mechanical contact was found on the bearing. The newly developed temporary left ventricular assist system using a disposable centrifugal pump with hydrodynamic bearing demonstrated consistent and satisfactory hemodynamic performance and hemocompatibility in the goat model.

Noise levels of neonatal high-flow nasal cannula devices--an in-vitro study.

PubMed

König, Kai; Stock, Ellen L; Jarvis, Melanie

2013-01-01

Excessive ambient noise levels have been identified as a potential risk factor for adverse outcome in very preterm infants. Noise level measurements for continuous positive airway pressure (CPAP) devices demonstrated that these constantly exceed current recommendations. The use of high-flow nasal cannula (HFNC) as an alternative non-invasive ventilation modality has become more popular in recent years in neonatal care. To study noise levels of two HFNC devices commonly used in newborns. As a comparison, noise levels of a continuous flow CPAP device were also studied. In-vitro study. The noise levels of two contemporary HFNC devices (Fisher & Paykel NHF™ and Vapotherm Precision Flow®) and one CPAP device (Dräger Babylog® 8000 plus) were measured in the oral cavity of a newborn manikin in an incubator in a quiet environment. HFNC flows of 4-8 l/min and CPAP pressures of 4-8 cm H2O were applied. The CPAP flow was set at 8 l/min as per unit practice. Vapotherm HFNC generated the highest noise levels, measuring 81.2-91.4 dB(A) with increasing flow. Fisher & Paykel HFNC noise levels were between 78.8 and 81.2 dB(A). The CPAP device generated the lowest noise levels between 73.9 and 77.4 dB(A). Both HFNC devices generated higher noise levels than the CPAP device. All noise levels were far above current recommendations of the American Academy of Pediatrics. In light of the long duration of non-invasive respiratory support of very preterm infants, less noisy devices are required to prevent the potentially adverse effects of continuing excessive noise exposure in the neonatal intensive care unit. Copyright © 2013 S. Karger AG, Basel.

Infusion-line pressure as a real-time monitor of convection-enhanced delivery in pre-clinical models.

PubMed

Lam, Miu Fei; Foo, Stacy W L; Thomas, Meghan G; Lind, Christopher R P

2014-01-15

Acute convection-enhanced delivery (CED) is a neurosurgical delivery technique that allows for precise and uniform distribution of an infusate to a brain structure. It remains experimental due to difficulties in ensuring successful delivery. Real-time monitoring is able to provide immediate feedback on cannula placement, infusate distribution, and if the infusion is proceeding as planned or is failing due to reflux or catheter obstruction. Pressure gradient is the driving force behind CED, with the infusion pressure being directly proportional to the flow-rate. The aim of this study was to assess the feasibility of using infusion-line pressure profiling to distinguish in real-time between succeeding and failing CED infusions. To do so we delivered cresyl violet dye at 0.5, 1.0 and 2.0 μl/min via CED in vitro using 0.6% agarose gel and in vivo to the rat striatum. Infusions that failed in agarose gel models could only be differentiated late during the procedures. In the rat in vivo model, the infusion-line profiles of obstructed infusions were not distinctive from those of successful infusions. Intraoperative magnetic resonance imaging (MRI) is used for real-time visualisation of cannula placement and infusate distribution. Particularly for animal pre-clinical work, it would be advantageous to supplement MRI with a cheap, accessible technique to monitor infusions and provide a real-time measure of infusion success or failure. Infusion-line pressure monitoring was of limited value in identifying successful CED with small volume infusions, whilst its utility for large volume infusion remains unknown. Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.

Refinement of a model of repeated cerebrospinal fluid collection in conscious rats.

PubMed

Amen, Eva Maria; Brecheisen, Muriel; Sach-Peltason, Lisa; Bergadano, Alessandra

2017-02-01

The cannulation of the cisterna magna in rats for in vivo sampling of cerebrospinal fluid serves as a valuable model for studying the delivery of new drugs into the central nervous system or disease models. It offers the advantages of repeated sampling without anesthesia-induced bias and using animals as their own controls. An established model was retrospectively reviewed for the outcomes and it was hypothesized that by refining the method, i.e. by (1) implementing pathophysiological-based anesthesia and analgesia, (2) using state-of-the-art peri-operative monitoring and supportive care, (3) increasing stability of the cement-cannula assembly, and (4) selecting a more adaptable animal strain, the outcome in using the model - quantified by peri-operative mortality, survival time and stability of the implant - could be improved and could enhance animal welfare. After refinement of the technique, peri-operative mortality decreased significantly (7 animals out of 73 compared with 4 out of 322; P = 0.001), survival time increased significantly (36 ± 14 days compared with 28 ± 18 days; P < 0.001), as well as the stability of the cement-cannula assembly (47 ± 8 days of adhesion compared with 33 ± 15 days and 34 ± 13 days using two other cement types; P < 0.001). Overall, the 3R concept of Russell and Burch was successfully addressed and animal welfare was improved by (1) the reduction in the total number of animals needed as a result of lower mortality or fewer euthanizations due to technical failure, and frequent use of individual rats over a time frame; and (2) improving the scientific quality of the model.

Randomized Comparison of Helmet CPAP Versus High-Flow Nasal Cannula Oxygen in Pediatric Respiratory Distress.

PubMed

Vitaliti, Giovanna; Vitaliti, Maria Concetta; Finocchiaro, Maria Carla; Di Stefano, Vita Antonella; Pavone, Piero; Matin, Nassim; Motamed-Gorji, Nazgol; Lubrano, Riccardo; Falsaperla, Raffaele

2017-08-01

The current study aimed to compare the efficacy and safety of 2 noninvasive respiratory support methods, which included helmet CPAP and high-flow nasal cannula (HFNC) in children with respiratory distress admitted to a pediatric intermediate care unit. This study was a prospective observational study conducted on children with respiratory distress (age 1-24 months) who were admitted to our acute and emergency operative unit. All included subjects were randomly treated with helmet CPAP or HFNC in a 1:1 fashion until their clinical picture, oxygen saturation, and arterial blood gas (ABG) parameters resolved. The efficiencies of helmet CPAP and HFNC were evaluated by breathing frequency, S pO 2 , ABG pH, ABG P aCO 2 , ABG P aO 2 , and P aO 2 /F IO 2 , recorded once at baseline and then after 1 and 6 h of treatment. Both noninvasive respiratory support modalities were compared with a control group of subjects with respiratory distress under standard therapeutic pharmaceutical protocols. We found that both helmet CPAP and HFNC were efficient in improving the clinical conditions of subjects with mild-to-moderate respiratory distress, although clinical response to helmet CPAP was more efficient and rapid compared with HFNC. Children who received respiratory support had a better clinical course in terms of hospitalization, days of intravenous rehydration therapy, and days of drug administration compared with the control group ( P < .001). Based on our knowledge, the present study is the first research comparing the effects of CPAP and HFNC in respiratory distress resolution in a pediatric intermediate care setting. It aims to identify the most efficient treatment to avoid pediatric ICU admissions and endotracheal intubation and reduce the administration of drugs and days of hospitalization. Copyright © 2017 by Daedalus Enterprises.

High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants.

PubMed

Taha, Dalal K; Kornhauser, Michael; Greenspan, Jay S; Dysart, Kevin C; Aghai, Zubair H

2016-06-01

To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP). This is a retrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis. A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035-1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group. In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants. Copyright © 2016 Elsevier Inc. All rights reserved.

High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants

PubMed Central

Taha, Dalal K.; Kornhauser, Michael; Greenspan, Jay S.; Dysart, Kevin C.; Aghai, Zubair H.

2017-01-01

Objective To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP). Study design This is aretrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤ 1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis. Results A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035–1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group. Conclusions In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants. PMID:27004673

Clinical Effectiveness of High-Flow Nasal Cannula in Hypoxaemic Patients during Bronchoscopic Procedures.

PubMed

Chung, Sang Mi; Choi, Ju Whan; Lee, Young Seok; Choi, Jong Hyun; Oh, Jee Youn; Min, Kyung Hoon; Hur, Gyu Young; Lee, Sung Yong; Shim, Jae Jeong; Kang, Kyung Ho

2018-06-19

Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure. We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017. Ten patients (44-75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation (SpO₂) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air SpO₂ pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases. This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: a systematic review of randomized-controlled trials.

PubMed

Beng Leong, Lim; Wei Ming, Ng; Wei Feng, Lee

2018-06-19

We reviewed the use of noninvasive ventilation (NIV) versus high flow nasal cannula (HFNC) oxygen in adult acute respiratory failure (ARF). We searched major databases and included randomized trials comparing at least NIV with HFNC or NIV+HFNC with NIV in ARF. Primary outcomes included intubation/re-intubation rates. Secondary outcomes were ICU mortality and morbidities. Five trials were included; three compared HFNC with NIV, one compared HFNC, NIV and oxygen whereas one compared HFNC+NIV with NIV. Patients had hypoxaemic ARF (PaO2/FiO2≤300 mmHg). Heterogeneity prevented result pooling. Three and two studies had superiority and noninferiority design, respectively. Patients were postcardiothoracic surgery, mixed medical/surgical patients and those with pneumonia. Two trials were conducted after extubation, two before intubation and one during intubation. Three trials reported intubation/re-intubation rates as the primary outcomes. The other two trials reported the lowest peripheral capillary oxygen saturation readings during bronchoscopy or intubation. In the former three trials, the odds ratio for intubation/re-intubation rates between HFNC versus the NIV group ranged from 0.80 (95% confidence interval: 0.54-1.19) to 1.65 (95% confidence interval: 0.96-2.84). In the latter two trials, only one reported a difference in the lowest peripheral capillary oxygen saturation between NIV+HFNC versus the NIV group during intubation [100% (interquartile range: 95-100) vs. 96% (interquartile range: 92-99); P=0.029]. The secondary outcomes included differences in ICU mortality and patient tolerability, favouring HFNC, were conflicting, but highlighted future research directions. These include patients with hypercapneic ARF, more severe hypoxaemia (PaO2/FiO2≤200 mmHg), a superiority design, an oxygen arm and patient-centred outcomes.

A new technique for repeated biopsies of the mammary gland in dairy cows allotted to Latin-square design studies

PubMed Central

de Lima, Luciano S.; Martineau, Eric; De Marchi, Francilaine E.; Palin, Marie-France; dos Santos, Geraldo T.; Petit, Hélène V.

2016-01-01

The objective of this study was to develop a technique for carrying out repeated biopsies of the mammary gland of lactating dairy cows that provides enough material to monitor enzyme activities and gene expression in mammary secretory tissue. A total of 16 Holstein cows were subjected to 4 mammary biopsies each at 3-week intervals for a total of 64 biopsies. A 0.75-cm incision was made through the skin and subcutaneous tissue of the mammary gland and a trocar and cannula were inserted using a circular motion. The trocar was withdrawn and a syringe was plugged into the base of the cannula to create a vacuum for sampling mammary tissue. To reduce bleeding, hand pressure was put on the surgery site after biopsy and skin closure and ice was applied for at least 2 h after the biopsy using a cow bra. The entire procedure took an average of 25 min. Two attempts were usually enough to obtain 800 mg of tissue. Visual examination of milk samples 10 d after the biopsy indicated no trace of blood, except in samples from 2 cows. All wounds healed without infection and subcutaneous hematomas resorbed within 7 d. There was no incidence of mastitis throughout the lactation. This technique provides a new tool for biopsy of the mammary gland repeated at short intervals with the main effect being a decrease in milk production. Although secondary complications leading to illness or death are always a risk with any procedure, this biopsy technique was carried out without complications to the health of animals and with no incidence of mastitis during the lactation. PMID:27408336

A new technique for repeated biopsies of the mammary gland in dairy cows allotted to Latin-square design studies.

PubMed

de Lima, Luciano S; Martineau, Eric; De Marchi, Francilaine E; Palin, Marie-France; Dos Santos, Geraldo T; Petit, Hélène V

2016-07-01

The objective of this study was to develop a technique for carrying out repeated biopsies of the mammary gland of lactating dairy cows that provides enough material to monitor enzyme activities and gene expression in mammary secretory tissue. A total of 16 Holstein cows were subjected to 4 mammary biopsies each at 3-week intervals for a total of 64 biopsies. A 0.75-cm incision was made through the skin and subcutaneous tissue of the mammary gland and a trocar and cannula were inserted using a circular motion. The trocar was withdrawn and a syringe was plugged into the base of the cannula to create a vacuum for sampling mammary tissue. To reduce bleeding, hand pressure was put on the surgery site after biopsy and skin closure and ice was applied for at least 2 h after the biopsy using a cow bra. The entire procedure took an average of 25 min. Two attempts were usually enough to obtain 800 mg of tissue. Visual examination of milk samples 10 d after the biopsy indicated no trace of blood, except in samples from 2 cows. All wounds healed without infection and subcutaneous hematomas resorbed within 7 d. There was no incidence of mastitis throughout the lactation. This technique provides a new tool for biopsy of the mammary gland repeated at short intervals with the main effect being a decrease in milk production. Although secondary complications leading to illness or death are always a risk with any procedure, this biopsy technique was carried out without complications to the health of animals and with no incidence of mastitis during the lactation.

Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis.

PubMed

Ni, Yue-Nan; Luo, Jian; Yu, He; Liu, Dan; Ni, Zhong; Cheng, Jiangli; Liang, Bin-Miao; Liang, Zong-An

2017-04-01

The effects of high-flow nasal cannula (HFNC) on adult patients with acute respiratory failure (ARF) are controversial. We aimed to further determine the effectiveness of HFNC in reducing the rate of endotracheal intubation in adult patients with ARF by comparison to noninvasive positive pressure ventilation (NIPPV) and conventional oxygen therapy (COT). The PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials databases, as well as the Information Sciences Institute Web of Science, were searched for all controlled studies that compared HFNC with NIPPV and COT in adult patients with ARF. The primary outcome was the rate of endotracheal intubation; the secondary outcomes were ICU mortality and length of ICU stay. Eighteen trials with a total of 3,881 patients were pooled in our final studies. Except for ICU mortality (I 2  = 67%, χ 2  = 12.21, P = .02) and rate of endotracheal intubation (I 2  = 63%, χ 2  = 13.51, P = .02) between HFNC and NIPPV, no significant heterogeneity was found in outcome measures. Compared with COT, HFNC was associated with a lower rate of endotracheal intubation (z = 2.55, P = .01) while no significant difference was found in the comparison with NIPPV (z = 1.40, P = .16). As for ICU mortality and length of ICU stay, HFNC did not exhibit any advantage over either COT or NIPPV. In patients with ARF, HFNC is a more reliable alternative than NIPPV to reduce the rate of endotracheal intubation than COT. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study).

PubMed

Milési, Christophe; Essouri, Sandrine; Pouyau, Robin; Liet, Jean-Michel; Afanetti, Mickael; Portefaix, Aurélie; Baleine, Julien; Durand, Sabine; Combes, Clémentine; Douillard, Aymeric; Cambonie, Gilles

2017-02-01

Nasal continuous positive airway pressure (nCPAP) is currently the gold standard for respiratory support for moderate to severe acute viral bronchiolitis (AVB). Although oxygen delivery via high flow nasal cannula (HFNC) is increasingly used, evidence of its efficacy and safety is lacking in infants. A randomized controlled trial was performed in five pediatric intensive care units (PICUs) to compare 7 cmH 2 O nCPAP with 2 L/kg/min oxygen therapy administered with HFNC in infants up to 6 months old with moderate to severe AVB. The primary endpoint was the percentage of failure within 24 h of randomization using prespecified criteria. To satisfy noninferiority, the failure rate of HFNC had to lie within 15% of the failure rate of nCPAP. Secondary outcomes included success rate after crossover, intubation rate, length of stay, and serious adverse events. From November 2014 to March 2015, 142 infants were included and equally distributed into groups. The risk difference of -19% (95% CI -35 to -3%) did not allow the conclusion of HFNC noninferiority (p = 0.707). Superiority analysis suggested a relative risk of success 1.63 (95% CI 1.02-2.63) higher with nCPAP. The success rate with the alternative respiratory support, intubation rate, durations of noninvasive and invasive ventilation, skin lesions, and length of PICU stay were comparable between groups. No patient had air leak syndrome or died. In young infants with moderate to severe AVB, initial management with HFNC did not have a failure rate similar to that of nCPAP. This clinical trial was recorded in the National Library of Medicine registry (NCT 02457013).

The effect of high flow nasal cannula oxygen therapy on middle ear pressure.

PubMed

Piastro, Kristina; Chaskes, Mark; Agarwal, Jay; Parnes, Steven

2016-01-01

To investigate the effect of high flow nasal cannula oxygen therapy (HFOT) on middle ear pressure. Ten patients (eight males and two females) with oxygen desaturations requiring HFOT were recruited with 19 ears available for our study. The study group was aged 29-90years (mean 65.3±16.5). All patients underwent a review of medical history, questioned about subjective hearing loss and underwent a standard otologic exam, with middle ear pressures measured with a GSI TympStar tympanometer. The middle ear peak pressures in our study group ranged from 25 to -200daPa (mean -13.7±56.3daPa). Volume of HFOT was delivered at 20-40L (mean 30.5±9L) and fraction of inspired oxygen required was 30-70% (mean 58±13%). There was a positive correlation between liters of oxygen delivery and middle ear pressure with a Pearson coefficient (R) of 0.436, although lacking statistical significance (p=0.06). Previous studies have shown that HFOT delivered in the range of 35-40L/min produces pharyngeal pressures at or above 5cm H2O. Since pharyngeal pressures of 5cm H2O produced via CPAP have shown to produce middle ear pressures above 40daPa, we expected HFOT to result in similar middle ear pressures of 35-40L/min. However, although our results show an increase in middle ear pressures with flow volume, HFOT did not produce significant increases in middle ear pressures. This may make HFOT an appropriate option of oxygen delivery to patients who require otologic procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Accuracy of Administrative Codes for Distinguishing Positive Pressure Ventilation from High-Flow Nasal Cannula.

PubMed

Good, Ryan J; Leroue, Matthew K; Czaja, Angela S

2018-06-07

Noninvasive positive pressure ventilation (NIPPV) is increasingly used in critically ill pediatric patients, despite limited data on safety and efficacy. Administrative data may be a good resource for observational studies. Therefore, we sought to assess the performance of the International Classification of Diseases, Ninth Revision procedure code for NIPPV. Patients admitted to the PICU requiring NIPPV or heated high-flow nasal cannula (HHFNC) over the 11-month study period were identified from the Virtual PICU System database. The gold standard was manual review of the electronic health record to verify the use of NIPPV or HHFNC among the cohort. The presence or absence of a NIPPV procedure code was determined by using administrative data. Test characteristics with 95% confidence intervals (CIs) were generated, comparing administrative data with the gold standard. Among the cohort ( n = 562), the majority were younger than 5 years, and the most common primary diagnosis was bronchiolitis. Most (82%) required NIPPV, whereas 18% required only HHFNC. The NIPPV code had a sensitivity of 91.1% (95% CI: 88.2%-93.6%) and a specificity of 57.6% (95% CI: 47.2%-67.5%), with a positive likelihood ratio of 2.15 (95% CI: 1.70-2.71) and negative likelihood ratio of 0.15 (95% CI: 0.11-0.22). Among our critically ill pediatric cohort, NIPPV procedure codes had high sensitivity but only moderate specificity. On the basis of our study results, there is a risk of misclassification, specifically failure to identify children who require NIPPV, when using administrative data to study the use of NIPPV in this population. Copyright © 2018 by the American Academy of Pediatrics.

Enhancement of extinction memory consolidation: the role of the noradrenergic and GABAergic systems within the basolateral amygdala.

PubMed

Berlau, Daniel J; McGaugh, James L

2006-09-01

Evidence from previous studies indicates that the noradrenergic and GABAergic influences within the basolateral amygdala (BLA) modulate the consolidation of memory for fear conditioning. The present experiments investigated whether the same modulatory influences are involved in regulating the extinction of fear-based learning. To investigate this issue, male Sprague Dawley rats implanted with unilateral or bilateral cannula aimed at the BLA were trained on a contextual fear conditioning (CFC) task and 24 and 48 h later were given extinction training. Immediately following each extinction session they received intra-BLA infusions of the GABAergic antagonist bicuculline (50 ng), the beta-adrenocepter antagonist propranolol (500 ng), bicuculline with propranolol, norepinephrine (NE) (0.3, 1.0, and 3.0 microg), the GABAergic agonist muscimol (125 ng), NE with muscimol or a control solution. To investigate the involvement of the dorsal hippocampus (DH) as a possible target of BLA activation during extinction, other animals were given infusions of muscimol (500 ng) via an ipsilateral cannula implanted in the DH. Bilateral BLA infusions of bicuculline significantly enhanced extinction, as did infusions into the right, but not left BLA. Propranolol infused into the right BLA together with bicuculline blocked the bicuculline-induced memory enhancement. Norepinephrine infused into the right BLA also enhanced extinction, and this effect was not blocked by co-infusions of muscimol. Additionally, muscimol infused into the DH did not attenuate the memory enhancing effects of norepinephrine infused into the BLA. These findings provide evidence that, as with original CFC learning, noradrenergic activation within the BLA modulates the consolidation of CFC extinction. The findings also suggest that the BLA influence on extinction is not mediated by an interaction with the dorsal hippocampus.

Ultrasound and bronchoscopic controlled percutaneous tracheostomy on trauma ICU.

PubMed

Kollig, E; Heydenreich, U; Roetman, B; Hopf, F; Muhr, G

2000-11-01

Tracheostomy is a common surgical procedure performed in long-term ventilated patients in intensive care. Since the role of percutaneous dilatational tracheostomy (PDT) on Intensive Care Unit (ICU) has become steadily more important in the last few years, a prospective study was started to evaluate the economic efficiency and to show the minimization of the complication rate of this procedure. In 72 patients we performed PDT as a bedside procedure. Initially the thyroid gland and the subcutaneous vessels were studied by ultrasound in every patient. The puncture of the trachea, the dilatational procedure and the insertion of the tracheal cannula were executed under bronchoscopic monitoring. Finally, a bronchoscopic control view followed via the new cannula to detect intratracheal complications. Mechanical ventilation was maintained during the procedure and controlled by continuous pulse oximetry. According to prior ultrasound findings the place to puncture the trachea was changed in 24% of the patients, in one case tracheostomy was performed as an open conventional procedure. The following complications could be observed: one case involving perforation of a cartilaginous ring, one case with venous bleeding of a small subcutaneous vein and two cases with punctures of the bronchoscope. There were no cases of miscannulation, penetration of the posterior tracheal wall or major bleeding requiring intervention or conversion. The followup study revealed that there was no sign of further complications in any patient. In addition, cost analysis demonstrated that there was a significant economical advantage of PDT in comparison with open standard tracheostomy. Standardized ultrasonographically and bronchoscopically controlled PDT turns out to be a safe, simple and cost effective bedside procedure on ICU. Because of ultrasound examination performed before the procedure, and bronchoscopic surveillance during the procedure, safety of this procedure can be enhanced, thus minimizing the rate of complications.

The clinical practice of high-flow nasal cannula oxygen therapy in adults: A Japanese cross-sectional multicenter survey.

PubMed

Ito, Jiro; Nagata, Kazuma; Sato, Susumu; Shiraki, Akira; Nishimura, Naoki; Izumi, Shinyu; Tachikawa, Ryo; Morimoto, Takeshi; Tomii, Keisuke

2018-05-01

High-flow nasal cannula oxygen therapy (HFNC) is widely used mainly in the acute care setting, but limited data are available on real-world practice in adults. The objective of this study was to describe HFNC practices in Japanese adults. A retrospective cross-sectional multicenter survey of adult patients receiving HFNC from January through March 2015 was conducted in 33 participating hospitals in Japan. We obtained information on 321 patients (median age, 76; 218 men, 103 women; median estimated PaO 2 /F I O 2, 178 mm Hg) from 22 hospitals. Do-not-intubate status was determined in 37.4% of patients. Prior to HFNC, 57.9% of patients received conventional oxygen therapy; 25.9%, noninvasive ventilation; and 15.0%, invasive mechanical ventilation. The common indications for HFNC were acute hypoxemic respiratory failure (ARF) (65.4%), postoperative respiratory support (15.9%), and post-extubation respiratory support (11.2%). The underlying etiology of ARF included interstitial lung disease, pneumonia, and cardiogenic pulmonary edema. HFNC was administered mostly in intensive care units or intermittent care units (60.7%) and general wards (36.1%). Median duration of HFNC was 4 days; median total flow rate, 40 L/min; and median F I O 2 , 50%. HFNC significantly improved PaO 2 , PaCO 2 , SpO 2 and respiratory rate from baseline. Two-thirds of patients finally survived to be discharged or transferred. We documented patient demographics, clinical indications, and settings of HFNC use in the real world. We also demonstrated positive effects of HFNC on respiratory parameters. Further studies are urgently needed regarding the efficacy and safety of HFNC in populations outside of previous clinical trials. Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study.

PubMed

Zimmermann, Markus; Bein, Thomas; Arlt, Matthias; Philipp, Alois; Rupprecht, Leopold; Mueller, Thomas; Lubnow, Matthias; Graf, Bernhard M; Schlitt, Hans J

2009-01-01

Pumpless interventional lung assist (iLA) is used in patients with acute respiratory distress syndrome (ARDS) aimed at improving extracorporeal gas exchange with a membrane integrated in a passive arteriovenous shunt. In previous studies, feasibility and safety of the iLA system was demonstrated, but no survival benefit was observed. In the present pilot study we tested the hypothesis that timely initiation of iLA using clear algorithms and an improved cannulation technique will positively influence complication rates and management of lung protective ventilation. iLA was implemented in 51 patients from multiple aetiologies meeting ARDS-criteria (American-European Consensus) for more than 12 hours. Initiation of iLA followed an algorithm for screening, careful evaluation and insertion technique. Patients with cardiac insufficiency or severe peripheral vascular disease were not considered suitable for iLA. Arterial and venous cannulae were inserted using a new strategy (ultrasound evaluation of vessels by an experienced team, using cannulae of reduced diameter). The incidence of complications and the effects on tidal volumes and inspiratory plateau pressures were primary outcome parameters, while oxygenation improvement and carbon dioxide removal capabilities were secondary study parameters. Initiation of iLA resulted in a marked removal in arterial carbon dioxide allowing a rapid reduction in tidal volume (

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method.

PubMed

Lee, Yong Kyu; Yang, Pil-Sung; Park, Kyoung Sook; Choi, Kyu Hun; Kim, Beom Seok

2015-07-01

The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min±16 min vs. 1 h 36 min±19 min, p<0.01), immediate post-procedural pain (2.43±1.80 vs. 3.14±2.07, p<0.05), and post-procedure days until ambulation (3.95±1.13 days vs. 6.17±1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71±7.05 days vs. 13.86±3.7 days). Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

PubMed Central

Lee, Yong Kyu; Yang, Pil-Sung; Park, Kyoung Sook; Choi, Kyu Hun

2015-01-01

Purpose The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. Materials and Methods Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. Results Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min±16 min vs. 1 h 36 min±19 min, p<0.01), immediate post-procedural pain (2.43±1.80 vs. 3.14±2.07, p<0.05), and post-procedure days until ambulation (3.95±1.13 days vs. 6.17±1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71±7.05 days vs. 13.86±3.7 days). Conclusion Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences. PMID:26069120

Assessment of oxygen supplementation during air travel.

PubMed Central

Cramer, D.; Ward, S.; Geddes, D.

1996-01-01

BACKGROUND: The aim of this study was to simulate an in flight environment at sea level with a fractional inspired concentration of oxygen (FiO2) of 0.15 to determine how much supplemental oxygen was needed to restore a subject's oxygen saturation (SaO2) to 90% or to the level previously attained when breathing room air (FiO2 of 0.21). METHODS: Three groups were selected with normal, obstructive, and restrictive lung function. Using a sealed body plethysmograph an environment with an FiO2 of 0.15 was created and mass spectrometry was used to monitor the FiO2. Supplemental oxygen was administered to the patient by nasal cannulae. SaO2 was continuously monitored and recorded at an FiO2 of 0.21, 0.15, and 0.15 + supplemental oxygen. RESULTS: When given 2 l/m of supplemental oxygen all patients in the 15% environment returned to a similar SaO2 value as that obtained using the 21% oxygen environment. One patient with airways obstruction needed 3 l/m of supplemental oxygen to raise his SaO2 above 90%. CONCLUSIONS: This technique, which simulates an aircraft environment, enables an accurate assessment to be made of supplemental oxygen requirements. PMID:8711658

Strychnine inhibits inflammatory angiogenesis in mice via down regulation of VEGF, TNF-α and TGF-β.

PubMed

Saraswati, Sarita; Agarwal, S S

2013-05-01

Strychnine is known to possess anti-inflammatory and antitumour activity, but its roles in tumour angiogenesis, the key step involved in tumour growth and metastasis, and the involved molecular mechanism are still unknown. We aimed to investigate the effects of strychnine on key components of inflammatory angiogenesis in the murine cannulated sponge implant angiogenesis model. Polyester-polyurethane sponges, used as a framework for fibrovascular tissue growth, were implanted in Swiss albino mice and strychnine (0.25, and 0.5 mg/kg/day) was given through installed cannulas for 9 days. The implants collected at day 9 postimplantation were processed for the assessment of haemoglobin (Hb), myeloperoxidase (MPO), N-acetylglucosaminidase (NAG) and collagen used as indexes for angiogenesis, neutrophil and macrophage accumulation and extracellular matrix deposition, respectively. Relevant inflammatory, angiogenic and fibrogenic cytokines were also determined. Strychnine treatment attenuated the main components of the fibrovascular tissue, wet weight, vascularization (Hb content), macrophage recruitment (NAG activity), collagen deposition and the levels of vascular endothelial growth factor (VEGF), tumour necrosis factor (TNF)-α and transforming growth factor (TGF-β). A regulatory function of strychnine on multiple parameters of main components of inflammatory angiogenesis has been revealed giving insight into the potential therapeutic underlying the actions of strychnine. Copyright © 2013 Elsevier Inc. All rights reserved.

Postimplant left ventricular assist device fit analysis using three-dimensional reconstruction.

PubMed

Truong, Thang V; Stanfield, J Ryan; Chaffin, John S; Elkins, C Craig; Kanaly, Paul J; Horstmanshof, Douglas A; Long, James W; Snyder, Trevor A

2013-01-01

Left ventricular assist devices (LVADs) are blood pumps that augment the function of the failing heart to improve perfusion, resulting in improved survival. For LVADs to effectively unload the left ventricle, the inflow cannula (IC) should be unobstructed and ideally aligned with the heart's mitral valve (MV). We examined IC orientation deviation from a hypothesized conventional angle (45° right-posterior) and the approximate angle for direct IC-MV alignment in many patients. Three-dimensional anatomic models were created from computed tomography scans for 24 LVAD-implanted patients, and angles were measured between the IC and the apical z-axis in both the coronal and the sagittal planes. Common surgical IC angulation was found to be 22 ± 15° rightward and 21 ± 12° posterior from the apical z-axis; 38% (n = 9) of patients fell in this range. Direct IC-MV angulation was found to be 34 ± 8° rightward and 15 ± 7° posterior; only 8% (n = 2) of patients fell in this range. Rightward deviation toward ventricular septal wall and anterior deviation toward LV anterior freewall are associated with mortalities more so than leftward and posterior deviation. In conclusion, anatomic reconstruction may be a useful preoperative tool to obtain general population and patient-specific alignment for optimal LVAD implantation.

Dorsal aorta catheterization in rainbow trout (Salmo gairdneri) I. Its validity in the study of blood gonadotropin patterns.

PubMed

Zohar, Y

1980-01-01

The use of a dorsal aorta catheterization technique to study gonadotropin secretion patterns in the rainbow trout was tested. Heparin used to flush the cannula between repetitive samplings did not have any effect on plasma GTH levels. Catheterization resulted in a slight short-term change in those levels. The gonadotropin levels returned to their initial values as soon as 30 min to 6 hrs after the operation. From then on, the GTH levels remained close to the initial values in fish exhibiting normal feeding behaviour, whereas they tended to decrease in "stressed" females which did not eat normally. The fish which adapted well to dorsal aortic catheterization did not show any changes in the diurnal pattern of GTH levels or in normal gonadal function and GTH profiles during the processes of oocyte maturation and ovulation. It is concluded that individual catheterized trout can be used advantageously for studying gonadotropin secretion patterns after a 3-day recovery period and the elimination of those fish which neither resume normal feeding nor return to initial, pre-operative GTH levels. Using this technique, it was demonstrated that hypophysial GTH release in trout with oocytes undergoing active vitellogenesis is probably effected by short-term bursts (pulses) of secretion.

Preliminary Study on Biosynthesis of Bacterial Nanocellulose Tubes in a Novel Double-Silicone-Tube Bioreactor for Potential Vascular Prosthesis.

PubMed

Hong, Feng; Wei, Bin; Chen, Lin

2015-01-01

Bacterial nanocellulose (BNC) has demonstrated a tempting prospect for applications in substitute of small blood vessels. However, present technology is inefficient in production and BNC tubes have a layered structure that may bring danger after implanting. Double oxygen-permeable silicone tubes in different diameters were therefore used as a tube-shape mold and also as oxygenated supports to construct a novel bioreactor for production of the tubular BNC materials. Double cannula technology was used to produce tubular BNC via cultivations with Acetobacter xylinum, and Kombucha, a symbiosis of acetic acid bacteria and yeasts. The results indicated that Kombucha gave higher yield and productivity of BNC than A. xylinum. Bacterial nanocellulose was simultaneously synthesized both on the inner surface of the outer silicone tube and on the outer surface of the inner silicone tube. Finally, the nano BNC fibrils from two directions formed a BNC tube with good structural integrity. Scanning electron microscopy inspection showed that the tubular BNC had a multilayer structure in the beginning but finally it disappeared and an intact BNC tube formed. The mechanical properties of BNC tubes were comparable with the reported value in literatures, demonstrating a great potential in vascular implants or in functional substitutes in biomedicine.

Preliminary Study on Biosynthesis of Bacterial Nanocellulose Tubes in a Novel Double-Silicone-Tube Bioreactor for Potential Vascular Prosthesis

PubMed Central

Wei, Bin; Chen, Lin

2015-01-01

Bacterial nanocellulose (BNC) has demonstrated a tempting prospect for applications in substitute of small blood vessels. However, present technology is inefficient in production and BNC tubes have a layered structure that may bring danger after implanting. Double oxygen-permeable silicone tubes in different diameters were therefore used as a tube-shape mold and also as oxygenated supports to construct a novel bioreactor for production of the tubular BNC materials. Double cannula technology was used to produce tubular BNC via cultivations with Acetobacter xylinum, and Kombucha, a symbiosis of acetic acid bacteria and yeasts. The results indicated that Kombucha gave higher yield and productivity of BNC than A. xylinum. Bacterial nanocellulose was simultaneously synthesized both on the inner surface of the outer silicone tube and on the outer surface of the inner silicone tube. Finally, the nano BNC fibrils from two directions formed a BNC tube with good structural integrity. Scanning electron microscopy inspection showed that the tubular BNC had a multilayer structure in the beginning but finally it disappeared and an intact BNC tube formed. The mechanical properties of BNC tubes were comparable with the reported value in literatures, demonstrating a great potential in vascular implants or in functional substitutes in biomedicine. PMID:26090420

Nicotine abstinence syndrome precipitated by central but not peripheral hexamethonium.

PubMed

Malin, D H; Lake, J R; Schopen, C K; Kirk, J W; Sailer, E E; Lawless, B A; Upchurch, T P; Shenoi, M; Rajan, N

1997-11-01

A rodent model of nicotine dependence has been developed based on continuous subcutaneous (s.c.) infusion of nicotine tartrate. Nicotine abstinence syndrome was precipitated by s.c. injection of the nicotinic antagonist mecamylamine, which freely crosses the blood-brain barrier. In contrast, the nicotinic antagonist hexamethonium crosses the blood-brain barrier very poorly. This study determined whether central or peripheral administration of hexamethonium could precipitate nicotine abstinence. In the first experiment, 26 nicotine-dependent rats were injected s.c. with 0.5, 5 or 10 mg/kg hexamethonium dichloride or saline alone and observed for 20 min. Few abstinence signs were observed in any group; there was no significant drug effect. In the second experiment, 18 rats were cannulated in the third ventricle and rendered nicotine dependent. One week later, rats were injected through the cannula with 12 or 18 ng hexamethonium or saline alone and observed for 20 min. Both dose groups differed significantly from the saline-injected group, and there was a significant positive linear trend of signs as a function of dose. The high dose had no significant effect in 14 nondependent rats. We conclude that hexamethonium is much more potent by the central route, and there is a major central nervous system component in nicotine dependence.

Interaction of serotonin and cholecystokinin in the lateral parabrachial nucleus to control sodium intake.

PubMed

Fratucci De Gobbi, J I; De Luca, L A; Johnson, A K; Menani, J V

2001-05-01

Serotonin [5-hydroxytryptamine (5-HT)] and CCK injected into the lateral parabrachial nucleus (LPBN) inhibit NaCl and water intake. In this study, we investigated interactions between 5-HT and CCK into the LPBN to control water and NaCl intake. Male Holtzman rats with cannulas implanted bilaterally in the LPBN were treated with furosemide + captopril to induce water and NaCl intake. Bilateral LPBN injections of high doses of the 5-HT antagonist methysergide (4 microg) or the CCK antagonist proglumide (50 microg), alone or combined, produced similar increases in water and 1.8% NaCl intake. Low doses of methysergide (0.5 microg) + proglumide (20 microg) produced greater increases in NaCl intake than when they were injected alone. The 5-HT(2a/2c) agonist 2,5-dimetoxy-4-iodoamphetamine hydrobromide (DOI; 5 microg) into the LPBN reduced water and NaCl intake. After proglumide (50 microg) + DOI treatment, the intake was not different from vehicle treatment. CCK-8 (1 microg) alone produced no effect. CCK-8 combined with methysergide (4 microg) reduced the effect of methysergide on NaCl intake. The data suggest that functional interactions between 5-HT and CCK in the LPBN may be important for exerting inhibitory control of NaCl intake.

Effects of Dietary Forage and Calf Starter Diet on Ruminal pH and Bacteria in Holstein Calves during Weaning Transition

PubMed Central

Kim, Yo-Han; Nagata, Rie; Ohtani, Natsuki; Ichijo, Toshihiro; Ikuta, Kentaro; Sato, Shigeru

2016-01-01

We investigated the relationship between ruminal pH and bacteria in calves fed calf starter with and without forage during weaning transition. First, 16 Holstein bull calves were obtained from dairy farms and equipped with rumen cannulas by cannulation surgery. Then, calves (73.5 ± 4.2 kg; mean ± SE) were assigned to groups fed calf starter either with forage (HAY, n = 8) or without forage (CON, n = 8), and all calves were weaned at 8 weeks of age. Ruminal pH was measured continuously, and rumen fluid samples were collected at 7, 8, 9, and 11 weeks of age, namely −1, 0, 1, and 3 weeks after weaning, respectively, to assess volatile fatty acid concentrations and bacterial DNA. The 24-h mean ruminal pH was significantly (P < 0.05) different between the two groups. Diurnal changes in the 1-h mean ruminal pH were observed throughout the study in the HAY group; however, they were not observed at 0 and 1 weeks after weaning in the CON group. Moreover, the HAY group had significantly (P < 0.05) higher proportions of acetate and butyrate and lower proportion of propionate, and significantly (P < 0.05) lower ruminal acetate-to-propionate ratios were observed in the CON group. The ruminal bacterial diversity indices decreased after −1 week in both groups and increased at 0 and 1 weeks after weaning in the HAY and CON groups, respectively. From the 454 pyrosequencing analysis, significant differences (P < 0.05) were observed in the relative abundance of several phyla (Bacteroidetes, Actinobacteria, and Tenericutes) and one genus (Prevotella) between the two groups. From quantitative real-time PCR analysis, the HAY group had the higher copy numbers of cellulolytic bacteria (Ruminococcus flavefaciens and Ruminococcus albus) compared with the CON group. This study demonstrated that feeding of dietary forage alleviates subacute ruminal acidosis due to diurnal changes in ruminal pH. Furthermore, changes in ruminal pH affect the ruminal bacterial diversity and relative abundance, and these changes might have influenced the establishment of fermentative ruminal functions during weaning transition. PMID:27818645

Prediction of the external work of the native heart from the dynamic H-Q curves of the rotary blood pumps during left heart bypass.

PubMed

Yokoyama, Yoshimasa; Kawaguchi, Osamu; Kitao, Takashi; Kimura, Taro; Steinseifer, Ulrich; Takatani, Setsuo

2010-09-01

The ventricular performance is dependent on the drainage effect of rotary blood pumps (RBPs) and the performance of RBPs is affected by the ventricular pulsation. In this study, the interaction between the ventricle and RBPs was examined using the pressure-volume (P-V) diagram of the ventricle and dynamic head pressure-bypass flow (H-Q) curves (H, head pressure: arterial pressure minus ventricular pressure vs. Q, bypass flow) of the RBPs. We first investigated the relationships in a mock loop with a passive fill ventricle, followed by validation in ex vivo animal experiments. An apical drainage cannula with a micro-pressure sensor was especially fabricated to obtain ventricular pressure, while three pairs of ultrasonic crystals placed on the heart wall were used to derive ventricular volume. The mock loop-configured ventricular apical-descending aorta bypass revealed that the external work of the ventricle expressed by the area inside the P-V diagrams (EW(Heart) ) correlated strongly with the area inside dynamic H-Q curves (EW(VAD)), with the coefficients of correlation being R² = 0.869 ∼ 0.961. The results in the mock loop were verified in the ex vivo studies using three Shiba goats (10-25 kg in body weight), showing the correlation coefficients of R² = 0.802 ∼ 0.817. The linear regression analysis indicated that the increase in the bypass flow reduced pulsatility in the ventricle expressed in EW(Heart) as well as in EW(VAD) . Experimental results, both mock loop and animal studies, showed that the interaction between cardiac external work and H-Q performance of RBPs can be expressed by the relationships "EW(Heart) versus EW(VAD) ." The pulsatile nature of the native heart can be expressed in the area underneath the H-Q curves of RBPs EW(VAD) during left heart bypass indicating the status of the level of assistance by RBPs and the native heart function. © 2010, Copyright the Authors. Artificial Organs © 2010, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.