Importance of the creation of a short musculofascial tunnel in peritoneal dialysis catheter placement.

BACKGROUND: Peritoneal dialysis (PD) catheter migration impedes the efficacy of dialysis. Therefore, several techniques involving additional sutures or incisions have been proposed to maintain catheter position in the pelvis. AIM: To evaluate the efficacy of creating a short musculofascial tunnel beneath the anterior sheath of the rectus abdominis during PD catheter implantation. METHODS: Patients who underwent PD catheter implantation between 2015 and 2019 were included in this retrospective study. The patients were divided into two groups based on the procedure performed: Patients who underwent catheter implantation without a musculofascial tunnel before 2017 and those who underwent the procedure with a tunnel after 2017. We recorded patient characteristics and catheter complications over a two-year follow-up period. In addition, postoperative plain abdominal radiographs were reviewed to determine the catheter angle in the event of migration. RESULTS: The no-tunnel and tunnel groups included 115 and 107 patients, respectively. Compared to the no-tunnel group, the tunnel group showed lesser catheter angle deviation toward the pelvis (15.51 ± 11.30 vs 25.00 ± 23.08, P = 0.0002) immediately after the operation, and a smaller range of migration within 2 years postoperatively (13.48 ± 10.71 vs 44.34 ± 41.29, P < 0.0001). Four events of catheter dysfunction due to migration were observed in the no-tunnel group, and none occurred in the tunnel group. There was no difference in the two-year catheter function survival rate between the two groups (88.90% vs 84.79%, P = 0.3799). CONCLUSION: The musculofascial tunnel helps maintain catheter position in the pelvis and reduces migration, thus preventing catheter dysfunction.

Effects of situational simulation and online first-aid training programs for nurses in general medical wards: A prospective study.

BACKGROUND: To maintain patient safety, effective first-aid skills are necessary during emergencies. It is important to develop in-service education programs to equip clinical nurses with first-aid skills. OBJECTIVES: This study explored the effects of first-aid skills and knowledge between situational simulation training and online teaching. It also examined the different effects of two training programs associated with nurses' baseline first-aid ability. DESIGN: This was a randomized, single-blind controlled study. SETTING: The study was conducted from December 15, 2016 to May 28, 2018, in the nursing department of a medical center in Taiwan. PARTICIPANTS: Participants were 92 general ward nurses. METHODS: Participants were randomly assigned to either a situational simulation training or an online teaching group. We used a first-aid knowledge test (FAKT) and a first-aid skills test (FAST) to measure the participants' learning outcomes after intervention and we did cost comparisons between groups. RESULTS: There were no significant differences in the changes in FAKT and FAST scores after intervention between situational simulation training and online teaching groups (p = 0.76, p = 0.45). All the participants in both training programs showed improvements via increased scores on FAST (M ± SD = 35.27 ± 12.08 for online teaching, M ± SD = 36.08 ± 10.78 for situational simulation training) and FAKT (M ± SD = 21.09 ± 18.59 for online teaching, M ± SD = 23.39 ± 15.36 for situational simulation training). However, for the subgroup of participants who scored <75% on the FAST pretest, better improvements only occurred in the situational simulation training, but the situational simulation training program had higher costs than the online teaching program. CONCLUSIONS: The improvement was greater in the situational simulation training group among nurses who could not exceed scores of 75% for first-aid skills. First-aid skill scores below 75% are likely a sign of nurses who need more assistance, discussion, and debriefing from situational simulation training.

Using Methacryl-Polyhedral Oligomeric Silsesquioxane as the Thermal Stabilizer and Plasticizer in Poly(vinyl chloride) Nanocomposites.

In this study, we investigated the influence of methacryl-functionalized polyhedral oligomeric silsesquioxane (MA-POSS) nanoparticles as a plasticizer and thermal stabilizer for a poly(vinyl chloride) (PVC) homopolymer and for a poly(vinyl chloride)/dissononyl cyclohexane-1,2-dicarboxylate (PVC/DINCH) binary blend system. The PVC and the PVC/DINCH blend both became flexible, with decreases in their glass transition temperatures and increases in their thermal decomposition temperatures, upon an increase in MA-POSS content, the result of hydrogen bonding between the C=O groups of MA-POSS and the H-CCl units of the PVC, as determined using infrared spectroscopy. Furthermore, the first thermal decomposition temperature of the pure PVC, due to the emission of HCl, increased from 290 to 306 °C, that is, the MA-POSS nanoparticles had a retarding effect on the decomposition of the PVC matrix. In tensile tests, all the PVC/DINCH/MA-POSS ternary blends were transparent and displayed flexibility, but their modulus and tensile strength both decreased, while their elongation properties increased, upon an increase in MA-POSS concentration, both before and after thermal annealing. In contrast, the elongation decreased, but the modulus and tensile strength increased, after thermal annealing at 100 °C for 7 days.

Detection of autoantibodies and increased concentrations of interleukins in plasma from patients with Tourette's syndrome.

The aim of this study was to assess levels of autoantibodies and cytokines in patients with Tourette's syndrome (TS, n = 40) and healthy control individuals (n = 40). Plasma interleukin (IL)-1ß, IL-6, IL-17, and soluble gp130 concentrations were significantly higher in the TS group compared with the control group (P < 0.001); whereas the soluble IL-6 receptor concentration was significantly decreased in the TS group compared with the control group (P < 0.001). Significantly more patients in the TS group were positive for antibrain and antinuclear antibodies, and antistreptolysin compared with the control group (P < 0.05). These findings suggest that immune activity is altered in patients with TS.