Beneficios de la asepsia del sitio de inserción del catéter venoso periférico corto. Análisis de datos secundarios / Benefits of asepsy of the short peripheral venous catheter insertion site. Secondary data analysis

Introducción: las enfermedades isquémicas del corazón ocupan los primeros lugares de morbimortalidad, lo que exige la amplia participación del profesional de enfermería en la atención de los pacientes con estos padecimientos, y el tratamiento de infusión (TI) es uno de los principales procedimientos que realiza, incluidos la instalación, el mantenimiento y el retiro oportuno de los dispositivos de acceso vascular (DAV), en especial el catéter venoso periférico corto (CVPC). Objetivo: analizar los beneficios de realizar limpieza en el sitio de inserción (LISI) del CVPC funcional como opción en el mantenimiento. Metodología: estudio prospectivo, transversal y comparativo de LISI en pacientes de una institución de tercer nivel de atención, durante abril de 2017 a junio de 2018, una muestra de 100 pacientes seleccionados por conveniencia. El grupo 1 de pacientes con CVPC muestra sangre en el sitio de inserción, se encuentra funcional y se realiza LISI; el grupo 2 tiene las mismas condiciones pero éste se retira y se instala otro dispositivo. Los datos se obtuvieron de la base de datos Análisis CVPC 2017-2019 de la Unidad de Vigilancia Epidemiológica. Resultados: el 58% de la muestra se integró con adultos mayores con una media de punciones de 2; el 25% duró más de cinco días y el 5% se retiró por aparición de alguna complicación, ninguna relacionada con la LISI. Con la LISI se obtiene un ahorro del 47.35% del costo total. Conclusión: la LISI puede evitar inserciones innecesarias, reduce costos hasta 50% y no aumenta la aparición de infecciones relacionas con el catéter.

Introduction: Ischemic heart diseases occupy the first places of morbidity and mortality, which requires the broad participation of the nursing professional in the care of patients with these conditions, infusion therapy (IT) being one of the main procedures performed, this includes the installation, maintenance and timely removal of vascular access devices (VADs), especially the short peripheral venous catheter (CVPC). Objective: To analyze the benefits of cleaning the insertion site (CIS) of the functional CVPC as an option in maintenance. Methods: Prospective, cross-sectional, comparative study of CIS in patients from a tertiary care institution, from April 2017 to June 2018, sample of 100 patients selected for convenience. Group 1 of patients with CVPC presents blood in the insertion site, it's functional, CIS is performed; Group 2 presents the same conditions but this is removed and another device installed. The data were obtained from the CVPC Analysis 2017-2019 database of the Epidemiological Surveillance Unit. Results: 58% of the sample was made up of older adults, mean number of punctures: 2, 25% lasted more than 5 days, 5% withdrew due to presenting some complication, none related to CIS. With the CIS there is a saving of 47.35% of the total cost. Conclusion: CIS might avoid unnecessary insertions, reduces costs by 50% and does not increase the presence of catheter-associated infections.

Infección del sitio de salida de los catéteres venosos centrales y su asociación con bacteriemia relacionada con catéter / Infection of the exit site central venous catheters and its association with bacteremia related to catheter

Introducción: Los catéteres venosos centrales (CVC) plantean un alto riesgo de infección. La infección del sitio de salida (ISS-CVC) es la menos estudiada, y se desconoce su asociación con la bacteriemia asociada a catéter (BAC) y su impacto en la evolución del paciente. Objetivo: Evaluar la asociación entre ISS-CVC, BAC y mortalidad. Materiales y métodos: Estudio prospectivo, de observación. Pacientes internados en una Unidad de Terapia Intensiva médico/quirúrgica que requirieron la colocación de CVC desde el 01/06/2010 hasta el 01/04/2012. Se evaluaron datos epidemiológicos, BAC (según criterios de los CDC) y gérmenes. Se utilizaron media ± DE, mediana y rango intercuartílico, y porcentajes. Resultados: Durante este período, ingresaron 575 pacientes, el 98% requirió CVC. Datos de los pacientes: edad 41 ± 26 años, APACHE II 15 ± 7, 96% con ventilación mecánica, días de ventilación mecánica 41 (33-63), días de internación 43 (25-67). Todos los CVC con ISS fueron retirados y cultivados. Se observaron 51 ISS: 5,5/1000-días-catéter: 33% subclavia, 38% yugular, 29% femoral. Seis pacientes con ISS (12%) tuvieron BAC (0,65/1000-días-catéter): 3 subclavias, 2 yugulares, 1 femoral; 2 con halo y 8 con secreción purulenta. Tiempo de permanencia del CVC: 7,5 días (5-10). Clínica al momento de la ISS: shock 50%, fiebre 83%, SOFA 6 ± 3. El 83% de las infecciones fueron monomicrobianas: 83% por bacilos gramnegativos (2 Klebsiella, 2 Pseudomonas, 1 Serratia y 1 Acinetobacter), 17% por enterococos resistentes a vancomicina. La mortalidad fue del 50%. Conclusión: Aunque la ISS provocó una baja incidencia de BAC, la mortalidad fue alta. Al parecer, la ISS no es un factor predictivo de BAC.(AU)

Introduction: Central venous catheters (CVC) are widely used and pose a high risk of infection. There are few studies on insertion site infection (ISI-CVC), and both its association with catheter-associated bloodstream infection (CABSI) and the outcome of patients are unknown. Objective: To determine the association between ISI-CVC, the presence of CABSI and mortality. Materials and methods: Prospective observational study. All patients admitted to a medical/surgical Intensive Care Unit requiring CVC insertion from 06/01/2010 to 04/01/2012 were included. Epidemiological data, CABSI (according to CDC criteria) and microorganisms involved were evaluated. Mean ± SD, median and interquartile range, and percentages were used. Results: During the period study, 575 patients were admitted, 98% required CVC. Patient´s data: age 41 ± 26 years, APACHE II 15 ± 7, 96% on mechanical ventilation, days on mechanical ventilation: 41 (33-63), length of stay 43 (25-67) days. All CVCs with ISI were removed and cultured. Fifty one ISI were observed (5.5/1000-catheter-day). Six patients with ISI (12%) presented CABSI (0.65/1000-catheter-day): 3 in subclavian, 2 in jugular, 1 femoral; 2 with erythema and 8 with purulent secretion. CVC permanence: 7.5 day (5-10). Signs and/or symptoms at the moment of ISI: shock 50%, fever 83%, SOFA 6 ± 3. The 83% of infections were caused by one microorganism: 83% due to gram-negative bacilli (2 Klebsiella, 2 Pseudomonas, 1 Serratia, and 1 Acinetobacter), 17% due to vancomycin-resistant enterococci. The mortality rate was 50%. Conclusion: Although ISI-CVC presented a low incidence of CABSI, mortality rate was high. The ISI-CVC might have a little predictable value for CABSI.(AU)

Study in influence of frequency of dressing change on PICC insertion site infection in neonates / 中国实用护理杂志

Objective To explore the relationship between frequency of dressing change and PICC insertion site infection in neonates. Methods A prospective study was undertaken. 95 neonates were randomized into 3 groups, group 1 changed dressing every 3 days, group 2 changed dressing every 5 days, group 3 changed dressing every 7 days. Insertion site infection was observed and underwent pathogenic detection,complications associated with dressing change were also observed in all the 3 groups. Results 31 neonates were randomized to group 1 ,there were 3(9.68%)episodes of insertion site infection,34 neonates were randomized to group 2,there were 2(5.88%)episodes of insertion site infection, 30 neonates were randomized to group 3, there were 5(16.67%)episodes of insertion site infection. Rates of insertion site infection did not differ in the 3 groups.8 strains of staphylococcus epidermidis(2 of them were methicillin resistant staphylococcus epidermidis)were founded in 10 neonates who developed insertion site infection,positive rate was 80%. Skin excoriation occurred in 4 of 31 neonates in group 1,no neonates in the other two groups developed skin excoriation. Conclusions We suggest change dressing of neonatal PICC every 7 days,replace dressing if the dressing becomes damp or loosened at any time.

Effects of BMI-1 over-expression on HOX family expression and cell cycle in HeLa cells / 中国病理生理杂志

AIM: To observe whether transfection of mammalian expression vector pEGFP containing the gene of B-cell specific moloney leukemia virus insertion site 1(BMI-1) could express in human cervix cancer cell line HeLa, and to detect its effect on HOX family expression and cell cycle.METHODS: pEGFP-BMI-1 was transfected into HeLa cells with Lipofectamine 2000. The expression of pEGFP-BMI-1 was determined by EGFP fluorescence and Western blotting. SYBR green I real-time RT-PCR was used to quantitate mRNA expression of P16~(INK4a), hTERT, HOXA9, HOXB4 and HOXC13. FACS analysis was used to detect the change of cell cycle.RESULTS: In HeLa cells transfected with pEGFP-BMI-1, the results of real-time RT-PCR showed that the mRNA expressions of P16~(INK4a), HOXA9 and HOXC13 were reduced to 9.2%, 10.9% and 69.7%, respectively, as compared to control HeLa cells (P<0.01). However, hTERT and HOXB4 mRNA expressions did not change significantly (P>0.05). FACS analysis showed a decrease from 65.68 % to 50.53% in G_1 population and a significant increase from 27.17% to 39.59 % in S population after transfection (P<0.01).CONCLUSION: BMI-1 over-expression in HeLa cells down-regulates mRNA expressions of P16~(INK4a), HOXA9 and HOXC13, decreases G_1 population and increases S population. Therefore, BMI-1 may be involved in carcinogenesis and cancer development.

Anterior Displacement of Muscle Insertion Site during Strabismus Surgery

PURPOSE: To study how far the insertion site of the extraocular muscle is displaced during strabismus surgery. METHODS: We studied 69 eyes of 36 patients for concomitant exodeviation. The distance between the center of the extraocular muscle insertion site and the nearest posterior limbus was measured before and after detaching the lateral rectus muscle. After fixating the insertion stump with forceps, the distance between the same points was measured. RESULTS: The distance between the limbus and the insertion site was measured as 6.54+/-0.65 mm before detaching the lateral rectus, 6.39+/-0.65 mm after detaching the muscle from the insertion, and 6.30+/-0.64 mm fixation of the insertion stump with forceps. Therefore, the muscle insertion site became displaced by 0.15+/-0.18 mm anteriorly from its original site after disinserting the muscle, and displaced anteriorly by a total of 0.25+/-0.22 mm after fixating the insertion stump with forceps. Differences in the distance at each stage were statistically significant (p<0.01, paired t-test). CONCLUSIONS: The insertion site of the lateral rectus muscle may be displaced anteriorly after disinserting the muscle and fixating the insertion stump with forceps. Therefore, the probability of error in strabismus surgery should be considered.

Muscle Width and Distance from Limbus to Muscle Insertion Site in Strabismus Patient

PURPOSE: This study investigated the differences of muscle width and distance from limbus to muscle insertion site according to age and sex, and the correlation with ocular axial length and strabismus degree. METHODS: The study subjects were 100 eyes of 50 horizontal strabismus patients undergoing rectus muscles recession. Ocular axial lengths were measured at preoperation, while muscle width and distance from limbus to muscle insertion site were measured during operation. Preoperative and postoperative comparison items were retrospectively investigated with the medical records. Correlations of muscle width, distance from limbus to muscle insertion site and the comparison items were verified by ANOVA test. RESULTS: Muscle width was 10.05+/-0.86 mm in medial rectus muscle and 9.38+/-1.03 mm in lateral rectus muscle. Distance from limbus to muscle insertion site was 5.21+/-0.85 mm in medial rectus muscle and 6.37+/-1.01 mm in lateral rectus muscle. Muscle width and distance from limbus to muscle insertion site had no correlations with ocular axial length and strabismus degree, but ocular axial length was significantly longer in the older group compared to the younger group and in the male group compared to the female group. CONCLUSIONS: It is presumed that muscle width and distance from limbus to muscle insertion site have no relationship with age, sex and strabismus degree.

Anatomical Assessment of the Proper Insertion Site for a Tibial Nailing

PURPOSE: To investigate the proper insertion site for a tibial intramedullary nail in the Korean. MATERIALS AND METHODS: Forty volunteers without trauma below knee joint were studied to determine relationship between central axis of medullary canal and lateral tibial spine, patellar tendon and the proper insertion site, and to evaluation changes of proper insertion site during rotation of knee and effective diameter. RESULTS: The proper insertion site located average 4.3+/-0.9 mm medial to the lateral tibial spine. The proper insertion site was in the medial 1/3 of patellar tendon in 6 knees, middle 1/3 of patellar tendon in 20 knees, and lateral 1/3 of patellar tendon in 14 knees. The proper insertion site might be changed two times in internal rotation more than in external rotation. The effective diameter was more narrow in medial slope than in lateral slope at proximal tibia. CONCLUSION: The study indicates the ideal insertion site of tibial nail is the medial aspect of the lateral tibial spine in Korean. To reduce the mal-reduction from a improper insertion site, lateral insertion site might be safer than medial one. However, individual variations in the relationship between the patellar tendon and tibial medullary canal should be considered.

Intestinal Obstruction Due to Incarcerated Hernia at CAPD Catheter Insertion Site

Patients who have undergone peritoneal dialysis can frequently experience abdominal wall complications, such as hernia due to increased intraabdominal pressure and peritoneal leakage. However, no case of incarcerated abdominal wall hernia through catheter insertion site of CAPD has yet been reported Recently the authors experienced a case of intestinal obstruction due to an incarcerated hernia at the catheter insertion site of CAPD. We report this case and present a literature review.

RNAi-silenced human Bmi-1 gene inhibits proliferation of human leukemia cell line K562 / 第三军医大学学报

Objective To explore the silence of B-cell specific Moloney murine leukaemia virus insertion site 1(Bmi-1)by RNA interference on the proliferation of human leukemia cell line K562 and its mechanisms.Methods Small interfering RNA(siRNA)targeting Bmi-1 gene was designed and double-stranded siRNA was chemically synthesized.After double-stranded siRNA was transfected into K562 cells with Lipofectamine 2000,the proliferation of K562 cells was detected by MTT colorimetry,cell cycle was determined by flow cytometry,and the expression of Bmi-1 and P16 were analyzed by Western blotting.Results The siRNA targeting human Bmi-1 gene effectively prolonged the double time of K562 cells,increased the percentage of cells at G1 phase,and the expression of Bmi-1 was significantly down-regulated but the expression of P16 was up-regulated.Conclusion The siRNA targeting human Bmi-1 gene inhibits the proliferation of K562 cells,and up-regulates the expression of P16 in the cells.

Expression of BMI-1 Gene in Children with Acute Leukemia and Its Clinical Significance / 实用儿科临床杂志

Objective To study the expression of BMI-l gene in children with acute leukemia and its clinical significance.Methods The clinical specimens of 46 children with acute leukemia who were diagnosed lately in the Third Affiliated Hospital of Zhengzhou University and other hospitals in Zhengzhou from Jul.1,2008 to Apr.30,2009 were collected,while peripheral blood specimens of 30 healthy children were collected as control group.With the guardians′ informed consent,the experiment was approved through the hospital ethics committee.The level of BMI-1 mRNA′s expression was tested using reverse transcription-polymerase chain reaction(RT-PCR),while data were analyzed through the application of SPSS 12.0 statistical software.Results 1.The level of BMI-l gene′s expression in children with acute leukemia was significantly higher than that in control group(P0.05),after complete remission,BMI-1 mRNA was not detected in the 2 groups;4.Compared with the complete remission group,expression of BMI-1 mRNA in the untreated group and the recurrence group was significantly higher(P0.05).Conclusions BMI-1 gene was highly expressed in children with acute leukemia,and the level of the gene expression in patients of complete remission normalized,which suggests that the gene may be involved in the occurrence and the development process of leukemia;therefore,it is possible to regard the gene as a molecular marker to evaluate the development,relapse and prognosis of the patients with acute leukemia.