Ultrasound-guided pacemaker implantation at the bedside: A lifesaving technique for cardiac emergencies.

OBJECTIVE: To investigate the safety and effectiveness of implanting temporary pacemakers using ultrasound-guidance at the bedside for rescuing patients in case of cardiac emergencies. METHODS: We enrolled 194 patients with cardiac emergencies requiring temporary pacemakers in this study, and randomly assigned them to either a bedside ultrasound-guided installation group or an electrocardiogram-guided installation group. There were 105 cases in the bedside ultrasound-guided installation group, aged approximately 66.3 ± 10.2 years, and 89 cases in the electrocardiogram-guided installation group, aged approximately 65.8 ± 9.5 years old, and disease composition was similar between the two groups. We then compared the duration of the procedure, success rates, and occurrence of adverse events between the two groups. RESULTS: The two groups showed similar clinical characteristics. The success rates of venipuncture and temporary pacemaker electrode placement were both 100% in the bedside ultrasound-guided installation group, compared to 87.8% and 96.7% respectively, in the electrocardiogram-guided installation group, with a statistically significant difference between the two groups. The duration of puncture was significantly shorter in the bedside ultrasound-guided installation group than in the electrocardiogram-guided installation group, with statistically significant differences. Moreover, no adverse events such as hematoma, pneumothorax and electrode dislodgement occurred in the bedside ultrasound-guided installation group, while 13 cases in the electrocardiogram-guided installation group experienced adverse events, and the difference was statistically significant. CONCLUSIONS: The bedside installation of temporary pacemakers using ultrasound guidance is a simple, safe, effective, and cost-efficient procedure that boasts a high success rate, does not involve radiation, and enables accurate placement of the electrode catheter.

The Value of Multimodal Ultrasonic Scoring System in the Diagnosis of Carotid Vulnerable Plaque: A Comparative Study With Pathology.

BACKGROUND AND AIMS: Vulnerable plaques are closely related to ischemic stroke. To investigate the diagnostic value of multimodal plaque vulnerability ultrasound scoring system (PV-USS) using histopathology as the gold standard. METHODS: A total of 45 subjects who would be underwent carotid endarterectomy were recruited. The postoperative specimens were examined by histopathology. All responsible plaques were scanned dynamically in multiple sections by carotid ultrasound to measure maximum thickness and lumen stenotic degree, as well as, the echo, homogeneity, surface morphology, and echo type were observed. The above two-dimensional (2D) ultrasonic features were systematically scored, that is, PV-USS2D . Combined with contrast-enhanced ultrasonography (CEUS), neovascularization grade in plaque was scored, which is PV-USS2D+CEUS . RESULTS: According to the pathological results, 45 subjects were divided into vulnerable plaque group (27 cases, 60%) and non-vulnerable plaque group (18 cases, 40%). PV-USS2D and PV-USS2D+CEUS in vulnerable plaque group were higher than those in non-vulnerable plaque group (PV-USS2D : 9.44 ± 2.10 vs 7.22 ± 1.73; PV-USS2D+CEUS: 12.37 ± 2.10 vs 8.28 ± 1.81, P < .001). ROC curve analysis showed that the AUC of PV-USS2D and PV-USSCEUS was 0.783 and 0.929, respectively (P < .001). The best cutoff values of PV-USS2D and PV-USS2D+CEUS were, respectively, 9.5 (the maximum Youden index was 0.425, the sensitivity was 48.1%, the specificity was 94.4%) and 10.5 (the maximum Youden index was 0.667, the sensitivity was 77.8%, the specificity was 88.9%). CONCLUSIONS: Ultrasound scoring system may be used as an effective method to evaluate the vulnerability of plaque. The diagnostic efficiency of PV-USS2D+CEUS is more higher than PV-USS2D .

Adverse events following immunization of measles,mumps and rubella,ormeasles and rubella combined attenuated live vaccine among8-month-old children in Jiaxing / 预防医学

Objective@#To analyze the surveillance of adverse event following immunization (AEFI) among 8-month-old children in Jiaxing who received measles, mumps and rubella combined attenuated live vaccine (MMR) or measles and rubella combined attenuated live vaccine (MR) , so as to provide support for the adjustment of vaccine immunization strategy.@*Methods @#The AEFI information of MR (December 1, 2016 to April 30, 2018) and MMR (December 1, 2018 to April 30, 2020) was collected through National AEFI Monitoring Information Management System to compare the incidence, clinical features, occurred time of AEFI as well as combined vaccination.@*Results@#Totally 94 287 doses of MR and 79 994 doses of MMR were administered, 145 and 156 cases of AEFI were reported, and the incidence rate was 15.38/10 000 after MR vaccination, which was lower than 19.50/10 000 after MMR vaccination (P<0.05). Most reported AEFI were abnormal reactions, with 93 cases (11.63/10 000) after MR vaccination and 101 cases (10.71/10 000) after MMR vaccination, among which 72 cases (7.64/10 000) and 76 cases (9.50/10 000) respectively had allergic rash. The AEFI cases mainly occurred less than one day after vaccination, with 113 cases (77.93%) after MR vaccination and 125 cases (80.13%) after MMR vaccination. Most cases of AEFI were vaccinated with Japanese encephalitis attenuated live vaccine (JEV), with 103 cases (71.03%) after MR vaccination and 102 cases (65.38%) after MMR vaccination.@*Conclusions@#The MMR is safety for 8-month-old children in Jiaxing. Most AEFI cases had abnormal reactions, occur within one day after vaccination, and are vaccinated with JEV.

Doppler ultrasonographic and clinical features of middle aortic syndrome.

OBJECTIVES: To discuss Doppler ultrasonographic and clinical features of middle aortic syndrome (MAS). MATERIALS AND METHODS: Doppler ultrasonographic images and clinical dates of 11 patients with MAS confirmed by angiography were retrospectively analyzed from January 2004 to September 2016. RESULTS: The median age of 11 patients was 10 years (1-39 years). Ten patients presented with hypertension, only 2 cases presented with symptomatic intermittent claudication, and 1 case presented with abdominal pain. The ultrasonographic features of 11 patients with MAS included: (a) Gray-scale image showed significant segmental narrowing of the aorta in 9 cases. (b) Color Doppler demonstrated aliasing in the suspicious narrowed vessels of all cases. (c) On Spectral Doppler image, peak systolic velocity in the location of aorta coarctation was significantly elevated (range, 2.3~4.8 m/s). When infrarenal aorta was involved, a tardus-parvus waveform was only seen in the distal aorta. When suprarenal or inter-renal aorta was involved, a tardus-parvus pattern was seen in the distal aorta as well as renal artery. CONCLUSIONS: Significant segmental narrowing and a tardus-parvus waveform are the important ultrasonographic features in patients with MAS, the latter may be more reliable. Doppler ultrasound can be used as a simple screening method, especially for children and adolescents suspected of having a vascular cause of refractory hypertension.