NPTX2 in Cerebrospinal Fluid Predicts the Progression From Normal Cognition to Mild Cognitive Impairment.

OBJECTIVE: This study examined whether cerebrospinal fluid (CSF) baseline levels of the synaptic protein NPTX2 predict time to onset of symptoms of mild cognitive impairment (MCI), both alone and when accounting for traditional CSF Alzheimer's disease (AD) biomarker levels. Longitudinal NPTX2 levels were also examined. METHODS: CSF was collected longitudinally from 269 cognitively normal BIOCARD Study participants (mean baseline age = 57.7 years; mean follow-up = 16.3 years; n = 77 progressed to MCI/dementia). NPTX2 levels were measured from 3 correlated peptides using quantitative parallel reaction monitoring mass spectrometry. Levels of Aß42 /Aß40 , p-tau181 , and t-tau were measured from the same CSF specimens using Lumipulse automated electrochemiluminescence assays. RESULTS: In Cox regression models, lower baseline NPTX2 levels were associated with an earlier time to MCI symptom onset (hazard ratio [HR] = 0.76, SE = 0.09, p = 0.023). This association was significant for progression within 7 years (p = 0.036) and after 7 years from baseline (p = 0.001). Baseline NPTX2 levels improved prediction of time to MCI symptom onset after accounting for baseline AD biomarker levels (p < 0.01), and NPTX2 did not interact with the CSF AD biomarkers or APOE-ε4 genetic status. In linear mixed effects models, higher baseline p-tau181 and t-tau levels were associated with higher baseline levels of NPTX2 (both p < 0.001) and greater rates of NPTX2 declines over time. INTERPRETATION: NPTX2 may be a valuable prognostic biomarker during preclinical AD that provides additive and independent prediction of MCI onset among individuals who are cognitively normal. We hypothesize that NPTX2-mediated circuit homeostasis confers resilience during the early phase of AD. ANN NEUROL 2023;94:620-631.

Response of mineral particles in inland lakes to water optical properties and its influence on chlorophyll-a estimation.

Many chlorophyll-a (Chl-a) remote sensing estimation algorithms have been developed for inland water, and they are proposed always based on some ideal assumptions, which are difficult to meet in complex inland waters. Based on MIE scattering theory, this study calculated the optical properties of mineral particles under different size distribution and refractive index conditions, and the Hydrolight software was employed to simulate remote sensing reflectance in the presence of different mineral particles. The findings indicated that the reflectance is significantly influenced by the slope (j) of particle size distribution function and the imaginary part (n') of the refractive index, with the real part (n) having a comparatively minor impact. Through both a simulated dataset containing 18,000 entries and an in situ measured dataset encompassing 2183 data from hundreds of lakes worldwide, the sensitivities of band ratio (BR), fluorescence baseline height (FLH), and three-band algorithms (TBA) to mineral particles were explored. It can be found that BR showed the best tolerance to mineral particles, followed by TBA. However, when the ISM concentration is less than 30 g m-3, the influence of CDOM cannot be ignored. Additionally, a dataset of over 400 entries is necessary for developing the BR algorithm to mitigate the incidental errors arising from differences in data magnitude. And if the amount of developing datasets is less than 400 but greater than 200, the TBA algorithm is more likely to obtain more stable accuracy.

Boosting Circularly Polarized Luminescence from Alkyl-Locked Axial Chirality Scaffold by Restriction of Molecular Motions.

Boosting the circularly polarized luminescence of small organic molecules has been a stubborn challenge because of weak structure rigidity and dynamic molecular motions. To investigate and eliminate these factors, here, we carried out the structure-property relationship studies on a newly-developed axial chiral scaffold of bidibenzo[b,d]furan. The molecular rigidity was finely tuned by gradually reducing the alkyl-chain length. The environmental factors were considered in solution, crystal, and polymer matrix at different temperatures. As a result, a significant amplification of the dissymmetry factor glum from 10-4 to 10-1 was achieved, corresponding to the situation from (R)-4C in solution to (R)-1C in polymer film at room temperature. A synergistic strategy of increasing the intramolecular rigidity and enhancing the intermolecular interaction to restrict the molecular motions was thus proposed to improve circularly polarized luminescence. The though-out demonstrated relationship will be of great importance for the development of high-performance small organic chiroptical systems in the future.

Hyperuricemia is associated with heart failure readmission in patients with heart failure and preserved ejection fraction-an observational study in Chinese.

BACKGROUND AND AIMS: This study aimed to explore the association between hyperuricemia and heart failure (HF) readmission in HF patients with preserved ejection fraction (HFpEF) because the impact of hyperuricemia on the prognosis of these patients has not been fully understood. METHODS AND RESULTS: This retrospective observational study included 538 hospitalized patients diagnosed with HFpEF. A total of 57.6 % of patients with HFpEF suffered from hyperuricemia (serum uric acid (SUA) was >7 mg/dL in men and >6 mg/dL in women). Compared to those without hyperuricemia, patients with hyperuricemia were more likely to be female (62.6 % vs. 53.9 %, p = 0.044) and older (78.0 ± 8.4 vs. 75.9 ± 9.0 years, p = 0.008). Our Cox analysis revealed that SUA level (hazard ratio (HR) = 1.158, 95 % confidence interval (CI): 1.087-1.234, p<0.001) and hyperuricemia (HR = 1.846, 95 % CI: 1.308-2.606, p<0.001) were associated with HF readmission in patients with HFpEF, respectively. Kaplan-Meier analysis showed that patients with hyperuricemia had a significantly worse prognosis (p<0.001). The receiver operating characteristic analysis revealed that the area under the ROC curve of SUA for predicting HF readmission was 0.6276 (95 % CI: 0.5763-0.6790) and a designated cut-off value of 7.53 mg/dL. CONCLUSIONS: Hyperuricemia is a common comorbidity among patients with HFpEF. Moreover, SUA level and hyperuricemia have been shown to be associated with HF readmission. Therefore, it is meaningful to monitor SUA levels in patients with HFpEF during the whole treatment period of HF. Whereas, whether intervention of hyperuricemia could benefit patients with HFpEF needs further studies.

Development and Validation of a Risk Prediction Model to Predict Postextubation Dysphagia in Elderly Patients After Endotracheal Intubation Under General Anesthesia: A Single-Center Cross-Sectional Study.

At present, the incidence and risk factors for dysphagia after extubation in elderly inpatients are still unclear, and we aimed to develop and validate a risk prediction model that prospectively identifies high-risk patients to reduce the occurrence rate of dysphagia. The 469 patients recruited were randomly divided into modeling and validation groups in a 7:3 ratio. In the modeling group, the postextubation dysphagia (PED) risk factors were analyzed, and a risk prediction model was established. In the validation group, the model was validated and evaluated. The model was constructed based on the risk factors determined by a binary logistic regression analysis. The discrimination ability of the model was evaluated by the receiver operating characteristic (ROC) curve. The calibration curve and Hosmer‒Lemeshow test were performed to evaluate the model's calibration ability. The clinical utility of the risk prediction model was analyzed by decision curve analysis (DCA). The results showed that the incidence of PED was 15.99%, and age, duration of indwelling gastric tube, difficult endotracheal intubation, atomization after extubation, anesthesia risk level and frailty assessment were identified as important risk factors. The model was validated to have favorable discrimination, calibration ability and clinical utility. It has a certain extension value and clinical applicability, providing a feasible reference for preventing the occurrence of PED.

Misdiagnosis-related harm quantification through mixture models and harm measures.

Investigating and monitoring misdiagnosis-related harm is crucial for improving health care. However, this effort has traditionally focused on the chart review process, which is labor intensive, potentially unstable, and does not scale well. To monitor medical institutes' diagnostic performance and identify areas for improvement in a timely fashion, researchers proposed to leverage the relationship between symptoms and diseases based on electronic health records or claim data. Specifically, the elevated disease risk following a false-negative diagnosis can be used to signal potential harm. However, off-the-shelf statistical methods do not fully accommodate the data structure of a well-hypothesized risk pattern and thus fail to address the unique challenges adequately. To fill these gaps, we proposed a mixture regression model and its associated goodness-of-fit testing. We further proposed harm measures and profiling analysis procedures to quantify, evaluate, and compare misdiagnosis-related harm across institutes with potentially different patient population compositions. We studied the performance of the proposed methods through simulation studies. We then illustrated the methods through data analyses on stroke occurrence data from the Taiwan Longitudinal Health Insurance Database. From the analyses, we quantitatively evaluated risk factors for being harmed due to misdiagnosis, which unveiled some insights for health care quality research. We also compared general and special care hospitals in Taiwan and observed better diagnostic performance in special care hospitals using various new evaluation measures.

Abrading-Induced Breakdown of Ag Nanoparticles into Atomically Dispersed Ag for Enhancing Antimicrobial Performance.

Silver is among the most essential antimicrobial agents. Increasing the efficacy of silver-based antimicrobial materials will reduce operating costs. Herein, we show that mechanical abrading causes atomization of Ag nanoparticles (AgNPs) into atomically dispersed Ag (AgSAs) on the surfaces of an oxide-mineral support, which eventually boosts the antibacterial efficacy considerably. This approach is straightforward, scalable, and applicable to a wide range of oxide-mineral supports; additionally, it does not require any chemical additives and operates under ambient conditions. The obtained AgSAs-loaded γ-Al2O3 inactivated Escherichia coli (E. coli) five times as fast as the original AgNPs-loaded γ-Al2O3. It can be utilized over 10 runs with minimal efficiency loss. The structural characterizations indicate that AgSAs exhibit a nominal charge of 0 and are anchored at the doubly bridging OH on the γ-Al2O3 surfaces. Mechanism studies demonstrate that AgSAs, like AgNPs, damage bacterial cell wall integrity, but they release Ag+ and superoxide substantially faster. This work not only provides a simple method for manufacturing AgSAs-based materials but also shows that AgSAs have better antibacterial properties than the AgNPs counterpart.

Multi-dimensional evaluation of cardiotoxicity in mice following respiratory exposure to polystyrene nanoplastics.

BACKGROUND: Nanoplastics (NPs) could be released into environment through the degradation of plastic products, and their content in the air cannot be ignored. To date, no studies have focused on the cardiac injury effects and underlying mechanisms induced by respiratory exposure to NPs. RESULTS: Here, we systematically investigated the cardiotoxicity of 40 nm polystyrene nanoplastics (PS-NPs) in mice exposed via inhalation. Four exposure concentrations (0 µg/day, 16 µg/day, 40 µg/day and 100 µg/day) and three exposure durations (1 week, 4 weeks, 12 weeks) were set for more comprehensive information and RNA-seq was performed to reveal the potential mechanisms of cardiotoxicity after acute, subacute and subchronic exposure. PS-NPs induced cardiac injury in a dose-dependent and time-dependent manner. Acute, subacute and subchronic exposure increased the levels of injury biomarkers and inflammation and disturbed the equilibrium between oxidase and antioxidase activity. Subacute and subchronic exposure dampened the cardiac systolic function and contributed to structural and ultrastructural damage in heart. Mechanistically, violent inflammatory and immune responses were evoked after acute exposure. Moreover, disturbed energy metabolism, especially the TCA cycle, in the myocardium caused by mitochondria damage may be the latent mechanism of PS-NPs-induced cardiac injury after subacute and subchronic exposure. CONCLUSION: The present study evaluated the cardiotoxicity induced by respiratory exposure to PS-NPs from multiple dimensions, including the accumulation of PS-NPs, cardiac functional assessment, histology observation, biomarkers detection and transcriptomic study. PS-NPs resulted in cardiac injury structurally and functionally in a dose-dependent and time-dependent manner, and mitochondria damage of myocardium induced by PS-NPs may be the potential mechanism for its cardiotoxicity.

Associations of Device-Measured Physical Activity, Sedentary Behavior, and Executive Function in Preadolescents: A Latent Profile Approach.

PURPOSE: This study investigated the associations between physical activity (PA), sedentary behavior, and executive function in preadolescents. METHODS: One hundred and twenty preadolescents were recruited from 2 Hong Kong primary schools. PA and sedentary behavior were recorded for 7 consecutive days by accelerometer. Executive function performance, including inhibition (Stroop task and Flanker task) and working memory (Sternberg paradigm task), were measured. Body mass index and cardiorespiratory fitness (multistage fitness test) were tested. Latent profile analysis explored the profiles of PA and sedentary behavior in preadolescents. RESULTS: Three distinct profiles were identified: low activity, average activity, and high activity. Participants in low activity performed worse in the accuracy of Stroop task (vs average activity, P = .03; vs high activity, P < .01), Flanker task (vs average activity, P = .02; vs high activity, P < .001), and Sternberg paradigm task (vs average activity, P < .01; vs high activity, P < .01). No significant difference was observed between participants with average and high activities. No significant association was observed for profiles on body mass index and cardiorespiratory fitness. CONCLUSION: Supplementing the consensus of the literature that moderate to vigorous PA benefits cognition, the authors conclude that light PA may also enhance preadolescents' executive functioning.

Longitudinal changes in brain oxygen extraction fraction (OEF) in older adults: Relationship to markers of vascular and Alzheimer's pathology.

INTRODUCTION: Oxygen extraction fraction (OEF) reflects the balance between oxygen delivery and consumption. We longitudinally measured OEF in older adults to examine the relationship with markers of Alzheimer's disease (AD) and vascular pathology. METHODS: One hundred thirty-seven participants were studied at two time-points at an interval of 2.16 years. OEF was measured using T2 -relaxation-under-spin-tagging (TRUST) magnetic resonance imaging (MRI). The association between OEF and vascular risks, white matter hyperintensities (WMH), cerebrospinal fluid (CSF) measures of amyloid beta (Aß), total tau (t-tau), and phosphorylated tau 181 (p-tau181) was examined. RESULTS: OEF increased from baseline to follow-up. The increase in OEF was more prominent in individuals with high vascular risks compared to those with low vascular risks, and was associated with progression of vascular risks and the growth in WMH volume. OEF change was not related to CSF markers of AD pathology or their progression. DISCUSSION: Longitudinal OEF change in older adults is primarily related to vascular pathology.

Obtaining optimal cutoff values for tree classifiers using multiple biomarkers.

In biomedical practices, multiple biomarkers are often combined using a prespecified classification rule with tree structure for diagnostic decisions. The classification structure and cutoff point at each node of a tree are usually chosen on an ad hoc basis, depending on decision makers' experience. There is a lack of analytical approaches that lead to optimal prediction performance, and that guide the choice of optimal cutoff points in a pre-specified classification tree. In this paper, we propose to search for and estimate the optimal decision rule through an approach of rank correlation maximization. The proposed method is flexible, theoretically sound, and computationally feasible when many biomarkers are available for classification or prediction. Using the proposed approach, for a prespecified tree-structured classification rule, we can guide the choice of optimal cutoff points at tree nodes and estimate optimal prediction performance from multiple biomarkers combined.

Are Mental Health and Substance Use Disorders Risk Factors for Missed Acute Myocardial Infarction Diagnoses Among Chest Pain or Dyspnea Encounters in the Emergency Department?

STUDY OBJECTIVE: To assess if having a mental health and/or substance use disorder is associated with a missed acute myocardial infarction diagnosis in the emergency department (ED). METHODS: This was a retrospective cohort analysis (2009 to 2017) of adult ED encounters at Kaiser Permanente Southern California. We used the validated symptom-disease pair analysis of diagnostic error methodological approach to "look back" and "look forward" and identify missed acute myocardial infarctions within 30 days of a treat-and-release ED visit. We use adjusted logistic regression to report the odds of missed acute myocardial infarction among patients with a history of mental health and/or substance use disorders. RESULTS: The look-back analysis identified 44,473 acute myocardial infarction hospital encounters; 574 (1.3%) diagnoses were missed. The odds of missed diagnoses were higher in patients with mental health disorders (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.23 to 1.77) but not in those with substance abuse disorders (OR 1.22, 95% CI 0.91 to 1.62). The highest risk was observed in those with co-occurring disorders (OR 1.90, 95% CI 1.30 to 2.76). The look-forward analysis identified 325,088 chest pain/dyspnea ED encounters; 508 (0.2%) were missed acute myocardial infarctions. No significant associations of missed acute myocardial infarction were revealed in either group (mental health disorder: OR 0.92, 95% CI 0.71 to 1.18; substance use disorder: OR 1.22, 95% CI 0.80 to 1.85). CONCLUSION: The look-back analysis identified patients with mental illness at increased risk of missed acute myocardial infarction diagnosis, with the highest risk observed in those with a history of comorbid substance abuse. Having substance use disorders alone did not increase this risk in either cohort. The look-forward analysis revealed challenges in prospectively identifying high-risk patients to target for improvement.

Association of Lifestyle Activities with Functional Brain Connectivity and Relationship to Cognitive Decline among Older Adults.

This study examines the relationship of engagement in different lifestyle activities to connectivity in large-scale functional brain networks, and whether network connectivity modifies cognitive decline, independent of brain amyloid levels. Participants (N = 153, mean age = 69 years, including N = 126 with amyloid imaging) were cognitively normal when they completed resting-state functional magnetic resonance imaging, a lifestyle activity questionnaire, and cognitive testing. They were followed with annual cognitive tests up to 5 years (mean = 3.3 years). Linear regressions showed positive relationships between cognitive activity engagement and connectivity within the dorsal attention network, and between physical activity levels and connectivity within the default-mode, limbic, and frontoparietal control networks, and global within-network connectivity. Additionally, higher cognitive and physical activity levels were independently associated with higher network modularity, a measure of functional network specialization. These associations were largely independent of APOE4 genotype, amyloid burden, global brain atrophy, vascular risk, and level of cognitive reserve. Moreover, higher connectivity in the dorsal attention, default-mode, and limbic networks, and greater global connectivity and modularity were associated with reduced cognitive decline, independent of APOE4 genotype and amyloid burden. These findings suggest that changes in functional brain connectivity may be one mechanism by which lifestyle activity engagement reduces cognitive decline.

Cu-Ce oxide Co-loaded silicon nanocapsules for hydrogen peroxide self-supplied Fenton-like catalysis and synergistically antibacterial therapy.

Antibacterial strategies based on reactive oxygen species (ROS) have opened up a new avenue for overcoming the great challenges of antibiotics topic including lack of broad-spectrum antibiotics and the emergence of super-resistant bacteria. Herein, we leveraged a strategy of constructing synergistic catalytic active sites to develop a simple yet efficient Fenton-like active nanocomposite, and investigated its catalysis mechanism and antibacterial performance thoroughly. This strategy provides a new direction for boosting the catalytic activity of nanocomposite catalysts for wide application. Specifically, by uniformly loading copper oxide and ceria onto the surface of silica nanocapsules (SiO2 NCs), we fabricated a bimetallic oxide nanocomposite Cu0.75Ce0.62O2@SiO2 NC, which performed superior Fenton-like capability in a wide pH range without additional exogenetic hydrogen peroxide (H2O2). Such excellent catalytic activity was originated from the charge interaction between the two metal oxide components, where formation of Cu+ and oxygen vacancies (OVs) was mutually reinforcing, resulting in a synergistic effect to produce H2O2 and catalyze the generation of •OH under the slight acid condition (pH = 6.0). In view of the outstanding Fenton-like activity, the Cu0.75Ce0.62O2@SiO2 NC was employed in antimicrobial testing, which demonstrated exceptional high in vitro antimicrobial efficacy against both the S. aureus and E. coli in a neutral environment (pH = 7.4). The excellent performance of the bimetallic nanocomposite Cu0.75Ce0.62O2@SiO2 NC, including its facile and mild preparation, high water-solubility and stability, superior catalytic and antimicrobial performances, manifests a promising broad-spectrum antibiotic that can be anticipated to deal with the contamination of the environment by bacteria.

Heavy metals pollution characteristics and risk assessment in sediments and waters: The case of Tianjin, China.

Potential health and ecological risks due to heavy metal pollution in surface waters and sediments were evaluated based on a health risk assessment model and a potential ecological risk index method. Combined with the reclamation progress of Tianjin Nangang Industrial Zone, in China, a survey was carried out in the area dealing with heavy metals concentrations in surface waters and sediments, covering from 2008 to 2018. Specifically, concentrations were determined for As, Cd, Hg, Cu, Pb, and Zn. The results show that As、Cd、Hg、Cu 、Pb、Zn average concentrations in surface water were 0.99 µg/L∼1.27 µg/L, 0.13 µg/L∼0.63 µg/L, 0.03 µg/L∼0.13 µg/L, 1.5 µg/L∼4.65 µg/L, 1.25 µg/L∼4.7 µg/L, 13.5 µg/L∼20.99 µg/L and which average concentrations in sediment were 5.12 mg/kg∼12.34 mg/kg, 0.12 mg/kg∼0.18 mg/kg, 0.04 mg/kg ∼0.087 mg/kg, 13.45 mg/kg∼31.92 mg/kg, 13.2 mg/kg ∼21.26 mg/kg, 21.58 mg/kg ∼77.21 mg/kg, respectively. The background values of the Hailuan River basin near the study area were taken as the reference and compared with the national sediment quality standards a tell us the quality of the sediments in Tianjin Nangang coastal area being good. As regards the characteristics of pollution, heavy metals showed a high concentration in 2008 and then decreased significantly, which related to the dredging of large amounts of contaminated surface sediment during port construction. According to the phase equilibrium partition coefficient (Kp) and temporal and spatial distribution characteristics of heavy metals, sediments can be seen as an obvious sink for lead, with this element being mainly affected by exogenous input in coastal seawater. Zn, As, Cd, and Hg contents in surface water were greatly affected by the endogenous release from sediments. The results of the environmental risk assessment showed that the main environmental health risk of Tianjin coastal waters was carcinogenic, and specifically due to As. The potential heavy metals ecological risk assessment results of surface sediments were mild for the affected areas.

Clinical significance of intracavitary electrocardiographic localization in the prevention of PICC heterotopia in children with tumor.

OBJECTIVE: To explore the clinical significance of intracavitary electrocardiogram positioning technology in preventing catheter ectopic position during peripherally inserted central catheter (PICC) catheterization in children with tumors. METHODS: A retrospective analysis of the clinical data of 62 children who required PICC catheterization was performed. The intracavitary electrocardiogram (ECG) positioning technology was used during the tube placement of the child patients. After the tube was successfully placed, the chest radiograph was taken. The ECG positioning result was compared with the chest radiograph positioning result after the tube was inserted, and the sensitivity and specificity of the ECG positioning were calculated. RESULTS: The intracavitary electrocardiogram results of 62 children with PICC catheters showed that 56 cases (90.32%) had characteristic P waves, and six cases (9.68%) had no characteristic P waves. The chest radiographs of 56 children with characteristic P wave showed that 33 cases (58.93%) of the catheter tip position was appropriate, 22 cases (39.29%) of the catheter tip was too deep, and 1 case was in a non-superior vena cava; six cases of chest radiographs of children with no characteristic P wave showed: one case was too deep at T8 level, one case was too shallow at T4 level, four cases were at non-superior vena cava, one case was contralateral internal jugular vein, two cases in the contralateral brachiocephalic vein, and one case was the contralateral subclavian vein. CONCLUSION: Intracavitary ECG positioning assisted catheter placement in infants can effectively improve the accuracy of catheter tip position.

ECG method for positioning the tip of peripherally inserted central catheters in patients with atrial fibrillation.

OBJECTIVE: To observe the changes of F waves on electrocardiograms (ECGs) in patients with persistent atrial fibrillation during the insertion of a peripherally inserted central catheter (PICC), and to analyze the application effect of the ECG method (through F wave changes) for guiding PICC tip positioning. METHODS: Seventy-two patients who met the inclusion criteria and needed a PICC catheter were selected as the research subjects. We observed waveforms in the ECGs when the tip of the catheter reached a predetermined position. The chest X-ray results were used as the gold standard to calculate the sensitivity and specificity, and judge the safety and accuracy of ECG-guided PICC tip positioning in patients with atrial fibrillation. RESULTS: Of the 72 patients, there was no significant difference between the ECG method and chest X-ray results (χ2 = 0.2, p > 0.05). Sixty-one patients had F wave changes on ECG and 10 had no obvious changes (X-ray results confirmed that five patients had a tip position that was too shallow, two had ectopic tip positions, and three were located in the correct place). The sensitivity of the method was 95.7% and the specificity was 80%. CONCLUSION: As the ECG baselines of patients with persistent atrial fibrillation were difficult to judge and the F wave was irregular, we found that the F wave was significantly higher than before catheter insertion and fell back while withdrawing the catheter, so the catheter should be fed until the F wave significantly increased as the correct position of the catheter tip.

Clinical significance of different atlas of intracavitary electrocardiogram for PICC localization in 961 cases.

PURPOSE: To explore the application of ECG-guided localization technology in PICC catheterization and the clinical significance of different maps of intracavitary ECG in PICC tip localization. METHODS: In the process of catheter placement under the guidance of ultrasound, the technique of intracavitary ECG location was used. The length of the catheter was measured on the body's surface. The amplitude of the P-wave and the QRS-wave groups of electrocardiograms before and during catheter placement was recorded. Nine hundred sixty-one patients who underwent X-ray chest film examination after catheterization were imaged on the chest film at the tip of the catheter. RESULTS: Eight hundred four cases had a characteristic P wave, 83.66%, of which, 331 cases (50% < P/R ≤80%) had 99.09%; 425 cases (80% < P/R ≤100%) had 99.29%; 48 cases (P/R >100%) had 100%. One hundred eighteen cases of non-specific P wave accounted for 12.28% and 79.66% of chest radiographs, of which 72 cases of P/R <50% were 100%; 46 cases of unchanged P wave were 47.83%; 34 cases of special cases accounted for 3.54% and 55.88% of chest radiographs; five cases of interference wave accounted for 0.25%, and the chest radiographs were self-control. The in-place rate of the body contrast catheter was 80%. CONCLUSIONS: The accuracy of the ECG characteristic map in guiding the location of the PICC tip is higher than that of the non-characteristic P wave, and it has more clinical significance in locating the best position of the PICC tip.

Intracavitary electrocardiography for femorally inserted central catheter tip location in adult patients.

BACKGROUND: In this study, the intracavitary electrocardiogram (ECG) P-wave and QRS-wave changes during femorally inserted central catheter (FICC) placement in adults were observed with the aim of reducing malposition occurrence. The observed method provides venous access in patients who have limited upper limb venous catheterization potential and require medium-term and long-term infusions. METHODS: A retrospective analysis of 34 adult patients who underwent FICC placement was conducted. After body surface measurements were taken, all patients were connected to an ECG during catheter placement, and the P-wave and QRS-wave changes were observed. Next, the catheter tip position was confirmed with an abdominal X-ray, and an analysis of the changes occurring during the procedure was conducted. RESULTS: In the 34 patients included in the present study, the catheter tips were located below the diaphragm level in the inferior vena cava. Of the patients, 18 showed negative P waves, biphasic P waves, and positive high-amplitude P waves with increasing the insertion depth. In 16 patients, no P-wave characteristic changes were observed during catheterization, and an abdominal X-ray confirmed that the catheter tip was positioned below the level of the first lumbar vertebra. CONCLUSION: Negative P waves, biphasic P waves, and positive high-amplitude P waves appeared during FICC placement in adults. Catheter withdrawal until the P wave reverted to normal indicated that a tip position close to the inferior vena cava above the diaphragm level was ideal.

Electrocardiographic localization of peripherally inserted central catheter tip position in critically ill patients with advanced cancer: An application study.

BACKGROUND: We compared the methods of electrocardiogram (ECG) and X-ray localization of the peripherally inserted central catheter (PICC) tip position, in order to find a more convenient, practical, and safe method. OBJECTIVE: To investigate the value of applying electrocardiographic localization of the PICC tip position in critically ill patients with advanced cancer in Hebei Province, China. METHOD: Enrolled 137 advanced cancers requiring PICC placement. The position of the catheter tip was localized with the bedside electrocardiogram in real time. Then, the localization was performed using a chest X-ray (the gold standard). The accuracy of electrocardiographic location was checked. RESULTS: Specific P waves were observed in 130 patients. No change in the P waves was observed for the remaining seven patients. The age of the latter group of patients was more advanced (87.29 [5.15] years), a significant difference to that of the 130 patients with specific P waves (71.58 [14.84] years) (t = -6.704, p < .001). Specific P waves not only involve ascendance in P waves but also ascendance in QRS waves. CONCLUSIONS: The use of an ECG to localize the PICC tip in critically ill patients with advanced cancer may replace the unnecessary use of chest X-rays. Specific P waves not only involve an increase in P waves but also an increase in QRS waves. If there is no change in the P wave, a chest X-ray film must be obtained. In elderly patients, because there is a possibility of catheter tip malposition, a comprehensive evaluation should be performed before surgery.