The Impact of Multidisciplinary Collaborative Nursing Intervention on Arteriovenous Fistula in Patients Undergoing Hemodialysis

This study was conducted to evaluate the effect of multidisciplinary collaborative nursing intervention on AVF in patients with chronic kidney disease (CKD) undergoing hemodialysis. Patients ( n = 84) with CKD who underwent the first autologous AVF were randomly divided into control group and multidisciplinary collaborative nursing intervention (MCNI) group and they received routine nursing procedure and multidisciplinary collaborative nursing intervention procedure, respectively. The natural blood flow and vessel diameter in MCNI group were higher than that in control group at the fourth week after surgery ( p < .05). The vessel diameter in MCNI group at 2 and 4 weeks after operation was significantly larger than that in control group ( p < .05).In conclusions, the implementation of multidisciplinary collaborative nursing intervention procedure can significantly promote the maturation of AVF, effectively increase the blood flow of AVF and promote the growth of vessel diameter.

Supplemental enteral tube feeding nutrition after hospital discharge of esophageal cancer patients who have undergone esophagectomy

Background After undergoing esophagectomy to treat esophageal cancer, there are changes in the normal intake patterns in most patients, with more than half found to have an inadequate oral intake at the time of their hospital discharge. However, the use of home supplemental enteral tube feeding nutrition after hospital discharge in esophagectomy patients has yet to be established. The aim of this study was to evaluate the feasibility of 90-day home supplemental enteral tube feeding nutrition in esophagectomy patients. Methods This single-center, prospective, and single-arm study evaluated the feasibility of using supplemental tube feeding nutrition intervention for 90 days in esophageal cancer patients who have undergone esophagectomy. Results This study enrolled 24 post-esophagectomy patients between February 2015 and September 2016. Twenty patients were administered 70% or more of the planned nutrient, with 83% of the patients completing the nutritional intervention procedure. There were no grade 3/4 adverse events observed, with a mean body weight change of − 7.6 ± 6.0%. Conclusions Our results showed that routine use of 90-day home supplemental enteral tube feeding nutrition after hospital discharge for esophagectomy patients was both feasible and acceptable. Trial registration UMIN000016286.

Rules are Rules: Reconceiving Monetary Gold as a Rule of Procedure

The Case of the Monetary Gold Removed from Rome in 1943 is familiar to all international lawyers. Like a catechism, we are taught that the ICJ will not proceed with a case where the legal interests of a State not before the Court “would not only be affected by a decision, but would form the very subject-matter of the decision.” Mollengarden and Zamir's proposal that the Court should dispense with the Monetary Gold principle feels almost heretical. The authors contend that the ICJ Statute sets out a framework for balancing the interests of third parties through the use of the intervention procedure, and that Monetary Gold “disrupts that balance.” Monetary Gold is, they submit, to be treated as only a judicial decision, entitled under Article 36(1)(d) of the Statute to little deference as a source of legal principle. I suggest taking an altogether different approach. The best way to understand the place of the Monetary Gold principle is in the context of the ICJ's rule making powers pursuant to Article 30(1) of the Court's Statute. These rule making powers are not limited to the promulgation of formal Rules of Court but extend to the determination of appropriate procedures during the hearing of a case. These procedural rules (small r), articulated in the context of particular cases, may in time evolve into formal Rules of Court through an iterative process. Monetary Gold is an instance of the Court defining a small r procedural rule in a manner that is consistent with the Court's Statute.

A Novel Procedure to Design a Positionable and Stable Drilling Template for Spine Surgery

Spine surgery is based, nowadays, on the use of cutting-edge instruments that optimize the intervention processes in the operating room, with advantages that affect the patient himself. Among these, rapid prototyping is configured as a first-rate tool, thanks to its ability to detail the diagnostic treatment according to the specific pathological case under examination. An example of this technology is represented by the generation of a drilling template, to assist the surgeon in identifying the optimal direction of insertion of the pedicle screws, capable of significantly reduce intervention times, in addition to the inevitable exposure of the patient to ionizing radiation, to which he is subjected during a normal arthrodesis intervention procedure. The design of a drilling guide requires, however, a particular attention in identifying the undercuts present on the vertebral surface, those areas of the spinous process which, reported inside the cavity of the template, involve complications at the time of extraction. In parallel, it is vitally important to carry out an evaluation of its stability during its use. In this article, starting from the analysis of the interferences present during the insertion of the template, a semi-automatic correction model is proposed for the generation of a new profile of the same, which facilitates its extraction without causing injury to the vertebral regions involved from the contact with the mask.

Advancement of Epigenetics in Stroke Research

With the advancement of epigenetic tools and technologies associated with intervention medicine, stroke research has entered into a new fertile, dynamic era of epigenetic studies, a wide plethora of intervention procedure, administration of tissue plasminogen activator, the introduction of mechanical thrombectomy, clinical studies, and drug developments over the last decennium. Against this vivid background of newly emerging pieces of knowledge, there is little to none advancement in the overall outcome of the disease. The stroke involves an overabundance of inflammatory responses arising in part due to the body’s immune response to brain injury. Neuroinflammation contributes to significant neuronal cell death and the development of functional impairment and death in stroke patients. Recent studies demonstrated epigenetic plays a key role in the overall outcome of the disease. In this review, we summarize the progress of epigenetics which provides an overview of recent advancements on the emerging key role of epigenetics over the last decade contributing to the regulation of neuroinflammation in stroke, potential epigenetic targets that might be key factors in the development of stroke therapies and their relation in respect to clinical practice.

Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously

This case is of a 76-year-old man with a known history of hypertension, type 2 diabetes mellitus, and ischemic heart disease, who presented to our department with chest pain and palpitations. His electrocardiogram showed a ventricular tachycardia (VT), but fortunately our patient was hemodynamically stable. A trial of adenosine was given to convert the patient’s heart back to sinus rhythm, but was unsuccessful and the rhythm remained as VT. Soon after, the patient suddenly became hemodynamically unstable as his blood pressure acutely declined; thus, the decision to perform a direct current cardioversion was taken. Bearing in mind that the patient was still awake, he was given 10 mg of intravenous etomidate as a pre-procedural sedative. During the time it took to prepare for the procedure, the patient’s rhythm reverted from VT to a regular sinus rhythm, raising his blood pressure back to normal and achieving hemodynamic stablility, negating the need of any electrical or chemical cardioversion. Our patient was then handed over to the cardiology team for an emergency percutaneous coronary intervention procedure and an implantable cardioverter-defibrillator procedure, both of which were successful. Etomidate was used in this case for the purpose of sedation, and as luck would have it, it seems that it had also incidentally reverted the arrhythmia back to normal.

Shoulder Kinematics Assessment towards Exoskeleton Development

Neuromuscular and sensorimotor degeneration caused by stroke or any other disease significantly reduce the physical, cognitive, and social well-being across the life span. Mostly, therapeutic interventions are employed in order to restore the lost degrees-of-freedom (DOF) caused by such impairments and automating these therapeutic tasks through exoskeletons/robots is becoming a common practice. However, aligning these robotic devices with the complex anatomical and geometrical motions of the joints is very challenging. At the same time, a good alignment is required in order to establish a better synergy of human-exoskeleton system for an effective intervention procedure. In this paper, a case study of an exoskeleton and shoulder joint alignment were studied through different size and orientation impairment models through motion capture data and musculoskeletal modeling in OpenSim. A preliminary result indicates that shoulder elevation is very sensitive to misalignment and varies with shoulder joint axes orientation; this is partly due to drastic displacement of the upper arm axes with respect to the shoulder joint origin during elevation. Additional study and analysis is required to learn any possible restraint on shoulder elevation that could potentially help in the exoskeleton development.

Efficacy of coronary imaging on bifurcation intervention

During the coronary bifurcation intervention procedure, imaging including intravascular ultrasound and optical coherence tomography is essential to provide precise anatomy of the lesion and morphological information. This consensus document between the Korean Bifurcation Club and the Japanese Bifurcation Club summarizes practical guidelines and current evidences on lesion assessment, device selection, procedural guidance, and the optimization of bifurcation intervention by the imaging.