Incision Precision of a Novel Wire-Guided Scalpel During Central Venous Catheter Placement: A Randomized Observational Trial.

OBJECTIVE: To determine whether the wire-guided scalpel (GuideBlade) improves incision precision, reduces the need to revise dermatotomy incision, improves the first-time success rate of a central venous catheter (CVC) placement, and decreases CVC-related complications. DESIGN: A randomized 2-arm observational trial. SETTING: At University of California Irvine Medical Center. PARTICIPANTS: Patients (n = 63) undergoing surgery requiring placement of a CVC as part of the standard of care recruited from August 1, 2021, to December 31, 2021. INTERVENTIONS: After randomization, either the GuideBlade (intervention) or the standard #11 scalpel (control) was used during CVC placement before surgery. MEASUREMENTS AND MAIN RESULTS: The number of dermatotomy attempts was higher using the GuideBlade (1.6 ± 1.0) compared to the standard #11 scalpel (1.4 ± 0.6); however, the difference did not reach statistical significance (p = 0.19). Similarly, the number of dilation attempts demonstrated no significant difference between the GuideBlade (1.2 ± 0.4) and the standard scalpel (1.1 ± 0.4; p = 0.65). No CVC-related infections or complications were documented. CONCLUSIONS: No superiority was observed with using the GuideBlade compared to the standard scalpel during central line insertion by novice users. User unfamiliarity and inadequate training may have contributed to this finding, highlighting the importance of proper technique and user experience.

Seizure from water intoxication following bowel preparation: a case report.

BACKGROUND: Bowel preparation prior to colonoscopic examination is generally considered a safe process. Hyponatremia is a complication that has been reported in literature during bowel preparation. Individuals who develop severe symptomatic hyponatremia are often older and have comorbidities such as hypothyroidism, chronic kidney disease, or adrenal insufficiency. However, other mechanisms and circumstances can also lead to this potentially fatal complication. CASE PRESENTATION: We present a unique case of a patient who developed seizure prior to colonoscopy due to acute hyponatremia without any well-known risk factors. With the subsequent diagnosis of water intoxication, the use of desmopressin was believed to have contributed to this serious complication. CONCLUSION: In addition to the use of certain well-documented medications and the presence of comorbidities that can lead to hyponatremia, clinicians should also be aware of the use of desmopressin as an important risk factor. Thorough history taking can guide individualized bowel preparation regimens to minimize the risk of undesired complications.

Mucormycosis causing massive lower gastrointestinal bleeding: a case report.

BACKGROUND: Lower gastrointestinal bleeding (LGIB) is very common in the hospital setting. Most bleedings stop spontaneously, but rare infectious causes of LGIB may lead to rapid and serious complications if left untreated and are sometimes very difficult to diagnose preoperatively. CASE PRESENTATION: We described a young man with poorly controlled Type I diabetes mellitus and chronic alcohol abuse who presented with acute altered mental status. During his hospitalization for treatment of diabetic ketoacidosis, acute renal failure, and sepsis, he suddenly developed massive hematochezia of 1500 mL. Colonoscopy was performed and a deep ulcer covered with mucus with peripheral elevation was noted at the transverse colon. Biopsy of the ulcer later revealed nonpigmented, wide (5-20 µm in diameter), thin-walled, ribbon-like hyphae with few septations and right-angle branching suggestive of mucormycosis demonstrated by Periodic acid-Schiff stain. He received 2 months of antifungal treatment. Follow up colonoscopy post-treatment was normal with no ulcer visualized. CONCLUSIONS: Early diagnosis and treatment of gastrointestinal (GI) mucormycosis infection is critical but can be challenging, especially in the setting of massive hematochezia. Therefore, clinical awareness for immunocompromised patients and prompt antifungal prophylaxis in cases with high suspicion of infection are essential.

The Specifics of Non-specific Low Back Pain: Re-evaluating the Current Paradigm to Improve Patient Outcomes.

Low back pain (LBP) is the leading cause of pain and debility worldwide and the most frequent reason for work-related disability. Global expenditures related to LBP are staggering and amount to billions of dollars each year in the United States alone. Yet, despite the considerable healthcare resources consumed, the care provided to patients with LBP has regularly been cited as both ineffective and exorbitant. Among the myriad reasons for this suboptimal care, the current approach to evaluation and management of patients with LBP is a likely contributor and is hitherto un-investigated. Following the current methodology, over 90% of patients with LBP are provided with no specific diagnosis, are managed inconsistently, and receive no express preventative care. We believed that this approach added costs and promoted chronic unresolved pain and disability. This narrative review highlights problems with the current methodology, proposes a novel concept for categorizing patients with LBP, and recommends strategies for improvement. Stratifying patients according to the etiology, in lieu of the prospects for morbidity, the strategy proposed in this article may help ascertain the cause of patient's LBP early, consolidate treatments, permit timely preventative measures, and, as a result, may improve patient outcomes.

Using Slippage to Construct a Prototypical Molecular "Lock & Lock" Box.

We report a new slippage system based on p-tert-butylbenzyl-terminated imidazolium ions and di(ethylene glycol)-containing macrocycles and their use as linking units for the construction of a prototypical molecular "Lock & Lock" box from a resorcinarene-based cavitand "bowl" and a porphyrin "cover". The multivalent structure with four slippage linkers provided the molecular box with high stability, yet the system dissociated into its two components upon application of suitable external stimuli.

Fabrication of microlens arrays based on the mass transport effect of SU-8 photoresist using a multiexposure two-beam interference technique.

Microlens arrays (MLAs) were fabricated based on the mass transport effect of SU-8 photoresist by a multiexposure two-beam interference technique. In particular, a direct single-step fabrication process, i.e., without developing, mask, and pattern transferring processes, is demonstrated. The effects of various parameters such as thicknesses, exposure dosage, and angle between two laser beams on MLAs were investigated. Square and hexagonal lattices of microlenses were obtained by controlling rotation angles between different exposures on SU-8 samples. In addition, microlenses with elliptical shape were fabricated by a double exposure at 0 degrees and 60 degrees. Finally, the surface profiles of microlenses in MLAs were characterized by atomic force microscopy.

The association of membrane frizzled-related protein (MFRP) gene with acute angle-closure glaucoma--a pilot study.

PURPOSE: The membrane frizzled-related protein (MFRP) has been proposed as a probable candidate gene for extreme hyperopia and nanophthalmos, which are factors for angle-closure glaucoma. The purpose of our study was to investigate whether there are significant associations between angle-closure glaucoma and sequence variants in the MFRP gene reported previously in Taiwanese subjects. METHODS: Genomic DNA was collected from 63 subjects with angle-closure glaucoma and 66 age-matched and gender-matched controls without angle-closure glaucoma. Three sequence variants were detected by polymerase chain reaction (PCR) and direct sequencing in all of the cases and controls. RESULTS: None of the three sequence variants showed a significant result in terms of association with disease. The pairwise linkage disequilibrium (LD) mapping confirmed that these alleles have a comparatively strong LD index greater than 0.7 for D' and greater than 0.4 for r(2) at these polymorphisms. However, we found there were no statistical associations between any of the three sequence variants located on MFRP and angle-closure glaucoma. CONCLUSIONS: In our pilot study, variations that we tested in MFRP were not associated with the development of acute angle-closure glaucoma in Taiwanese subjects.

Fabrication of microlens array diffuser films with controllable haze distribution by combination of breath figures and replica molding methods.

This work demonstrates the fabrication of a simple, low-cost microlens array (MLA) diffuser film with controllable haze distribution (diffusion effect) by a combination of "breath figures" (BFs) and micro-replica molding methods. Polystyrene (PS) molds obtained by BFs method contain concave, hexagonal packed air holes formed by the condensation of water vapor on cooling surfaces in a chamber in which relevant influence factors can be controlled. The sizes of the air holes in the BFs PS molds can be controlled by varying such factors as chamber temperature, chamber relative humidity, substrate temperature and others. The temperature distribution on the substrate affects the distribution of diameters of the air holes formed in a BFs PS mold. Convex PDMS (poly-dimethylsiloxane) MLAs were obtained by molding from the BFs PS molds. The focal lengths of MLAs were measured and compared with theoretical values. The diffusion effect of the diffuser films with MLAs of diameters 6 microm and 3 microm were compared. The results indicate that an MLA with a smaller diameter has a larger diffusion effect.

The association of single nucleotide polymorphisms in the MMP-9 genes with susceptibility to acute primary angle closure glaucoma in Taiwanese patients.

PURPOSE: To study the relationships between single nucleotide polymorphisms (SNPs) of extracellular matrix, matrix metalloproteases (MMPs), tissue inhibitors of MMPs, and other glaucoma-associated genes and acute primary angle closure glaucoma (PACG). METHODS: We extracted DNA samples from 78 adult patients with acute PACG and 86 control subjects to study the relationships between these specific genes and acute PACG. Genotyping was performed for 35 genes by the GenomeLab SNPstream genotyping system after PCR amplification of chromosomal DNA. The association between these genetic polymorphisms and risk of primary PACG was estimated by chi2 and logistic regression. RESULTS: The genotyping success rate was 99%. Genotyping for the MMP9 site (rs2664538) was significantly different between the two groups (p=0.000001) and the odds ratio was 2.586 (95% CI: 1.715-3.898, p<0.00001). However, there were no associations of SNPs to other genes in patients with acute PACG. CONCLUSIONS: Our results reveal that SNP rs2664538, which is located at the MMP9 gene, is likely to be associated with acute PACG.

The association of single nucleotide polymorphisms in the 5'-regulatory region of the lumican gene with susceptibility to high myopia in Taiwan.

PURPOSE: To study the relationships between single nucleotide polymorphisms (SNPs) of lumican, decorin, and DSPG3 genes and high myopia. METHODS: One hundred and twenty adult patients with high myopia (< -10.0 D) and 137 controls were used to study the relationships between the decorin, lumican, and DSPG genes and high myopia. All subjects were free of ocular diseases, other than myopia, as well as of other systemic genetic diseases. Genotyping was performed by direct sequencing after PCR amplification of chromosomal DNA. Allele frequencies were tested for Hardy-Weinberg disequilibrium. The chi(2) or Fisher test was conducted to investigate the genotypic and allelic distribution between the high myopia and control groups. RESULTS: The genotyping success rate was 100%. Univariate analysis revealed significant differences between patients and control subjects with respect to one of the SNPs (rs3759223, C->T) of the lumican gene, with a p value of 0.000283. There was no significant relationship between other SNPs of lumican, decorin, and DSPG genes and high myopia. CONCLUSIONS: Our results indicate that an SNP (rs3759223), which is located in the promoter region of the lumican gene, may be worth further investigation to determine its association with development of high myopia.

Enhanced corneal wound healing with hyaluronic acid and high-potassium artificial tears.

BACKGROUND: The aim of this study was to investigate the therapeutic role of preservative-free artificial tears containing hyaluronic acid and high potassium ion concentration (HA/high-K artificial tears) on mechanically scraped or alkali-induced corneal epithelial defects in rats. METHODS: We created mechanically scraped epithelial defects on the corneas of 24 Sprague-Dawley (SD) rats (three groups of eight rats) and alkali-induced epithelial defects on the corneas of 27 SD rats (three groups of nine rats). Then we applied topical 0.3 per cent or 0.15 per cent HA/high-K artificial tears four times daily for 1.5 days and compared its effect with that of topical phosphate buffered saline (PBS). The fluorescein staining analysis and histological examination were performed immediately after and at 12, 24 and 36 hours after injury. RESULTS: In the mechanical scraping model, the areas of fluorescein staining in the eyes after topical application of 0.3 per cent HA/high-K artificial tears were significantly smaller than those after PBS treatment at 12 and 24 hours after injury. At 36 hours, the staining areas of both 0.3 per cent and 0.15 per cent HA/high-K artificial tears-treated eyes were found to be significantly smaller than those of the PBS-treated eyes. In the alkali burn model, the promotion of corneal epithelial wound healing after treatment with 0.3 per cent and 0.15 per cent HA/high-K artificial tears was not significantly different compared to that after treatment with PBS. CONCLUSION: Hyaluronic acid and high potassium ion concentration artificial tears promoted corneal epithelial wound healing in the mechanical scraping model; however, in the alkali burn model, no significant beneficial effect of this treatment was observed.

Comparing myopic progression of urban and rural Taiwanese schoolchildren.

PURPOSE: To compare myopic progression rates in Taiwanese schoolchildren between urban and rural areas. METHODS: Several longitudinal studies of myopic progression were performed in urban and rural areas. Five primary schools, four junior high schools, and two senior high schools were selected from both urban and rural areas. Ages ranged from 7 to 18 years. The refractive state of each student was measured with an autorefractometer under cycloplegia. RESULTS: Mean myopic progression in primary school children (ages 7 to 12) in the urban areas was around 0.20 D/year for boys and 0.27 D/year for girls. The mean myopic progression rate in urban children from primary to junior high school age (ages 10 to 15) was 0.43 D/year for boys and 0.50 D/year for girls, faster than that in rural children (0.24 and 0.31 D/year, respectively). The average progression rate was fastest in children in junior high school (ages 13 to 15), around 0.45 D/year in urban areas and 0.28 D/year in rural areas. In senior high schools (ages 16 to 18), myopic progression slowed to 0.17 D/ year in boys and 0.33 D/year in girls. Myopic progression in all groups was faster in myopic eyes than in emmetropic or hyperopic eyes. CONCLUSIONS: The average myopic progression in urban areas was greater than that in rural areas. Environmental factors such as urban development and academic grade level may be important contributing factors to myopic progression.

Lens thickness changes among schoolchildren in Taiwan.

PURPOSE: To explore the possible influence of ocular growth, refractive error and age on the crystalline lens in school-age children. METHODS: A Taiwan nationwide survey of myopia performed in 2006 was used to determine the prevalence and severity of myopia and the changes in ocular components. A total of 11,656 students were enrolled, including 5,390 boys and 6,266 girls, with ages ranging from 7 to 18 years. Refractive status was measured with an autorefractometer with the subject under cycloplegia. Lens thickness, anterior chamber depth, and axial length were measured with biometric ultrasound. RESULTS: Data revealed that the crystalline lens became thinner between the ages of 7 and 11. Subsequent increases in the lens thickness correlated with age and the stability of myopia. This phenomenon was found not only in myopic eyes, but also in emmetropic and hyperopic eyes. The changes in anterior chamber depth inversely correlated with the changes in the lens. In school-age children, the ratio of lens/axial length was found to be significant: approximately 0.147 in the emmetropic group. However the ratio was seen to increase with age. The ratio of anterior segment/axial length was found to be approximately 0.3 in emmetropic eyes among all age groups and less than 0.3 in the myopic eyes of schoolchildren. CONCLUSIONS: Lens thinning appeared to be compensatory in nature with respect to the increased axial length of normal eye growth. Myopic eye growth induces the lens to compensate by becoming much thinner. The change in anterior chamber depth corresponded inversely with lens thickness.