Investigation of Impulse Oscillometry for the Detection of Extravasations using Design of Experiments and an Infusion Simulator.

Extravasation is a phenomenon that occurs when the infusion solution misses the vein and enters the surrounding tissue. We developed a sensor prototype utilising impulse oscillometry to detect extravasations at an early stage. A hydraulic impulse is injected into the infusion line to observe and analyse its progress. The aim of this study was to determine the tissue parameters that might influence the sensor measurement signal and signal changes during extravasation. We developed a simulator that simulates infusions and extravasations to test the prototype. Tissue-specific parameters can be adjusted independently. The effects of the tissue parameters, including blood pressure, blood flow, blood density, blood viscosity, vein diameter, venous wall thickness, and tissue modulus of elasticity, were investigated using the design of experiments method. The parameter values were varied between two levels and tested across 16 experiments. Blood pressure, blood viscosity, vein diameter, and venous compliance demonstrated the greatest impact on the sensor signal (p < .001). The other parameters showed negligible effects. Significant differences (p = .006) in the pressure signal of the sensor could be observed when the catheter changed from the venous position to the extravasal position.

Evaluation of Impulse-Oscillometric Extravasation Prevention.

Infusion liquid extravasation occurs in up to 6% of all intensive care patients and up to 78% for neonates. Currently, emerging extravasation cannot be detected. An impulse-oscillometric method to detect the onset of extravasation is tested and evaluated in vitro. A pinch valve compresses the infusion line, an impulse is formed, and the pressure response is recorded at the peripheral vein catheter. The response of this catheter-sensor-system is analysed by measuring the transient-step response (n = 10) for an opened and closed pinch valve. Trials utilising porcine shanks (n = 15) are performed with venous and extravasational catheter placement. The fundamental frequency, maximum amplitude, damping and decay constant of the pressure response are tested for differences between venous and extravasational placement. The response of the catheter-sensor-system shows no significant differences between an opened or closed pinch valve. The maximum amplitude, frequency, damping and decay constant of the pressure response differ highly significant for venous and extravasational catheter placement (p < .001). The parameters also differ depending on the presence of infusion liquid flow (p < .001). The method enables the detection of the onset of extravasation. Further tests are performed to investigate the relationships between impulse response and hydraulic impedance.

Cytomegalovirus and proliferative signals in the vascular wall of CABG patients.

OBJECTIVE: To further elucidate the mechanism by which cytomegalovirus (CMV) may promote atherosclerosis, we studied the expression pattern of cellular inflammatory and proliferative signals in the aortic wall of CMV(+) and CMV(-) patients undergoing coronary artery bypass grafting (CABG). METHODS: Aortic biopsies and blood samples of 68 CABG patients were investigated for CMV-DNA by PCR and IN SITU hybridisation. Expression of pp65 antigen, adhesion molecules (ICAM-1, VCAM-1, E-selectin), growth factors (PDGF-AA, TGF-beta), and the cellular proliferation factor Ki-67 was studied by immunohistochemistry. Logistic regression was used to test the correlation between the presence of CMV, vascular inflammation, and traditional noninflammatory risk factors for atherosclerosis. RESULTS: CMV-DNA was detected in the aortic tissue of 52 (76%) patients, and was localised predominantly in vascular smooth muscle cells. In CMV(+) patients, the expression of adhesion molecules and growth factors in the aortic endothelium was increased compared with CMV(-) patients. A positive correlation of elevated CRP, the induction of adhesion molecules and growth factors and CMV(+) was found. Female gender, smoking, and hyperlipidaemia were identified as risk factors for CMV(+). CONCLUSIONS: CMV-DNA in smooth muscle cells induces local growth factor expression as well as endothelial activation, both of which can promote the progression of atherosclerosis. Since traditional atherogenic risk factors increase the likelihood of aortic CMV manifestation, we suggest that CMV plays a crucial role in mediating the progression of atherosclerosis.

Ribosomal highly basic 23-kDa protein as a reliable standard for gene expression analysis.

BACKGROUND/AIMS: Analysis of gene expression is dependent on normalization using housekeeping genes. However, many of these housekeeping genes (e.g. GAPDH, beta-actin) are upregulated in chronic pancreatitis and pancreatic cancer, and cannot be used for normalization. For this reason we tried to identify a housekeeping gene useful for expression analysis in pancreatic diseases. METHODS: RNA isolated from various tissues and states of disease was subjected to reverse transcription and subsequently amplified by PCR using primers for GAPDH and for the ribosomal highly basic 23-kDa (rb 23-kDa, RPL13A) protein. RESULTS: As anticipated, expression of GAPDH varied markedly in the different tissues, whereas the expression of rb 23-kDa was constant in all samples investigated. CONCLUSION: We recommend the use of the ribosomal highly basic 23-kDa protein as a standard for normalization at least for the pancreas and the prostate.