Central venous catheter use increases ischemic stroke risk: a nationwide population-based study.

BACKGROUND: Central venous catheter (CVC) placement is a common procedure used for the treatment of critically ill patients. However, ischemic stroke is a complication after CVC placement. AIM: This study investigated the association between CVC placement and ischemic stroke risk in an Asian population. DESIGN: Population-based retrospective study. METHODS: We enrolled 37 623 patients who ever-received CVC placement over 2000-10 and propensity score-matched individuals without CVC placement as the comparison cohort from the Taiwan National Health Insurance Research Database. We determined the cumulative incidence rates and adjusted hazard ratios (aHRs) for ischemic stroke. RESULTS: We finally identified and enrolled 34 164 propensity score-matched pairs of individuals. Compared with the comparison group, CVC placement increased the average annual ischemic stroke incidence [19.5 vs. 11.6 per 10 000 person-years; crude HR=1.28, 95%, confidence interval (CI)=1.21-1.35; adjusted subhazard ratio (aSHR)=1.4, 95% CI = 1.33-1.47; P<0.001). In addition, compared with those aged >35 years, stroke risk was significantly higher in <35-year-old patients with CVC placement (aSHR=14.3, 95% CI=6.11-33.4; P<0.001). After <1-year follow-up, the ischemic stroke incidence rate in the CVC placement group was ∼3.25-fold higher than that in the comparison group (aHR=3.25, 95% CI=2.9-3.63; P<0.0001). CONCLUSION: CVC placement increases ischemic stroke risk, particularly in those aged ≤35 years; this trend warrants further investigation.

Highly sensitive magneto-motive photoacoustic and ultrasound (PAUS) imaging with cyclic excitations.

Highly specific molecular imaging with photoacoustics (PA) must suppress background endogenous signals while maintaining signals from target nanoagents. Magneto-motive PA was introduced to perform motion-based background suppression using a low frequency magnetic field. Previous studies show suppression based on displacement magnitude can suffer if significant physiological motion is present. This limitation can be overcome using cyclic magneto-motive PA (cmmPA), where multiple cycles of an ac magnetic field are used and the coherence of detected displacements is the retrieved information. In this paper, we show a method to enhance the magnetic response of an electromagnet specifically for cmmPA. Several magnetic frequencies were tested and a simple model is proposed to describe displacement frequency dependence. By choosing optimal parameters based on this model, we show that the technique can detect a low number of tagged cells using either US-based or PA-based displacement estimation. In addition, robustness to physiological motion is demonstrated in a moving phantom.

Effects of General-epidural Anaesthesia on Haemodynamics in Patients with Myasthenia Gravis.

OBJECTIVE: The current study aims to explore the effects of general-epidural anaesthesia (GEA) on the perioperative haemodynamics in patients with myasthenia gravis (MG), as well as their extubation time. METHODS: A total of 42 MG patients (Ossermann I-II b types) receiving elective total thymectomy were randomized into GEA (n = 20) and general anaesthesia alone (GA; n = 22) groups. Changes in their mean arterial pressure (MAP) and heart rate (HR) were recorded before anesthesia and at the time of intubation, skin incision, sternotomy and extubation. Dosages of general anaesthetics during time unit and the time of extubation and complete recovery from the ending of the operation were also recorded. RESULTS: After anaesthesia, both groups displayed increased MAPs and HRs, with those in the GA group significantly higher than those in the GEA group (p < 0.05). The total consumption of general anaesthetics in the GA group was markedly higher than that in the GEA group (p < 0.01). CONCLUSION: The GEA group had shorter postoperative extubation and recovery time than the GA group (p < 0.01). General-epidural anaesthesia stabilizes perioperative haemodynamics, reduces the consumption of general anaesthetics and shortens extubation time. It is a feasible and ideal anaesthetic method at present.