Safety and effectiveness of tunneled peripherally inserted central catheters versus conventional PICC in adult cancer patients.

OBJECTIVES: This study aimed to compare the safety and effectiveness of tunneled peripherally inserted central catheters (T-PICC) vs. conventional PICCs (C-PICC) in adult cancer patients. METHODS: A multicentre randomized controlled trial was conducted between April 2021 and January 2022 in seven hospitals in China. 564 participants were randomly assigned to T-PICC or C-PICC. These data were collected and compared: the baseline characteristics and catheterization-related characteristics, periprocedural complications, and long-term complications. RESULTS: Five-hundred fifty-three participants (aged, 52.6 ± 12.3 years; female, 39.1%) were ultimately analyzed. No significant differences in periprocedural complications were found between the T-PICC and C-PICC groups (all p > 0.05). Compared with C-PICC, T-PICC significantly reduced the incidence of long-term complications (26.4% vs. 39.9%, p < 0.001). Specifically, reduced complications were found in central line-associated bloodstream infection (1.8% vs. 5.1%, p = 0.04), thrombosis (1.1% vs. 4.0%, p = 0.03), catheter dislodgement (4.7% vs. 10.1%, p = 0.01), non-infectious oozing (17.3% vs. 28.6%, p = 0.002), local infection (3.6% vs. 7.6%, p = 0.04), skin irritation (6.1% vs. 10.9%, p = 0.046), and reduced unplanned catheter removal (2.2% vs. 7.2%, p = 0.005). No significant differences were found between T-PICC and C-PICC regarding catheter occlusion (6.5% vs. 5.8%, p = 0.73) or skin damage (2.2% vs. 2.9%, p = 0.58). CONCLUSION: T-PICC is safe and effectively reduces long-term complications. CLINICAL RELEVANCE STATEMENT: The tunneled technique is effective in reducing PICC-related long-term complications. Thus, it is recommended for cancer patients at high risk of PICC-related complications. TRIAL REGISTRATION: The registration number on https://www.chictr.org.cn/ is ChiCTR2100044632. The name of the trial registry is "A multicenter randomized controlled study of clinical use of tunneled vs. non-tunneled PICC". KEY POINTS: Cather-related complications are associated with the technique of catheterization. Compared with conventional PICC, tunneled PICC reduced catheter-related long-term complications. Tunneled PICC placement provides an alternative catheterization method for cancer patients.

Glyphosate spraying exacerbates nitrogen and phosphorus loss in karst slope farmland.

Glyphosate herbicide is an indispensable material in agricultural production. In order to explore the potential environmental effects of glyphosate application in karst slope farmland, this paper used a variable slope steel tank to simulate the surface microtopography and underground pore structure characteristics of karst slope farmland, and combined with artificial rainfall experiments to explore the migration path of glyphosate in karst slope farmland and the impact of spraying glyphosate on soil nitrogen and phosphorus loss. The results showed that under the condition of heavy rain, glyphosate in karst slope farmland was mainly transported and diffused by surface runoff, supplemented by underground runoff; secondly, in different hydrological paths, glyphosate directly affected the content of nitrogen and phosphorus in runoff, and all showed extremely significant positive correlation (p < 0.001). In addition, rainfall conditions such as rainfall intensity, rainfall duration, and runoff affected the content of nitrogen and phosphorus in runoff to varying degrees. In conclusion, the application of glyphosate significantly increased the content of nitrogen and phosphorus in different runoff and accelerated the loss of nitrogen and phosphorus from soil, which not only led to soil degradation, but also threatened the safety of aquatic ecosystem. Therefore, in the prevention and control of agricultural non-point source pollution, the threat of glyphosate to the surrounding aquatic ecosystem cannot be ignored, especially in karst areas with frequent rainstorms and serious water erosion, long-term monitoring and risk assessment of glyphosate are needed.

A systematic review comparing early with late removal of indwelling urinary catheters after pelvic organ prolapse surgery.

BACKGROUND: An indwelling catheter is routinely used after pelvic organ prolapse surgery to prevent urinary retention. However, the timing of catheter removal remains controversial. OBJECTIVES: To investigate the optimal timing of catheter removal following prolapse surgery. METHODS: Electronic databases including the Cochrane Center Controlled Test Center, Embase, CINAHL, MEDLINE, PubMed, Web of Science and CNKI were searched up to January 2010. Randomized controlled trials (RCTs) comparing different timings of catheter removal after prolapse surgery were eligible. Results from RCTs comparing early versus late removal were pooled, and different durations of catheterization were divided into three sub-comparisons (≤ 2 days versus > 2 days; ≤ 1 day versus 2 days; < 1 day versus 1 day). Primary outcomes were urinary tract infection (UTI) and re-catheterization. Secondary outcomes were the length of hospital stay and patient-reported outcomes. RESULTS: Seven RCTs with 964 women were involved in the analysis. Early catheter removal was associated with a reduced incidence of UTI (RR 0.46, 95% CI 0.24 to 0.9) but an increased risk of re-catheterization (RR 2.67, 95% CI 1.6 to 4.48). Significant differences in primary outcomes were found in the sub-comparison of ≤ 2 days versus > 2 days. Three of six trials found a significantly shorter length of hospital stay in the early removal group. The results for postoperative pain were mixed. CONCLUSION: Among patients following pelvic organ prolapse surgery, early catheter removal is preferred. Moreover, the timing for removal is preferably within 2 days postoperatively.

Ecological security and health risk assessment of soil heavy metals on a village-level scale, based on different land use types.

Land use affects the accumulation of heavy metals in soil, which will endanger ecological safety and human health. Taking the village as an administrative unit, the ecological safety and health risks of heavy metals, namely, Cr, Cu, Zn, and Pb in soils in the Houzhai River Watershed of Guizhou Province, China, were evaluated based on land use types by the Hakanson potential ecological risk methods and human health risk model. Results showed that the spatial heterogeneity of Cu and Zn was greatly affected by primary structural factors, and Cr and Pb were interfered by both structural factors and human activities. The geo-accumulation index of the heavy metals showed a light pollution in the study area. The comprehensive potential ecological risk of heavy metal in the area was divided into three levels: slight, moderate, and intense, and it is spatially high in the northwest and low in the southeast. Both non-carcinogenic risk and carcinogenic risk of the heavy metals to the human body are not significant and are acceptable. The risks of children are higher than adults, and direct intake is the primary route of exposure in the area. The potential ecological risk and human health risk of soil heavy metals are relatively obviously affected by digital elevation data and normalized vegetation index. The study has certain reference value for the prevention and control of regional soil heavy metal risk.

Risk assessment models for PICC-related venous thrombosis in adult patients with cancer: A network meta-analysis.

OBJECTIVES: This review aims to compare the performance of available risk assessment models (RAMs) for predicting peripherally inserted central catheter-related venous thrombosis (PICC-RVT) in adult patients with cancer. METHODS: A systematic search was conducted across ten databases from inception to October 20, 2023. Studies were eligible if they compared the accuracy of a RAM to that of another RAM for predicting the risk of PICC-RVT in adult patients with cancer. Two reviewers independently performed the study selection, data extraction and risk of bias assessments. A Bayesian network meta-analysis (NMA) was used to evaluate the performance of the RAMs. RESULTS: A total of 1931 studies were screened, and 7 studies with 10 RAMs were included in the review. The most widely used RAMs were the Caprini (4 studies), Padua prediction score (3 studies), Autar (3 studies), Michigan risk score (2 studies) and Seeley score (2 studies). The sensitivity, specificity and accuracy varied markedly between the models. Notably, the Caprini score achieved higher sensitivity than 4 RAMs (Wells, Revised Geneva, modified MRS, MRS). The Michigan risk score had greater specificity than did the other 6 RAMs (Caprini, Autar, Padua, Seeley, the novel RAM, Wells). The predictive accuracy of the MRS is significantly greater than that of the Caprini and Autar RAM. CONCLUSION: The MRS could be the most accurate RAM for identifying patients at high risk of PICC-RVT. However, as limited studies are available, more rigorous studies should be conducted to examine the accuracy of the Michigan risk score for PICC-RVT in different contexts.

Characteristics and factors influencing soil organic carbon composition by vegetation type in spoil heaps.

Introduction: The variation of organic carbon content in spoil heaps is closely related to improving soil structure, maintaining soil fertility, and regulating soil carbon cycling balance. Analyzing the soil organic carbon content and related driving factors during the natural vegetation restoration process of spoil heaps is of great significance for promoting the accumulation of soil organic carbon in the spoil heaps. Methods: we selected spoil heaps with the same number of years of restoration to research the variations in soil organic carbon components under different vegetation types (grassland: GL, shrubland: SL, secondary forest: SF) and compared the results with those on bare land (BL). Results: Our results showed that vegetation type and soil depth significantly affect the content of soil organic carbon components. There was no difference in soil organic carbon components between SF and SL, but both were considerably superior to GL and BL (p<0.05), and the particulate organic carbon (POC) and light fraction organic carbon (LFOC) contents of SL were the highest. A significant positive linear correlation existed between SOC and active organic carbon components. Pearson's correlation and redundancy analysis showed that the available potassium (AK) and total nitrogen (TN) contents and gravel content (GC) in the BL soil significantly impacted soil organic carbon. When vegetation is present, TN, total phosphorus (TP), and Fine root biomass (FRB) significantly affect soil organic carbon. Structural equation modelling (SEM) shows that AK and soil moisture content (SMC) directly affect the organic carbon composition content of BL, When there is vegetation cover, fine root biomass (FRB) had the largest total effect in the SEM. Soil bulk density (BD) has a negative impact on soil organic carbon, especially in the presence of vegetation. Conclusion: These findings suggest that vegetation restoration can significantly increase soil organic carbon content, FRB, AK, and TN play important roles in enhancing soil organic carbon. Supplementation with nitrogen and potassium should be considered in the bare land stage, and shrubs nitrogen-fixing functions and well-developed roots are more beneficial for the accumulation of soil organic carbon.

A Randomized Controlled Trial to Compare Peripherally Inserted Central Catheter Tunnel Lengths in Adult Patients With Cancer.

BACKGROUND: Evidence is insufficient on the effect of tunnel lengths on tunneled peripherally inserted central catheter (PICC) placement in adult patients with cancer. OBJECTIVES: The primary objective was to explore whether there is an optimal PICC tunnel length to reduce the risk of PICC-related complications. The secondary objective was to compare patients' pain and comfort levels during catheter placement with different tunnel lengths. METHODS: Two hundred patients were randomly assigned to groups based on PICC tunnel length. Data collected included baseline characteristics, catheter-related characteristics, PICC-related complications, and patients' pain and comfort levels. FINDINGS: Patients with 4 cm, 5 cm, and 6 cm PICC tunnel lengths had a longer catheter dwell time and fewer PICC-related complications. No significant differences were found among all groups regarding patients' pain and comfort levels. The results suggest that a tunneled PICC is safe and effective. A tunnel length longer than 4 cm is recommended for tunneled PICC placement.

Global patterns and changes of carbon emissions from land use during 1992-2015.

Carbon emissions from land use (E LUC) are an important part of anthropogenic CO2 emissions, but its size and location remain uncertain, and our knowledge of the relationship between E LUC and GDP remains partial. We showed that the carbon emissions directly caused by land use change (direct E LUC) during 1992-2015 was 26.54 Pg C (1.15 Pg C yr-1), with a decreased trend and a net reduction rate of -0.15 Pg C yr-1. The areas that exhibited reductions were concentrated in South America, Central Africa, and Southeast Asia, and those with increments were scattered in Northwestern North America, Eastern South America, Central Africa, East Asia, and parts of Southeast Asia. For the indirect carbon emissions from the utilization of built-up land (indirect E LUC), it manifested an upward trend with a total emission of 27.51 Pg C (1.2 Pg C yr-1). The total value resulted by global E LUC was $136.3 × 109 US, and the value of annual was equivalent to 3.7 times the GDP of the Central African Republic in 2015 ($5.93 × 109 US yr-1). Among the 79 countries and regions considered in this study, 54 represented the upward GDP with increased emissions, and only 25 experienced GDP growth with emission reductions. These findings highlight the pivotal role of land use change in the carbon cycle and the significance of coordinated development between GDP and carbon emissions.