4,378 research outputs found
Ultrasonic locating devices for central venous cannulation: meta-analysis
OBJECTIVES: To assess the evidence for the clinical
effectiveness of ultrasound guided central venous
cannulation.
DATA SOURCES: 15 electronic bibliographic databases,
covering biomedical, science, social science, health
economics, and grey literature.
DESIGN: Systematic review and meta-analysis of
randomised controlled trials.
POPULATIONS: Patients scheduled for central venous
access.
INTERVENTION REVIEWED: Guidance using real time two
dimensional ultrasonography or Doppler needles and
probes compared with the anatomical landmark
method of cannulation.
DATA EXTRACTION: Risk of failed catheter placement
(primary outcome), risk of complications from
placement, risk of failure on first attempt at
placement, number of attempts to successful
catheterisation, and time (seconds) to successful
catheterisation.
DATA SYNTHESIS: 18 trials (1646 participants) were
identified. Compared with the landmark method, real
time two dimensional ultrasound guidance for
cannulating the internal jugular vein in adults was
associated with a significantly lower failure rate both
overall (relative risk 0.14, 95% confidence interval
0.06 to 0.33) and on the first attempt (0.59, 0.39 to
0.88). Limited evidence favoured two dimensional
ultrasound guidance for subclavian vein and femoral
vein procedures in adults (0.14, 0.04 to 0.57 and 0.29,
0.07 to 1.21, respectively). Three studies in infants
confirmed a higher success rate with two dimensional
ultrasonography for internal jugular procedures (0.15,
0.03 to 0.64). Doppler guided cannulation of the
internal jugular vein in adults was more successful
than the landmark method (0.39, 0.17 to 0.92), but the
landmark method was more successful for subclavian
vein procedures (1.48, 1.03 to 2.14). No significant
difference was found between these techniques for
cannulation of the internal jugular vein in infants. An
indirect comparison of relative risks suggested that
two dimensional ultrasonography would be more
successful than Doppler guidance for subclavian vein
procedures in adults (0.09, 0.02 to 0.38).
CONCLUSIONS: Evidence supports the use of two
dimensional ultrasonography for central venous
cannulation
Preliminary Monte Carlo simulations of linear accelerators in Time-of-Flight Compton Scatter imaging for cargo security
The economic impact of illicit trade is in the trillions of dollars per year, with a proportion of this trade concealed within cargo containers. The interdiction of this trade relies upon efficient and effective external screening of cargo containers, typically using x rays. The present work introduces a technique of x-ray screening that aims to increase the efficiency and effectiveness of x-ray screening. Traditional X-ray screening of cargo containers is performed using high-energy (MV) transmission imaging or low-energy (kV) Compton scatter imaging to provide two-dimensional images. Two-dimensional images can contain complex, overlapping objects and require significant experience and time to interpret. Time-of-Flight information can be used in conjunction with Compton scatter imaging to provide information about the depth of each Compton scatter interaction, leading to three-dimensional images, reducing false positives and image analysis time. The expected Time-of-Flight from photons scattered back from a set of objects is well defined when the photons are produced with a delta-type (infinitely narrow) pulse duration, however, commercially available linear accelerators used for cargo screening typically have pulse widths of the order of 1 μs. In the present work, the possible use of linear accelerators for Time-of-Flight Compton scatter imaging is investigated using a mixture of analytic and Monte Carlo methods. Ideal data are obtained by convolving a number of wide x-ray pulses (up to 5 μs) with the expected Time-of-Flight from a set of objects using a delta-type pulse. Monte Carlo simulations, using Geant4, have been performed to generate x-ray spectra produced by a linear accelerator. The spectra are then used as the input for detailed Monte Carlo simulations of the Time-of-Flight of photons produced by a single linear accelerator pulse scattering back from a set of objects. Both ideal and Monte Carlo data suggest that Time-of-Flight information can be recovered from a wide linear accelerator pulse, provided that the leading and falling edge of the pulse are sharp. In addition, it has been found that using a linear accelerator leads to double the amount of Time-of-Flight information as both the leading and falling edge are utilised (unlike for a delta-type pulse)
Charts for the Computation of Equilibrium Composition of Chemical Reactions in the Carbon-hydrogen-oxygen-nitrogen System at Temperatures from 2000 to 5000 K
The distribution of iodine and bromine in the sediments of the southwestern Barents Sea
In 42 surface sediments from the southwestern Barents Sea, iodine and bromine ranged from 60 to 828 p.p.m. and 12 to 257 p.p.m., respectively. In the surface environment, both I and Br are related to organic matter; the dependence of halogens on the grain size of the sediment is small...
Transmyacardial Laser Revasularisation for Angina not Controlled by Medication or Amenable to Surgery
Evidence for Rapid Oxidative Phosphorylation and Lactate Fermentation in Motile Human Sperm by Hyperpolarized 13C Magnetic Resonance Spectroscopy
Poor sperm motility is a common cause of male infertility for which there are no empirical therapies. Sperm motility is powered by adenosine triphosphate but the relative importance of lactate fermentation and Oxidative Phosphorylation (OxPhos) is debated. To study the relationship between energy metabolism and sperm motility we used dissolution Dynamic Nuclear Polarization (dDNP) for the first time to show the rapid conversion of 13C1-pyruvate to lactate and bicarbonate, indicating active glycolytic and OxPhos metabolism in sperm. The magnitude of both lactate and bicarbonate signals were positively correlated with the concentration of progressively motile sperm. After controlling for sperm concentration, increased progressive sperm motility generated more pyruvate conversion to lactate and bicarbonate. The technique of dDNP allows ‘snapshots’ of sperm metabolism to be tracked over the different stages of their life. This may provide help to uncover the causes of poor sperm motility and suggest new approaches for novel treatments or therapies
A Simulation Study of Spectral Cerenkov Luminescence Imaging for Tumour Margin Estimation
Breast cancer is the most common cancer in women in the world. Breast-conserving surgery (BCS) is a standard surgical treatment for breast cancer with the key objective of removing breast tissue, maintaining a negative surgical margin and providing a good cosmetic outcome. A positive surgical margin, meaning the presence of cancerous tissues on the surface of the breast specimen after surgery, is associated with local recurrence after therapy. In this study, we investigate a new imaging modality based on Cerenkov luminescence imaging (CLI) for the purpose of detecting positive surgical margins during BCS. We develop Monte Carlo (MC) simulations using the Geant4 nuclear physics simulation toolbox to study the spectrum of photons emitted given 18F-FDG and breast tissue properties. The resulting simulation spectra show that the CLI signal contains information that may be used to estimate whether the cancerous cells are at a depth of less than 1 mm or greater than 1 mm given appropriate imaging system design and sensitivity. The simulation spectra also show that when the source is located within 1 mm of the surface, the tissue parameters are not relevant to the model as the spectra do not vary significantly. At larger depths, however, the spectral information varies significantly with breast optical parameters, having implications for further studies and system design. While promising, further studies are needed to quantify the CLI response to more accurately incorporate tissue specific parameters and patient specific anatomical details
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