Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group.

To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization

Fire in the Operating Room During Hypospadias Repair

Fire in the operating room (OR) is a very distressful and shocking occurrence with potential dramatic consequences. Despite safety rules and rigorous recommendations, such unintentional events do occur every so often. Notably, the vast majority of cases have been reported in the adult population, with very few pediatric cases described to date. Herein, we report on a 16-month-old boy undergoing reconstructive surgery for penoscrotal hypospadias, who experienced an OR fire most likely related to the use of alcohol-based solution ignited by monopolar electrocautery

Price discrimination in the Italian medical device industry: an empirical analysis

In this paper we ascertain that the Italian market for medical devices is characterized by significant price dispersion. We have, therefore, carried out an econometric analysis, as well as a Bayesian network analysis to verify if price dispersion is due to price discrimination. We have found that ASLs (Aziende Sanitarie Locali) incur higher procurement costs than AOs (Aziende Ospedaliere), which purchase larger quantities as Centralized purchasing agencies do. Consequently, second-degree price discrimination may be one of the causes of price differences. Price levels are also inversely related to product age because of intense innovative activity, making product differentiation more likely than price discrimination. Public procurement agents located in Southern Italy pay higher prices than those located in Northern or Central Italy. This is due to the higher probability for Southern procurement agents to purchase from independent wholesalers, rather than from producers, implying a double marginalization effect which raises final prices. It is also more likely that obsolete medical devices are sold to Southern health care providers

Phase-averaged characterization of turbulent isothermal free swirling jet after vortex breakdown

This work mainly focused on the near-exit region of a round isothermal free swirling jet to characterize the effect of swirl on the flow field and to identify large coherent structures. 3C-2D PIV was employed to capture the instantaneous flow field close to the nozzle exit for non-swirling (S=0) and a high swirling jets (S=1.26) both with a Reynolds number of 21800. At swirl level of 1.26 the pressure fluctuations measured by a capacitive microphone indicate the existence of periodic instability, the so called precessing vortex core (PVC). A three-component proper orthogonal decomposition (POD) applied to the instantaneous velocity fields allow to identify the dominant flow structure associated to the PVC. The time coefficients of the two first most energetic POD modes were used to reconstruct the phase of the oscillatory motion in the swirling flow. The phase information was then used to conditionally average the instantaneous velocity field s, this allowed the 3D structure of the PVC to be reconstructed. The instantaneous minima of negative swirling strength values calculated from the instantaneous velocity field revealed the presence of two helical structures located in the inner and outer shear layers. By phase averaging the instantaneous swirling strength maps, the 3D helical vortex structure was reconstructed . The two co-winding counter-rotating helical structure fade out at an axial location of approximately z/ D = 1.5. The findings evidence that the combined application of PIV, POD and frequency analysis using capacitive microphone can provide detailed observations of coherent fluctuations ind uced by vortex precession

Optical coherence tomography and optical coherence tomography angiography in uveitis : a review

Optical coherence tomography (OCT) has dramatically changed the understanding and management of uveitis and other ocular conditions. Currently, OCT angiography (OCTA) combines structural information with the visualization of blood flow within the imaged area. The aim of this review is to present the basic principles of OCT and OCTA interpretation and to investigate the role of these imaging techniques in the diagnosis and management of uveitis. Common complications of intraocular inflammation such as macular oedema and inflammatory choroidal neovascularization are often diagnosed and followed with OCT/OCTA scans. However, uveitis specialists can obtain much more information from tomographic scans. This review provides a comprehensive description of typical OCT/OCTA findings characterizing different ocular structures in uveitis, proceeding from the cornea to the choroid. A careful interpretation of OCT/OCTA images can help in the differential diagnosis, the prediction of clinical outcomes, and the follow-up of patients with uveitis

Signals were broadly positive for months, but never definitive: the tocilizumab story

BACKGROUND: Most COVID-19 treatment guidelines currently recommend tocilizumab in combination with dexamethasone in critically ill patients who are exhibiting rapid respiratory decompensation. OBJECTIVES: To produce a critical review and summary of the pathway which led to the repurposing of tocilizumab for COVID-19 treatment, from in vitro observations to guidelines recommendations. SOURCES: All studies evaluating the effectiveness of tocilizumab to treat COVID-19 disease published over July 2020-July 2021. CONTENT: Two large methodologically well conducted observational studies, the TESEO and the STOP COVID cohorts, showed a reduction in the risk of invasive mechanical ventilation or death in patients treated with tocilizumab as compared to standard of care in 2020. Concomitantly and up to February 2021 a number of small sample size randomized trials (RCTs) were showing discrepant results. These RCTs had a number of issues: small sample size, various designs and inclusion criteria and different dosages of tocilizumab used. The confidence interval of the meta-analytic estimate for the RCT results was consistent with the hypothesis of no efficacy of tocilizumab. In our opinion, this was mainly because the meta-analysis included small and heterogeneous studies. These results led to a delay in the inclusion of tocilizumab in guidelines which occurred only in the summer of 2021. IMPLICATIONS: Although observational studies are unable to control for unmeasured confounding, they can be put together quickly during a pandemic and promptly provide important information. The large sample size allows us to investigate effect measure modifiers and better target interventions. It is key that the effect size is somewhat large (RR>2), all sources of bias are properly accounted for and the direct evidence is weighted against these factors. It appears to us that for tocilizumab, not having dismissed the results of carefully designed and analysed observational studies in 2020 could have prevented many deaths over those months

Extra-abdominal cryptorchidism associated with gastroschisis and impacted urethral calculus: two uncommon urologic conditions in one patient

The testis is rarely encountered within the organs prolapsed outside the abdominal wall defect of patients with gastroschisis. Optimal treatment strategy of this unusual type of cryptorchidism remains undefined, with less than 30 cases reported to date. We describe a new case where simple relocation of the testis into the abdomen was followed by spontaneous testicular descent. Additionally, he developed a urinary calculus impacted in the navicular fossa 4 years later. Given the rarity of the 2 conditions, the probability of their co-occurrence is exceptionally rare, especially considering that they seem to be causally and temporally unrelated to one another