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Differences In Depth Of Soft Tissue At The Proximal Tibia Intraosseous Catheter Insertion Site Based On Sex And BMI
Get PDFIntroduction
Intraosseous (IO) cannulation is commonly used for emergent vascular access in unstable patients treated in the emergency department (ED). However, inappropriate depth of IO insertion may be associated with increased risk of complications associated with IO catheter use, including extravasation and subsequent compartment syndrome. Our objective was to characterize the thickness of soft tissue overlying the proximal tibial IO insertion site according to patient sex, body mass index (BMI), and common medical comorbidities.
Methods
Retrospective chart review was performed for patients who received x-ray imaging of the proximal tibia at the study site. Patients were excluded if they had traumatic injury at the site of insertion, or if data were unavailable regarding BMI or other demographics. X-ray images were reviewed by trained abstractors utilizing a standardized protocol including a priori methods for depth measurements. Data were presented utilizing standard techniques, including mean values with standard deviation.
Results
A total of 373 patients were included in the analysis, although five patients were excluded due to lack of BMI data, leaving 368 patients for the final data analysis. Mean age for included patients was 60.0 years (SD 14.0), and 189 (50.7%) patients were male. A total of 201 (54.6%) patients had their left lower extremity imaged. The mean depth of soft tissue overlying the proximal tibial IO insertion site for all patients was 18.2-mm (SD 8.4 mm), including a depth of 14.2 mm (SD 5.8) for genetic males and 22.4 mm (SD 8.6) for females, with a statistically-significant difference seen between sexes (p
Conclusion
We found that genetic sex appeared to influence the depth of IO insertion at the proximal tibia, with statistically-significant greater depth of IO insertion required for genetic females than with males at the proximal tibia, despite no significant difference in BMI between sex groups. Larger studies are needed with more enrolled subjects to determine if these differences may be explained by other factors
The Effect of Anesthetic Drugs During Craniotomy on Patient Outcomes
Get PDFGlioblastoma remains an aggressive, highly malignant brain cancer with poor prognosis despite treatment options including surgery, radiotherapy, and chemotherapy. The objective of this retrospective chart review study was to evaluate if there is a correlation between the type and dose of anesthetic drugs administered during craniotomy surgery for glioblastoma and the time to first postoperative tumor progression and mortality. Based on preliminary data in mice, it was hypothesized that the use of propofol during surgery is associated with slower tumor progression and lower mortality, when compared with other anesthetic drugs. In the observed time frame, 133 patients were diagnosed with glioblastoma and underwent a total of 161 craniotomy surgeries (23 awake, 138 asleep) at Henry Ford Hospital. Propofol was utilized in 97.5% of these surgeries. Other anesthetics such as isoflurane (53.4%), dexmedetomidine (37.7%), sevoflurane (31.0%), desflurane (14.3%), and nitrous oxide (4.9%) were used less frequently. Data analysis regarding time to progression and mortality after use of each anesthetic remains in progress. This study will guide the administration of anesthetic drugs during surgery to treat glioblastoma, with potential to improve the poor prognosis for these patients
Intravital Imaging of Cellular Response due to Traumatic Brain Injury Using Confocal Microscopy
Get PDFIntroduction: Cellular reaction to traumatic brain injury is complex and involves considerable interactions between cells and reactivity to foreign bodies. Our objective was to assess neurons, microglia, astrocytes, and intracellular Ca2+ signaling by creating a novel confocal microscopy technique involving an air immersed lens that does not sacrifice resolution and limits signal attenuation. This study aimed to create a consistent dynamic methodology to observe the cortical cellular response using real-time intravital imaging as trauma is being induced.
Methods: Once surgical plane was achieved, rodent cortices were exposed via craniotomy and blunt insertion with a silicone shunt catheter into the lateral ventricle was performed at a controlled rate. Neurons, microglia, astrocytes, and intracellular Ca+2signaling were fluorescently tagged with DiD (4-chlorobenzenesulfonate), tomato lectin from lycopersicon esculentum, sulforhodamine B, and Cal 520 AM, respectively. Activity tracking of fluorescently tagged markers 700 microns from blunt insertion TBI was performed using upright resonant scanning confocal microscopy.
Results: Neurons, microglia, astrocytes, and Ca2+ signaling were identified at a depth of 100 microns from the meninges. Gross movement of cells was visualized during shunting by identifying specific cells and tracking movement over time. Preliminary data shows that astrocytes are in closest proximity to the inserted shunt catheter.
Conclusion: This novel method identified cell types and tracked gross movement. Although preliminary data and other post-hoc studies indicate primarily astrocytic involvement, it shows that we can successfully record immediate cell involvement around the shunt catheter for the first time. Future studies will improve cellular tracking and imaging resolution
Signaling the Signaler: What Do Radiology Directors Advise Radiology Applicants about the Supplemental Application?
Get PDFThe Impact of Caregiver and Community Education On Influenza Vaccination Acceptance
Get PDFIntroduction: Pediatric populations are particularly vulnerable to influenza, and rely on parental approval of the pediatric influenza vaccine (PIV). We conducted a survey to better understand our community’s perspective on the PIV.
Methods: An urban pediatric clinic’s records were gathered for the 2017-2019 flu seasons (i.e., pre-survey period). Surveys were distributed during the 2019-2020 flu season to assess vaccination status and their reasoning for acceptance or rejection of the PIV for their child(ren). Children vaccination rates were divided into 3 groups: 6 months-3 years, 3-5 years, and 5-18 years.
Results: During the 2017-2018 flu season, the overall vaccination rate (n=1791) was 34.1%. For the 2018-2019 flu season, the overall vaccination rate (n=1795) was 41.7%. During the 2019-2020 flu season, the overall vaccination rate (n=1620) increased to 45.3%. This was a statistically significant increase from 2018-2019 flu season (p=0.035).
The most common reason to vaccinate was, I do not want my child to get the flu/the shot reduces the likelihood of child getting the flu (52.2% in \u3c5 years age group, 56.5% in \u3e5 years age group). The most common reason to not vaccinate was, I do not want the flu shot for my child (35.7% in \u3c5 years age group, 38.6% in \u3e5 years age group).
Discussion: Understanding community perceptions will allow for efficacious educational materials and allow healthcare providers to tailor their strategies for the sake of preventive medicine and community health
