Challenging the distal-to-proximal cannulation technique for administration of anti-cancer therapies : a prospective cohort study

Background: Distal-to-proximal technique has been recommended for anti-cancer therapy administration. There is no evidence to suggest that a 24-hour delay of treatment is necessary for patients with a previous uncomplicated venous puncture proximal to the administration site. Objectives: This study aims to identify if the practice of 24-hour delay between a venous puncture and subsequent cannulation for anti-cancer therapies at a distal site is necessary for preventing extravasation. Methods: A prospective cohort study was conducted with 72 outpatients receiving anti-cancer therapy via an administration site distal to at least one previous uncomplicated venous puncture on the same arm in a tertiary cancer centre in Australia. Participants were interviewed and assessed at baseline data before treatment and on day 7 for incidence of extravasation/phlebitis. Results: Of 72 participants with 99 occasions of treatment, there was one incident of infiltration (possible extravasation) at the venous puncture site proximal to the administration site and two incidents of phlebitis at the administration site. Conclusions: A 24 hour delay is unnecessary if an alternative vein can be accessed for anti-cancer therapy after a proximal venous puncture. Implications for practice: Extravasation can occur at a venous puncture site proximal to an administration site in the same vein. However, the nurse can administer anti-cancer therapy at a distal site if the nurse can confidently determine the vein of choice is not in any way connected to the previous puncture site through visual inspection and palpation.

Complete genome sequence and intracellular protein localization of Datura yellow vein nucleorhabdovirus

A limited number of plant rhabdovirus genomes have been fully sequenced, making taxonomic classification, evolutionary analysis and molecular characterization of this virus group difficult. We have for the first time determined the complete genome sequence of 13,188 nucleotides of Datura yellow vein nucleorhabdovirus (DYVV). DYVV genome organization resembles that of its closest relative, Sonchus yellow net virus (SYNV), with six ORFs in antigenomic orientation, separated by highly conserved intergenic regions and flanked by complementary 3′ leader and 5′ trailer sequences. As is typical for nucleorhabdoviruses, all viral proteins, except the glycoprotein, which is targeted to the endoplasmic reticulum, are localized to the nucleus. Nucleocapsid (N) protein, matrix (M) protein and polymerase, as components of nuclear viroplasms during replication, have predicted strong canonical nuclear localization signals, and N and M proteins exclusively localize to the nucleus when transiently expressed as GFP fusions. As in all nucleorhabdoviruses studied so far, N and phosphoprotein P interact when co-expressed, significantly increasing P nuclear localization in the presence of N protein. This research adds to the list of complete genomes of plant-infecting rhabdoviruses, provides molecular tools for further characterization and supports classification of DYVV as a nucleorhabdovirus closely related to but with some distinct differences from SYNV.

Novel ATPase activity of the polyprotein intermediate, Viral Protein genome-linked-Nuclear Inclusion-a protease, of Pepper vein banding potyvirus

Potyviruses temporally regulate their protein function by polyprotein processing. Previous studies have shown that VPg (Viral Protein genome-linked) of Pepper vein banding virus interacts with the NIa-Pro (Nuclear Inclusion-a protease) domain, and modulates the kinetics of the protease. In the present study, we report for the first time that VPg harbors the Walker motifs A and B, and the presence of NIa-Pro, especially in cis (cleavage site (E191A) VPg-Pro mutant), is essential for manifestation of the ATPase activity. Mutation of Lys47 (Walker motif A) and Asp88:Glu89 (Walker motif B) to alanine in E191A VPg-Pro lead to reduced ATPase activity, confirming that this activity was inherent to VPg. We propose that potyviral VPg, established as an intrinsically disordered domain, undergoes plausible structural alterations upon interaction with globular NIa-Pro which induces the ATPase activity. (C) 2012 Elsevier Inc. All rights reserved.

Evaluation of airline exercises prescribed to avoid deep vein thrombosis using fiber Bragg grating sensors

Various leg exercises have been recommended to prevent deep vein thrombosis (DVT), a condition where a blood clot forms in the deep veins, especially during long-haul flights. Accessing the benefit of each of these exercises in avoiding the DVT, which can be fatal, is important in the context of suggesting the correct and the most beneficial exercises. Present work aims at demonstrating the fiber Bragg grating (FBG)-based sensing methodology for measuring surface strains generated on the skin of the calf muscle to evaluate the suggested airline exercises to avoid DVT. As the dataset in the experiment involves multiple subjects performing these exercises, an inertial measurement unit has been used to validate the repetitiveness of each of the exercises. The surface strain on the calf muscle obtained using the FBG sensor, which is a measure of the calf muscle deformation, has been compared against the variation of blood velocity in the femoral vein of the thigh measured using a commercial electronic-phased array color Doppler ultrasound system. Apart from analyzing the effectiveness of suggested exercises, a new exercise which is more effective in terms of strain generated to avoid DVT is proposed and evaluated. (C) 2013 Society of Photo-Optical Instrumentation Engineers (SPIE)

Segurança do paciente na utilização de heparina sódica intravenosa: cuidados de enfermagem baseados na análise dos fatores de risco para eventos hemorrágicos

O objeto deste estudo são os eventos hemorrágicos em pacientes críticos que utilizam infusão contínua de heparina sódica. Tem como objetivo geral propor cuidados de enfermagem para pacientes que recebem infusão contínua de heparina, a fim de aumentar a segurança do paciente e reduzir a ocorrência de hemorragia, com base nos fatores de risco. Esta pesquisa procura contribuir com a farmacovigilância da heparina e com a qualidade da assistência de enfermagem. Trata-se de um estudo de coorte retrospectivo, com análise em prontuário, desenvolvido em unidade intensiva e semi-intensiva de um hospital público do Rio de Janeiro. Foram investigados 867 prontuários de 2010 a 2011, encontrando-se uma população de 79 pacientes que fizeram uso de heparina sódica em infusão contínua. As variáveis do estudo foram submetidas a tratamentos estatísticos não paramétricos e a medidas de associação. Os resultados apontam entre os pacientes três diagnósticos: fibrilação atrial, trombose venosa profunda e síndrome coronariana; percebe-se ainda predomínio do sexo feminino (58,23%) e de idosos (md=65 anos). A taxa de eventos hemorrágicos foi de 21,52% e se mostrou mais elevada quando comparada a outros estudos. Evidencia-se que pacientes com TTPa maior do que 100s tem um risco 9,29 vezes maior de apresentar eventos hemorrágicos. Todos os fatores de risco idade maior do que sessenta anos, hipertensão arterial sistêmica, TTPa maior do que 100s, uso prévio de anticoagulante e insuficiência renal apresentam associação positiva com a presença de evento hemorrágico. Entre os pacientes com eventos hemorrágicos, 94,16% apresentam um ou mais fatores de risco para sangramento. Os eventos hemorrágicos foram identificados na pele (47,37%), em sítio de punção, nas vias aéreas, no sistema geniturinário (15,79%) e no sistema gastrointestinal (10,53%). A maioria (55%) dos eventos hemorrágicos foi classificada com tipo 2 de BARC. Na associação entre o dispositivo invasivo utilizado e o tipo de sangramento, 100% dos pacientes com sangramento de via aérea ou do sistema gastrointestinal utilizavam sonda nasoentérica. Paciente com cateter vesical de demora (CVD) tem sete vezes mais risco de hematúria quando comparados com pacientes sem CVD; já pacientes com acesso venoso periférico tem menos risco de sangramento de sítio de punção quando comparados ao pacientes com acesso venoso central (RR= 0,74; 1,29). Essas associações norteiam a assistência de enfermagem e sugerem que o enfermeiro seja cauteloso ao realizar esses procedimentos nos pacientes com heparina sódica. Frente às variações no TTPa dosado, analisou-se o seguimento do protocolo e detectou-se que, nos pacientes com eventos hemorrágicos, a taxa de erro no ajuste da infusão foi maior (76,24%) quando comparada com os pacientes sem eventos hemorrágicos (39,05%). Ao se associar a taxa de erro da infusão com a presença de evento hemorrágico, evidencia-se que, quando a heparina não é ajustada segundo o protocolo, aumenta-se em 3,3 vezes o risco de evento hemorrágico. Portanto, para garantir o uso seguro na infusão de heparina, descrevem-se alguns cuidados específicos de enfermagem baseados nos fatores de risco e na indicação clínica de cada paciente.

Effect of bend orientation on life and puncture point location due to solid particle erosion of a high concentration flow in pneumatic conveyors

An investigation into predicting failure of pneumatic conveyor pipe bends due to hard solid particle impact erosion has been carried out on an industrial scale test rig. The bend puncture point locations may vary with many factors. However, bend orientation was suspected of being a main factor due to the biased particle distribution pattern of a high concentration flow. In this paper, puncture point locations have been studied with different pipe bend orientations and geometry (a solids loading ratio of 10 being used for the high concentration flow). Test results confirmed that the puncture point location is indeed most significantly influenced by the bend orientation (especially for a high concentration flow) due to the biased particle distribution and biased particle flux distribution. © 2004 Elsevier B.V. All rights reserved.

G protein signaling and vein graft intimal hyperplasia: reduction of intimal hyperplasia in vein grafts by a Gbetagamma inhibitor suggests a major role of G protein signaling in lesion development.

Vein grafting results in the development of intimal hyperplasia with accompanying changes in guanine nucleotide-binding (G) protein expression and function. Several serum mitogens that act through G protein-coupled receptors, such as lysophosphatidic acid, stimulate proliferative pathways that are dependent on the G protein betagamma subunit (Gbetagamma)-mediated activation of p21ras. This study examines the role of Gbetagamma signaling in intimal hyperplasia by targeting a gene encoding a specific Gbetagamma inhibitor in an experimental rabbit vein graft model. This inhibitor, the carboxyl terminus of the beta-adrenergic receptor kinase (betaARK(CT)), contains a Gbetagamma-binding domain. Vein graft intimal hyperplasia was significantly reduced by 37% (P<0.01), and physiological studies demonstrated that the normal alterations in G protein coupling phenotypically seen in this model were blocked by betaARK(CT) treatment. Thus, it appears that Gbetagamma-mediated pathways play a major role in intimal hyperplasia and that targeting inhibitors of Gbetagamma signaling offers novel intraoperative therapeutic modalities to inhibit the development of vein graft intimal hyperplasia and subsequent vein graft failure.

Adjuvant portal-vein infusion of fluorouracil and heparin in colorectal cancer: A randomised trial

Background. There is conflicting evidence on the efficacy of regional adjuvant chemotherapy, via portal-vein infusion (PVI), after resection of colorectal cancer. We undertook a randomised controlled multicentre trial to investigate the efficacy of PVI (500 mg/m2 fluorouracil plus 5000 IU heparin daily for 7 days). Methods. 1235 of about 1500 potentially eligible patients were randomly assigned surgery plus PVI or surgery alone (control). The patients were followed up for a median of 63 months, with yearly screening for recurrent disease. The primary endpoint was survival; analyses were by intention to treat. Findings. 619 patients in the control group and 616 in the PVI group met eligibility criteria. 164 (26%) control-group patients and 173 (28%) PVI-group patients died. 5-year survival did not differ significantly between the groups (73 vs 72%; 95% CI for difference -6 to 4). The control and PVI groups were also similar in terms of disease-free survival at 5 years (67 vs 65%) and the number of patients with liver metastases (79 vs 77%). Interpretation. PVI of fluorouracil, at a dose of 500 mg/m2 for 7 days, cannot be recommended as the sole adjuvant treatment for high-risk colorectal cancer after complete surgical excision. However, these results cannot eliminate a small benefit when PVI is used at a higher dosage or in combination with mitomycin.

Effect of bend orientation on life and puncture point location due to solid particle erosion of a high concentration flow in pneumatic conveyors

An investigation into predicting failure of pneumatic conveyor pipe bends due to hard solid particle impact erosion has been carried out on an industrial scale test rig. The bend puncture point locations may vary with many factors. However, bend orientation was suspected of being a main factor due to the biased particle distribution pattern of a high concentration flow. In this paper, puncture point locations have been studied with different pipe bend orientations and geometry (a solids loading ratio of 10 being used for the high concentration flow). Test results confirmed that the puncture point location is indeed most significantly influenced by the bend orientation (especially for a high concentration flow) due to the biased particle distribution and biased particle flux distribution.