Scale ultrasound-guided radial artery cannulation in infant: A randomized controlled trial

Background: Cannulation of the radial artery can be extremely challenging in infants. Scale ultrasound can provide accurate arterial location and guidance for operators. We hypothesized that scale ultrasound helps increase the initial success rate of radial artery cannulation in this population. Method: Seventy-six infants aged 0–3 months who needed arterial puncture after general anesthesia were randomly divided into two groups (1:1 ratio): the scale ultrasound group and the traditional ultrasound group. The primary endpoints were the success rate of the first attempt and the total success rate of arterial cannulation. The secondary endpoints were the time during arterial puncture and the incidence of vascular complications. Results: The success rate of the first attempt and the total success rate of arterial cannulation were 92.1% (35/38) versus 50% (19/38) and 100% (38/38) versus 86.8% (33/38) in the scale ultrasound and traditional ultrasound group ( p < 0.005), respectively. The median time to ultrasound location, needle entry into the radial artery, and successful cannulation in the scale ultrasound group were significantly shorter than those in the traditional ultrasound group: 10 (8.0, 17.2) s, 15 (11.7, 20) s, and 65 (53.8, 78.5) s vs 30 (26.5, 43.5) s, 35 (23, 51) s, and 224.5 (123.5, 356) s ( p < 0.001), respectively. The incidence of hematoma was higher in the traditional group ( p < 0.005). Conclusions: Scale ultrasound-guided radial arterial cannulation can significantly improved initial success rate and overall success rate, shorten puncture time in infant, compared with that achieved with the use of traditional ultrasound guidance.

Prestenting Versus Nonprestenting on the Outcomes of Flexible Ureteroscopy for Large Upper Urinary Stones: A Systematic Review and Meta-Analysis

<b><i>Introduction:</i></b> The purpose of this article is to evaluate the efficacy and safety of prestenting (PS) versus non-PS (NPS) of flexible ureteroscopy (fURS) to treat large upper urinary stones. <b><i>Methods:</i></b> We conducted a systematic literature research of PubMed, Ovid, Scopus (up to August 2019), and citation lists to identify eligible studies. All studies comparing PS versus NPS of fURS were included. Data were analyzed using the Cochrane Collaboration’s Review Manager (RevMan) 5.3 software. <b><i>Results:</i></b> Overall, 7 studies including 3,145 patients (PS 1,408; NPS 1,737) were included in this article. PS group was associated with older age (weighted mean difference [WMD] 0.91 year; <i>p</i> &#x3c; 0.001) and more male patients (odds ratio [OR] 1.34; <i>p</i> &#x3c; 0.001). There were no statistical differences between PS and NPS in BMI (WMD 0.34 kg/m²; <i>p</i> = 0.13), stone size (WMD 0.13 mm; <i>p</i> = 0.77), and operative time (WMD 0.44 min; <i>p</i> = 0.86). Compared with NPS, PS showed better initial success rate (OR 4.04; <i>p</i> &#x3c; 0.001) and higher SFR (OR 1.64; <i>p</i> &#x3c; 0.001). There were no statistical differences for complications (OR 0.84; <i>p</i> = 0.42) and Clavien-Dindo score ≥3 complications (OR 1.04; <i>p</i> = 0.93). <b><i>Conclusion:</i></b> PS could improve initial success rate and avoid secondary general anesthesia for first ureteral access sheath failed patients. PS could provide better SFR than NPS in the treatment of large upper urinary stones with fURS.

Treatment of acute acquired concomitant esotropia

Background The treatment efficacy of botulinum toxin bilateral medial rectus injections for acute acquired concomitant esotropia (AACE) in adult is not clear. We characterize the effects of botulinum toxin injection in the treatment of AACE, especially in patients over 14 years old, and compared it with surgical treatment. Methods In this prospective, nonrandomized, controlled clinical study, patients with AACE in our hospital from March 2017 to March 2020 elected to receive bilateral medial rectus injections of botulinum toxin or to undergo extraocular muscle surgery. Ocular position and stereopsis were evaluated before and after treatment. Results A total of 60 patients were treated: 40 patients in the botulinum toxin group, and 20 patients in the surgery group. The botulinum toxin group included 31 cases ≥ 14 years of age and 9 cases < 14 years of age. After 1–3 botulinum injections, the cumulative initial success rate was 95% (38/40), and the recurrence rate was 22.5% (9/40). Nine children < 14 years of age were treated successfully, without recurrence. In the surgery group, the initial success rate after surgery was 75% (17/20), and the recurrence rate was 20% (4/20). There was no significant difference between groups in the rate of success rate or the rate of recurrence (P > 0.05). Conclusion The injection of botulinum toxin has a good effect on AACE in adults and children. The outcomes achieved with injected botulinum toxin are similar to those achieved with surgery. Trial registration ChiCTR, ChiCTR2000032544. Registered May 2, 2020, Retrospectively registered.

Scale Ultrasound-guided Radial Artery Cannulation in infant: A Randomized Controlled Trial

BackgroundCannulation of the radial artery can be extremely challenging in infants. Scale ultrasound can provide accurate arterial location and guidance for operators. We hypothesized that scale ultrasound helps increase the initial success rate of radial artery cannulation in this population.MethodThis is a double-blinded, parallel-group trial prospective study. Seventy-six infants aged 0–3 months who needed arterial puncture after general anesthesia were randomly divided into two groups (1:1 ratio): the scale ultrasound group and the traditional ultrasound group. Patients in the traditional ultrasound group underwent conventional ultrasound-guided radial artery puncture, whereas radial artery puncture was guided by scale ultrasound in the scale ultrasound group. The primary endpoints were the success rate of the first attempt and the total success rate of arterial cannulation. The secondary endpoints were the time of ultrasound location, the time of the needle entering the radial artery, the time of successful cannulation, times of the arterial puncture and the incidence of vascular complications. Data analysis was performed with Minitab 18.0 (Minitab Inc., USA).Main ResultsThe success rate of the first attempt and the total success rate of arterial cannulation were 92.1% (35/38) and 100% (38/38) in the scale ultrasound group and 50% (19/38) and 86.8% (33/38) in the traditional ultrasound group (p < 0.005), respectively. The median time to ultrasound location, needle entry into the radial artery and successful cannulation in the scale ultrasound group were significantly shorter than those in the traditional ultrasound group: 10 (8.0, 17.2) s, 15 (11.7, 20) s and 65 (53.8, 78.5) s vs 30 (26.5, 43.5) s, 35 (23, 51) s and 224.5 (123.5, 356) s (p < 0.001), respectively. The incidence of hematoma was higher in the traditional group (p < 0.005).ConclusionsScale ultrasound-guided radial arterial cannulation can significantly improved initial success rate and overall success rate, shorten puncture time in infant,compared with that achieved with the use of traditional ultrasound guidance.

Treatment of Acute Acquired Concomitant Esotropia

Background: The treatment efficacy of botulinum toxin bilateral medial rectus injections for acute acquired concomitant esotropia (AACE) in adult is not clear. We characterize the effects of botulinum toxin injection in the treatment of AACE, especially in patients over 14 years old,and compared it with surgical treatment.Methods: In this prospective, nonrandomized, controlled clinical study, patients with AACE in our hospital from March 2017 to March 2020 elected to receive bilateral medial rectus injections of botulinum toxin or to undergo extraocular muscle surgery. Ocular position and stereopsis were evaluated before and after treatment.Results: A total of 60 patients were treated: 40 patients in the botulinum toxin group, and 20 patients in the surgery group. The botulinum toxin group included 31 cases ≥14 years of age and 9 cases <14 years of age. After 1–3 botulinum injections, the cumulative initial success rate was 95% (38/40), and the recurrence rate was 22.5% (9/40). Nine children <14 years of age were treated successfully, without recurrence. In the surgery group, the initial success rate after surgery was 75% (17/20), and the recurrence rate was 20% (4/20). There was no significant difference between groups in the rate of success rate or the rate of recurrence (P>0.05).Conclusion: The injection of botulinum toxin has a good effect on AACE in adults with minimal squinting and in children. The outcomes achieved with injected botulinum toxin are similar to those achieved with surgery.Trial registration: ChiCTR, ChiCTR2000032544. Registered May 2, 2020，Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=52349

Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion

Introduction: As a countermeasure against the organized thrombi frequently observed in vascular access occlusion, we devised a percutaneous excision method for organized thrombi under superficial ultrasound guidance using biopsy forceps. The Radial JawTM 3 (2 mm) biopsy forceps of Boston Scientific Corporation was used. The usefulness of this method was investigated. Method: The following protocol, which is suitable for endovascular treatment, was prepared and used: (1) all procedures were performed under ultrasound guidance and (2) use of the forceps was assisted via a long sheath in cases involving a complicated bloodstream. Subjects: Among 564 cases of arterio-venous access occlusion that received treatment at this hospital between May 2014 and April 2017, the subjects of this study were 468 cases who could be followed up. Thrombectomy of an organized thrombus using the biopsy forceps was performed 194 times in 138 cases. Biopsy forceps were used in the initial treatment in a total of 115 cases, including 71 cases of acute occlusion of an autologous vein, 3 cases of chronic occlusion of an autologous vein, and 41 cases of acute occlusion of a prosthetic vessel. Results: The initial success rate for all cases of occlusion was 97.2%. The initial success rate for cases in which biopsy forceps were used was 98.2%. For cases using biopsy forceps, the primary patency rates were 47.1% at 3 months, and the secondary patency rates (until occlusion) were 89.1% at 3 months. Conclusion: This method was considered to be a valuable choice as a countermeasure against organized thrombi.

Management of Dental Implant Fractures. A Case History

The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant fracture is one possible complication that results in ultimate failure of the dental implant. Such a complication poses a management crisis even for the most experienced clinician. This article reports on a case of implant fracture, its possible causes, and how the case was managed.