The effects of ultrasound guidance on first-attempt success for difficult peripheral intravenous catheterization: a systematic review and meta-analysis.

Identifying patients at risk of difficult intravenous access (DIVA) and increasing the success rates of peripheral intravenous catheterization (PIVC), preferably on the first catheterization attempt, is of clinical importance. The aim of this study was to compare the use of dynamic ultrasound guidance for PIVC with the traditional technique of visualization and palpation in patients with predicted DIVA. A systematic review and meta-analysis comparing ultrasound-guided PIVC with the traditional technique was performed. Data were systematically collected through MEDLINE and EMBASE databases from inception to March 2021. Eligibility criteria included randomized controlled trials performed on patients meeting criteria for difficult catheterization comprising either (a) no palpable or visible veins, (b) previous history of difficult venous catheterization, (c) patient age less than 4 years, (d) suspicion of difficult catheterization by operator, or (e) two or more unsuccessful attempts using the traditional technique before enrollment were included. For all outcomes, a random-effects meta-analysis using the DerSimonian and Laird method was performed. The primary outcome was the first-attempt success rate, and the secondary outcomes were the overall success rate and the number of attempts for successful intravenous catheterization. Bias was assessed using the Revised Cochrane Risk of Bias tool. Seven studies with a total of 994 patients were included. Patients comprised both children and adults and settings included operating rooms, emergency departments, and intensive care units. Ultrasound guidance was associated with a higher first-attempt success rate (OR, 3.07; 95% CI, 1.66-5.65; P < 0.001). For the secondary outcomes, ultrasound guidance was associated with a higher overall success rate (OR, 3.02; 95% CI, 1.04-8.79; P = 0.04); however, this finding did not meet statistical significance in a sensitivity analysis (OR, 2.90; 95% CI, 0.71-11.93; P = 0.14). Ultrasound was not associated with a significantly different number of attempts compared with the traditional technique (difference in means, 0.14; 95% CI, -0.32 to 0.05; P = 0.15). The use of ultrasound guidance resulted in a three-fold increase in odds for the first-attempt success rate in patients with predicted DIVA compared with the traditional technique of PIVC.

Impaired microvascular reactivity after eccentric muscle contractions is not restored by acute ingestion of antioxidants or dietary nitrate.

Unaccustomed eccentric exercise leads to impaired microvascular function but the underlying mechanism is unknown. In this study, we evaluated the role of oxidative stress and of nitric oxide (NO) bioavailability. Thirty young men and women performed eccentric contractions of the tibialis anterior (TA) muscle (ECC), with the contralateral leg serving as nonexercising control (CON). Participants were randomized into three groups ingesting an antioxidant cocktail (AO), beetroot juice (BR) or placebo 46 h postexercise. At baseline and 48 h postexercise, hyperemic responses to brief muscle contractions and 5 min of cuff occlusion were assessed bilaterally in the TA muscles using blood oxygen level dependent (BOLD) magnetic resonance imaging. Eccentric contractions resulted in delayed time-to-peak (~22%; P < 0.001), blunted peak (~21%; P < 0.001) and prolonged time-to-half relaxation (~12%, P < 0.001) in the BOLD response to brief contractions, with no effects of AO or BR, and no changes in CON. Postocclusive time-to-peak was also delayed (~54%; P < 0.001) in ECC, with no effects of AO or BR, and no changes in CON. Impaired microvascular reactivity after eccentric contractions is confined to the exercised tissue, and is not restored with acute ingestion of AO or BR. Impairments in microvascular reactivity after unaccustomed eccentric contractions may result from structural changes within the microvasculature that can diminish muscle blood flow regulation during intermittent activities requiring prompt adjustments in oxygen delivery.

Experiences with Recruitment of Marginalized Groups in a Danish Health Promotion Program: A Document Evaluation Study.

BACKGROUND: Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. METHOD: Documents from all 12 of the included municipalities were collected to conduct a document evaluation. The collected documents consisted of 1,500 pages of written material with 12 project descriptions, three midterm and 10 final evaluations. The collected data were analyzed through a qualitative content analysis. RESULTS: The results are based on the fact that only 10 municipalities have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability to cope with new situations and strangers. Additional geographical challenges emerged, especially in rural areas. Positive experiences with recruitment approaches were mainly related to relationship building and trust building, especially through face-to-face contact and the project employees' presence in the neighborhood. Additionally, adjusting some of the interventions and the recruitment strategy increased participation. CONCLUSION: This study found that relation and trust between the residents and the project employees is an important factor in the recruitment of marginalized groups in deprived neighborhoods as well as adjusting the health interventions or recruitment strategy to the target groups. In future research, it is necessary to examine which recruitment approaches are effective under which circumstances to increase participation among marginalized groups.

Complex metabolism of aromatic glucosinolates in Pieris rapae caterpillars involving nitrile formation, hydroxylation, demethylation, sulfation, and host plant dependent carboxylic acid formation.

We investigated the metabolism of two chain elongated phenolic glucosinolates and the corresponding O-methyl derivatives upon ingestion by caterpillars of the butterfly Pieris rapae (L.). The glucosinolates (GSLs) were 4-hydroxyphenethylGSL, (R)-2-hydroxy-2-(4-hydroxyphenyl)ethylGSL, 4-methoxyphenethylGSL, and (R)-2-hydroxy-2-(4-methoxyphenyl)ethylGSL, variously occurring in foliage of two Arabis species: Arabis hirsuta (L.) Scop. and Arabis soyeri Reut. & Huet subsp. subcoriacea (Gren. ex Nyman) Breitstr. (Brassicaceae). Frass from caterpillars reared on each Arabis species contained two sulfated nitriles (4-sulfates of 3-(4-hydroxyphenyl)propanenitrile and 3-hydroxy-3-(4-hydroxyphenyl)propanenitrile) as apparent GSL metabolites. Comparison of glucosinolate levels in foliage and levels of sulfated nitriles in frass, and experiments with isolated GSLs spiked to crucifer foliage and ingested by P. rapae, demonstrated that phenolic GSLs and the corresponding O-methyl derivatives were metabolised to sulfated nitriles, and that metabolites lacking a beta-hydroxy group were partially hydroxylated in this position during metabolism in P. rapae. In contrast, an induction experiment did not show increased levels of beta-hydroxylated GSLs in A. soyeri plants upon caterpillar feeding. Frass contents of other putative GSL metabolites from the interaction with the two Arabis species differed significantly; caterpillars reared on A. hirsuta excreted significant amounts of four carboxylic acids (3-(4-hydroxyphenyl)propanoic acid, 3-hydroxy-3-(4-hydroxyphenyl)propanoic acid, and the corresponding 4-sulfates), which were low or absent when the caterpillars were reared on A. soyeri. The excreted carboxylic acids could be formed by hydrolysis of nitriles to carboxylic acids in caterpillar guts by an ingested nitrilase enzyme from A. hirsuta foliage; this hypothesis was supported by demonstration of 3-(4-hydroxyphenyl)propanenitrile hydrolysing nitrilase activity (E.C. 3.5.5.x) in a crude A. hirsuta extract. Some hypothetic metabolites, glycine conjugates of phenolic carboxylic acids, were not detected. Conditions for group separation and HPLC isolation of intact GSLs and sulfated metabolites were optimised, NMR spectroscopic data of the compounds are reported, and evolutionary and ecological implications are discussed.