A modified access technique of Impella 5.0 axillary artery insertion

The conventional method for the axillary artery insertion of Impella 5.0 is a non-tunneling route of the side-graft. We present an alternative technique in order to facilitate device insertion and to ensure protection from potential wound contamination. The technique consists of exiting the graft separately and away from the main incision with an intact skin and subcutaneous fat between the two sites. By proper isolation of the main wound, the risk of infection can thus be largely mitigated. Furthermore, this technique allows a better landing entry angle of graft insertion; the resulting smoother curve trajectory leads to facile device insertion, while the risk of kinking after resumption of flow is readily avoided. A further possible advantage would be a less likely to produce thrombosis at the anastomosis. Differences of this technique have already been reported for insertions of extracorporeal membrane oxygenation (ECMO), and for aortic dissections and aneurysms. Our experience in 8 cases suggests the applicability of our method to access the axillary artery for Impella 5.0 insertion

Heater test planning for the near surface test facility at the Hanford reservation

The underground test facility NSTF being constructed at Gable Mountain, is the site for a group of experiments designed to evaluate the thermo-mechanical suitability of a deep basalt stratum as a permanent repository for nuclear waste. Thermo-mechanical modeling was performed to help design the instrumentation arrays for the three proposed heater tests (two full scale tests and one time scale test) and predict the thermal environment of the heaters and instruments. The modeling does not reflect recent RHO revisions to the in situ heater experiment plan. Heaters, instrumentation, and data acquisition system designs and recommendations were adapted from those used in Sweden. (DLC

Clinical use of [TIMP-2]•[IGFBP7] biomarker testing to assess risk of acute kidney injury in critical care: guidance from an expert panel

BackgroundThe first FDA-approved test to assess risk for acute kidney injury (AKI), [TIMP-2]center dot[IGFBP7], is clinically available in many parts of the world, including the USA and Europe. We sought to understand how the test is currently being used clinically.MethodsWe invited a group of experts knowledgeable on the utility of this test for kidney injury to a panel discussion regarding the appropriate use of the test. Specifically, we wanted to identify which patients would be appropriate for testing, how the results are interpreted, and what actions would be taken based on the results of the test. We used a modified Delphi method to prioritize specific populations for testing and actions based on biomarker test results. No attempt was made to evaluate the evidence in support of various actions however.ResultsOur results indicate that clinical experts have developed similar practice patterns for use of the [TIMP-2]center dot[IGFBP7] test in Europe and North America. Patients undergoing major surgery (both cardiac and non-cardiac), those who were hemodynamically unstable, or those with sepsis appear to be priority patient populations for testing kidney stress. It was agreed that, in patients who tested positive, management of potentially nephrotoxic drugs and fluids would be a priority. Patients who tested negative may be candidates for fast-track protocols.ConclusionIn the experience of our expert panel, biomarker testing has been a priority after major surgery, hemodynamic instability, or sepsis. Our panel members reported that a positive test prompts management of nephrotoxic drugs as well as fluids, while patients with negative results are considered to be excellent candidates for fast-track protocols