Computed Tomography–Guided Microcoil Localization of Pulmonary Nodules: Effects of Multiple Punctures

Background The aim of the study is to analyze the effect of multiple punctures in computed tomography (CT)-guided microcoil localization of pulmonary nodules with other risk factors for common complications. Methods Consecutive patients who underwent CT-guided microcoil localization and subsequent video-assisted thoracoscopic surgery (VATS) between January 2020 and February 2021 were enrolled. Nodules successfully located after only one puncture were defined as the single puncture group, and nodules requiring two or more punctures were defined as the multiple puncture group. Binary logistic regression analysis was performed to assess the relationship between the number of punctures and pneumothorax and intrapulmonary hemorrhage. Results A total of 121 patients were included. There were 98 (68.1%) pulmonary nodules in the single puncture group compared with 46 (31.9%) nodules in the multiple puncture group. The frequencies of pneumothorax and intrapulmonary hemorrhage were higher in the multiple puncture group than in the single puncture group (p = 0.019 and <0.001, respectively). Binary logistic regression demonstrated that independent risk factors for developing pneumothorax included lateral positioning of the patient (p < .001) and prone positioning (p = 0.014), as well as multiple punctures (p = 0.013). Independent risk factors for intrapulmonary hemorrhage included the distance between the distal end of the coil and the surface of the pleura (p = 0.033), multiple punctures (p = 0.003), and passage through the pulmonary vasculature (p < 0.001). Conclusion Multiple punctures resulted in an increased incidence of pneumothorax and intrapulmonary hemorrhage compared with single puncture during CT-guided microcoil localization of pulmonary nodules and were independently associated with both pneumothorax and intrapulmonary hemorrhage.

Prevention and Nursing Research of PICC Catheter-Related Complications in Patients with Digestive System Malignant Tumor Based on Smart Medical Block Chain

Malignant tumors of digestive system mainly include gastric cancer, colorectal cancer, and esophageal cancer, which generally need chemotherapy. PICC refers to peripherally inserted central venous catheter, which plays an important role in the treatment of malignant tumor patients with chemotherapy, and it has the characteristics of high success rate of puncture and reducing the pain of patients. Its principle is to use PICC catheter for drug delivery, which can effectively reduce the pain of tumor patients for multiple puncture, and also can avoid drug extravasation or local stimulation of drugs. However, PICC catheter-related complications cannot be ignored, to some extent, directly affect the treatment effect of patients, and increase the pain and burden of patients. Therefore, this paper proposes a study of PICC catheter-related complications and protective nursing for patients with digestive system cancer based on smart medical block chain. First of all, using the method of literature, this paper deeply studied the combination of smart medicine and block chain and further strengthened the research on PICC catheter-related complications. Based on this, we designed a study on the prevention and nursing of PICC catheter-related complications in patients with digestive system cancer. Before the implementation of nursing, the incidence of complications in patients with digestive system cancer was 17.35%; after the implementation of nursing, the incidence of complications decreased to 4.08%. The purpose of this study is to analyze the causes through clinical research and put forward the protective nursing measures of related diseases, so as to reduce the incidence of PICC-related complications.

Incidence and Predictors of Post-catheterisation Femoral Artery Access Vascular Complication in North Indian Population

Introduction: Vascular access-site complications following percutaneous interventions done using femoral approach, are an important cause of mortality, morbidity, prolonged stay and greater cost burden. Aim: To study the incidence and the factors which predict femoral artery access vascular complication after catheterisation in North Indian population. Materials and Methods: This was a prospective longitudinal observational study conducted at Department of Cardiology SMS Medical College at Jaipur, Rajasthan ,India between April 2016 to November 2017. All patients (n=11200) who underwent catheterisation from the femoral approach from April 2016 till November 2017 in the study institute were included. Duplex ultrasound was performed in cases with clinical suspicion of vascular complications. Clinical data and procedural variables were compared with a control group of 100 randomly selected patients. Univariate analysis and a logistic regression model for multivariate analysis for predicting independent variable was performed. Results: Femoral artery access vascular complication incidence rate was 2.05% (230). Complications rate was higher for interventional procedures (3.6%) than diagnostic procedures (1.25%). The most common vascular complication was haematoma which was seen in 1.29% (145) patients, other complication were femoral artery venous fistula seen in 0.37% (42) patients, pseudo-aneurysm in 0.41% (46) patients, acute limb ischemia in 0.1% (12) and infection in 0.09% (11) patients. It was found that advanced age (>60 years), female gender, obesity and hypertension were predictors of complication. Patients who received thrombolytic agent or low molecular weight heparin prior to procedure, use of large sheath size (7F v/s 6F) and multiple puncture to achieve femoral artery access were also independent predictors of vascular complication. Diabetes mellitus and duration of manual compression had no impact on vascular complication. Conclusion: Femoral artery access vascular complication is not uncommon following diagnostic or interventional cardiac catheterisation. The strongest predictors of vascular complication were advanced age (>60 year), female gender, overweight & obesity, hypertension, use of thrombolytic agent or anticoagulant prior to procedure, large size sheath 7F, and multiple puncture. Use of smaller sheaths, improved access techniques, safer antithrombotic therapy and use of vascular closure devices may be helpful for prevention of these vascular complications.

Review on Immersion Vaccines for Fish: An Update 2019

Immersion vaccines are used for a variety of aquacultured fish to protect against infectious diseases caused by bacteria and viruses. During immersion vaccination the antigens are taken up by the skin, gills or gut and processed by the immune system, where the resulting response may lead to protection. The lack of classical secondary responses following repeated immersion vaccination may partly be explained by the limited uptake of antigens by immersion compared to injection. Administration of vaccines depends on the size of the fish. In most cases, immersion vaccination is inferior to injection vaccination with regard to achieved protection. However, injection is problematic in small fish, and fry as small as 0.5 gram may be immersion vaccinated when they are considered adaptively immunocompetent. Inactivated vaccines are, in many cases, weakly immunogenic, resulting in low protection after immersion vaccination. Therefore, during recent years, several studies have focused on different ways to augment the efficacy of these vaccines. Examples are booster vaccination, administration of immunostimulants/adjuvants, pretreatment with low frequency ultrasound, use of live attenuated and DNA vaccines, preincubation in hyperosmotic solutions, percutaneous application of a multiple puncture instrument and application of more suitable inactivation chemicals. Electrostatic coating with positively charged chitosan to obtain mucoadhesive vaccines and a more efficient delivery of inactivated vaccines has also been successful.

Treatment of Cutaneous Warts With Multiple Puncture Technique

Background: Despite a multitude of treatment options, cutaneous warts on the hands can be a recalcitrant clinical problem. Methods: Based on Current Procedural Terminology ( CPT) billing codes, the office database was searched for a 10-year period of warts treated with a puncture technique after institutional review board approval. Office notes were examined, and patients were contacted to assess wart resolution or the need for further treatment as well as any complications. Results: Of 16 patients who were identified with the treatment and diagnosis, 13 were able to be contacted. Median time to resolution was 22 days with a range of 10 to 30 days. Median size was 10 mm, range of 6 to 20 mm. Patients ages ranged from 7 to 88 years. Symptom duration prior to treatment was a median of 16 months, range of 5 to 48 months. Follow-up median was 6 years, range of 2 to 156 months. Three patients were less than 1 year from treatment, all others had follow-up more than 4 years. Complete resolution was seen in 11 patients (85%). Four patients had resolution of other warts in the local area who were not treated with puncture. Three patients had resolution of untreated warts at distant sites. Other than local tenderness, there were no complications. Conclusions: Barbotage, the multiple puncture of cutaneous warts, may be a reasonable treatment with minimal morbidity.