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Scientific Reports Jun 2021The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm... (Clinical Trial)
Clinical Trial
The amniotic fluid (AF) cell-free RNA was shown to reflect physiological and pathological processes in pregnancy, but its value in the prediction of spontaneous preterm delivery is unknown. Herein we profiled cell-free RNA in AF samples collected from women who underwent transabdominal amniocentesis after an episode of spontaneous preterm labor and subsequently delivered within 24 h (n = 10) or later (n = 28) in gestation. Expression of known placental single-cell RNA-Seq signatures was quantified in AF cell-free RNA and compared between the groups. Random forest models were applied to predict time-to-delivery after amniocentesis. There were 2385 genes differentially expressed in AF samples of women who delivered within 24 h of amniocentesis compared to gestational age-matched samples from women who delivered after 24 h of amniocentesis. Genes with cell-free RNA changes were associated with immune and inflammatory processes related to the onset of labor, and the expression of placental single-cell RNA-Seq signatures of immune cells was increased with imminent delivery. AF transcriptomic prediction models captured these effects and predicted delivery within 24 h of amniocentesis (AUROC = 0.81). These results may inform the development of biomarkers for spontaneous preterm birth.
Topics: Adult; Amniocentesis; Amniotic Fluid; Cell-Free Nucleic Acids; Cross-Sectional Studies; Female; Gene Expression Regulation; Humans; Obstetric Labor, Premature; Pregnancy; RNA-Seq; Retrospective Studies
PubMed: 34188072
DOI: 10.1038/s41598-021-92439-x -
The European Respiratory Journal Nov 2020Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines...
BACKGROUND
Thoracentesis using suction is perceived to have increased risk of complications, including pneumothorax and re-expansion pulmonary oedema (REPO). Current guidelines recommend limiting drainage to 1.5 L to avoid REPO. Our purpose was to examine the incidence of complications with symptom-limited drainage of pleural fluid using suction and identify risk factors for REPO.
METHODS
A retrospective cohort study of all adult patients who underwent symptom-limited thoracentesis using suction at our institution between January 1, 2004 and August 31, 2018 was performed, and a total of 10 344 thoracenteses were included.
RESULTS
Pleural fluid ≥1.5 L was removed in 19% of the procedures. Thoracentesis was stopped due to chest discomfort (39%), complete drainage of fluid (37%) and persistent cough (13%). Pneumothorax based on chest radiography was detected in 3.98%, but only 0.28% required intervention. The incidence of REPO was 0.08%. The incidence of REPO increased with Eastern Cooperative Oncology Group performance status (ECOG PS) ≥3 compounded with ≥1.5 L (0.04-0.54%; 95% CI 0.13-2.06 L). Thoracentesis in those with ipsilateral mediastinal shift did not increase complications, but less fluid was removed (p<0.01).
CONCLUSIONS
Symptom-limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPO are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPO increased with poor ECOG PS and drainage ≥1.5 L. Symptom-limited drainage using suction without pleural manometry is safe.
Topics: Adult; Drainage; Humans; Pleural Effusion; Pneumothorax; Retrospective Studies; Suction; Thoracentesis
PubMed: 32499336
DOI: 10.1183/13993003.02356-2019 -
The Western Journal of Emergency... Jul 2021Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during...
INTRODUCTION
Pericardiocentesis is a high-risk/low-frequency procedure important to emergency medicine (EM). However, due to case rarity it is not often performed on a patient during residency training. Because the coronavirus disease 2019 pandemic limited cadaver-based practice, we developed a novel, low-cost, low-fidelity pericardiocentesis model using three dimensional-printing technology to provide advances on prior home-made models.
METHODS
Residents watched a 20-minute video about performing a pericardiocentesis and practiced both a blind and ultrasound-guided technique. We assessed model fidelity, convenience, and perceived provider competence via post-workshop questionnaire.
RESULTS
A total of 24/26 (93%) individuals practicing on the ultrasound-guided model and 22/24 (92%) on the blind approach model agreed or strongly agreed that the models reasonably mimicked a pericardial effusion.
CONCLUSION
Our low-cost, low-fidelity model is durable, mimics the clinical case, and is easy to use. It also addresses known limitations from prior low-fidelity models.
Topics: COVID-19; Emergency Medicine; Humans; Internship and Residency; Pericardiocentesis; Ultrasonography
PubMed: 35354017
DOI: 10.5811/westjem.2021.3.49876 -
Texas Heart Institute Journal Dec 2023Endoscopic ultrasonography-guided transesophageal pericardiocentesis was performed for a posteriorly located effusion not amenable to transthoracic drainage in a...
Endoscopic ultrasonography-guided transesophageal pericardiocentesis was performed for a posteriorly located effusion not amenable to transthoracic drainage in a 58-year-old woman with a history of recurrent breast adenocarcinoma who presented with dyspnea. The patient had a pericardial effusion that resulted in cardiac tamponade. Transthoracic pericardiocentesis was unsuitable because of the posterior location of the effusion. Pericardiocentesis via the transesophageal route was performed. The pericardial sac was punctured with a 19-gauge needle, and 245 mL of pericardial fluid were aspirated, resulting in the resolution of the tamponade physiology. Endoscopic ultrasonography-guided transesophageal drainage is a novel and promising therapeutic option for posteriorly located pericardial effusions.
Topics: Female; Humans; Middle Aged; Pericardial Effusion; Pericardiocentesis; Cardiac Tamponade; Pericardium; Needles
PubMed: 38087478
DOI: 10.14503/THIJ-23-8230 -
Stomatologija 2021The article presents a systematic overview of single- and double-puncture techniques of arthrocentesis methods published in the Scopus database during 2016-2020,... (Review)
Review
OBJECTIVE
The article presents a systematic overview of single- and double-puncture techniques of arthrocentesis methods published in the Scopus database during 2016-2020, highlighting the advantages and shortcomings of different methods.
MATERIALS AND METHODS
A search was conducted in the Scopus database using the terms "TMJ OR temporomandibular OR mandibular OR jaw AND arthrocentesis". Arthrocentesis techniques were described and categorized mostly as single- or double-needle ones.
RESULTS
The literature reviewed in the article represents studies of arthrocentesis treatment in 2675 patients involving 2740 joints. Arthrocentesis techniques can mainly be divided into single- and double-needle techniques. Single-needle techniques are subcategorized into type 1 and type 2, of which the first is a single-needle cannula technique where inflow and outflow pass through the same lumen, while the second uses a Y-shaped device, which has two ports and two lumens. Double needle techniques use two needles - one for the inflow and the other for the outflow. The literature found in the Scopus database during the period investigated presents 28% of single-puncture (type 1 - 10%, type 2 - 15%, single puncture with distention of the upper joint compartment - 3%), 69% of double-puncture, 1% of ancillary second-puncture methods and 1% employing a CBCT-based tragus-supported guide with 3 needles.
CONCLUSION
All of the arthrocentesis techniques described in the literature are effective as treatment modalities, none appears to be superior to others. The selection of the method to be used depends on the surgeon´s choice and experience.
Topics: Arthrocentesis; Humans; Needles; Punctures; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 35635520
DOI: No ID Found -
BMJ Case Reports Aug 2021A 56-year-old woman presented to hospital with chest pain. Following review and investigations in the medical assessment unit, she was diagnosed with costochondritis and...
A 56-year-old woman presented to hospital with chest pain. Following review and investigations in the medical assessment unit, she was diagnosed with costochondritis and discharged home. She represented 10 days later and was mottled and hypotensive with a high lactate, raised inflammatory markers, an acute kidney injury and bilateral loin pain. A CT of the thorax, abdomen and pelvis showed pleural effusions and a large pericardial effusion with features of cardiac tamponade on subsequent echocardiography. A pericardiocentesis was performed and she was admitted to intensive care for haemofiltration. Once the patient was stable, an inpatient cardiac MRI was requested to further investigate an enhancing pericardium and echo-bright areas in the inferior, inferoseptal and inferolateral walls of the left ventricle demonstrated on echocardiography. The cardiac MRI showed evidence of a recent infarction in the right coronary artery (RCA) territory with pericardial inflammation and a resolved pericardial effusion. Overall, the findings were in keeping with Dressler's syndrome.
Topics: Cardiac Tamponade; Echocardiography; Female; Humans; Middle Aged; Myocardial Infarction; Pericardial Effusion; Pericardiocentesis
PubMed: 34380681
DOI: 10.1136/bcr-2021-243577 -
Archives of Gynecology and Obstetrics Mar 2022
Topics: Amniocentesis; COVID-19; Female; Humans; Pandemics; Pregnancy; Prenatal Diagnosis; SARS-CoV-2
PubMed: 34618213
DOI: 10.1007/s00404-021-06276-4 -
Hepatology Communications Nov 2023Thromboelastography (TEG) informs the need for blood product transfusions to prevent procedural bleeding complications in patients with cirrhosis. We aimed to evaluate...
BACKGROUND
Thromboelastography (TEG) informs the need for blood product transfusions to prevent procedural bleeding complications in patients with cirrhosis. We aimed to evaluate the impact of using a TEG-based transfusion protocol on blood product utilization before paracentesis and the post-paracentesis hemoperitoneum (PPH) incidence.
METHODS
We conducted an ambispective analysis of patients with cirrhosis who underwent paracentesis from 2017 to 2021. In May 2019, we enacted a TEG-based transfusion protocol to guide pre-paracentesis blood product use. Patients with platelets < 20,000 or international normalized ratio ≥ 4 underwent TEG and received blood products if r value > 10 min or MA <30 mm. Patients were divided into pre-TEG and post-TEG protocol cohorts based on the date of paracentesis. Pre-paracentesis blood product transfusions in the form of platelets, fresh frozen plasma, and cryoprecipitates were recorded. PPH was defined as a decrease in hemoglobin of ≥1 g and the presence of blood on diagnostic imaging and/or the need for therapeutic intervention.
RESULTS
A total of 483 patients underwent 1281 paracenteses. The main etiologies of cirrhosis were alcohol (43%) and NASH (25%), and the mean MELD-sodium was 22±6. Pre-TEG and post-TEG protocol cohort sizes were similar: 253 patients and 607 paracenteses versus 230 patients and 674 paracenteses. After TEG-protocol implementation, blood product transfusions decreased significantly (228 vs. 49 products, p<0.001) with associated cost savings. One patient in each cohort developed PPH.
CONCLUSION
Implementation of a pre-paracentesis TEG-based transfusion protocol for patients with cirrhosis successfully resulted in decreased blood product use with no associated increase in incidence of PPH.
Topics: Humans; Thrombelastography; Hemoperitoneum; Blood Transfusion; Liver Cirrhosis; International Normalized Ratio
PubMed: 37889553
DOI: 10.1097/HC9.0000000000000292 -
Revista Do Colegio Brasileiro de... 2022to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students.
OBJECTIVES
to describe the assembly of a low-cost paracentesis simulator and evaluate its effectiveness, acceptance and impact on the learning of medical students.
METHODOLOGY
a paracentesis simulator was built using a mannequin and materials such as plastic bottles, Velcro, polyvinyl chloride sheets and silicone were used. A cross-sectional and experimental study was carried out with undergraduate medical students without previous practical experience with paracentesis, which sought to validate the model, evaluating its benefits in learning and obtaining technical skills.
RESULTS
after using the simulator there was an increase of 82.4% in the level of confidence in performing paracentesis in a patient, with 98% of respondents considering that the model fulfilled the simulator function with satisfaction, and 100% considering it useful as a teaching tool.
CONCLUSION
the built simulator was effective as an educational resource, serving as an alternative to high-cost commercial models, allowing for greater accessibility in the use of this tool in medical education.
Topics: Ascites; Clinical Competence; Cross-Sectional Studies; Education, Medical; Humans; Paracentesis; Students, Medical; Teaching
PubMed: 35239853
DOI: 10.1590/0100-6991e-20223099 -
European Journal of Clinical... Jun 2021Gaps of knowledge still exist about the potential association between severe thrombocytopenia and increased risk of procedure-associated bleeding in patients with liver... (Review)
Review
BACKGROUND
Gaps of knowledge still exist about the potential association between severe thrombocytopenia and increased risk of procedure-associated bleeding in patients with liver disease.
METHODS
In this narrative review, we aimed at examining the association between procedure-related bleeding risk and platelet count in patients with cirrhosis and severe thrombocytopenia in various settings. We updated to 2020 a previously conducted literature search using MEDLINE/PubMed and EMBASE. The search string included clinical studies, adult patients with chronic liver disease and thrombocytopenia undergoing invasive procedures, any interventions and comparators, and haemorrhagic events of any severity as outcome.
RESULTS
The literature search identified 1276 unique publications, and 15 studies met the inclusion criteria and were analysed together with those identified by the previous search. Most of the new studies included in our analysis did not assess the association between post-procedural bleeding risk and platelet count alone in patients with chronic liver disease. Furthermore, some results could have been biased by prophylactic platelet transfusions. A few studies found that severe thrombocytopenia may be predictive of bleeding following percutaneous liver biopsy, dental extractions, percutaneous ablation of liver tumours and endoscopic polypectomy.
CONCLUSIONS
Currently available literature cannot support definitive conclusions about the appropriate target platelet counts to improve the risk of bleeding in cirrhotic patients who underwent invasive procedures; moreover, it showed enormous variability in the use of prophylactic platelet transfusions.
Topics: Biopsy, Large-Core Needle; Blood Loss, Surgical; Carcinoma, Hepatocellular; Catheter Ablation; Endoscopy, Digestive System; Esophageal and Gastric Varices; Humans; Ligation; Liver; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Paracentesis; Postoperative Hemorrhage; Severity of Illness Index; Thrombocytopenia; Tooth Extraction
PubMed: 33539542
DOI: 10.1111/eci.13508