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Positive susceptibility vessel sign (SVS) in patients with acute ischaemic stroke has been associated with friable red blood cell-rich clots and more effective recanalisation using stent retrievers versus contact aspiration. We compared the safety and efficacy of stent retrievers plus contact aspiration (combined technique) versus contact aspiration alone as the first-line thrombectomy technique in patients with acute ischaemic anterior circulation stroke and SVS-positive occlusions. Adaptive Endovascular Strategy to the Clot MRI in Large Intracranial Vessel Occlusion (VECTOR) was a prospective, randomised, open-label study with blinded evaluation. Patients with SVS-positive anterior circulation occlusions on pretreatment MRI and arterial puncture within 24 h of symptom onset were enrolled from 22 centres in France. A centralised web-based method was used by interventional neuroradiologists for dynamic randomisation by minimisation. Patients were randomly assigned 1:1 to the combined technique or contact aspiration alone. The primary outcome was expanded Thrombolysis in Cerebral Infarction (eTICI) grade 2c or 3 reperfusion after three or fewer passes on post-treatment angiogram, adjudicated by a blinded independent central imaging core laboratory. The intention-to-treat population was used to assess the primary and secondary outcomes. This trial is registered with ClinicalTrials.gov (NCT04139486) and is complete. Between Nov 26, 2019, and Feb 14, 2022, 526 patients were enrolled, of whom 521 constituted the intention-to-treat population (combined technique, n=263; contact aspiration alone, n=258). The median age of participants was 74·9 years (IQR 64·4–83·3); 284 (55%) were female and 237 (45%) male. The primary outcome did not differ significantly between groups (152 [58%] of 263 patients for the combined technique vs 135 [52%] of 258 for contact aspiration; odds ratio [OR] 1·27; 95% CI 0·88–1·83; p=0·19). Procedure-related adverse events occurred in 32 (12%) of 263 patients in the combined technique group and 27 (11%) of 257 in the contact aspiration group (OR 1·14; 0·65–2·00; p=0·65). The most common adverse event was intracerebral haemorrhage (146 [56%] of 259 patients for the combined technique vs 123 [49%] of 251 for contact aspiration; OR 1·32; 0·91–1·90; p=0·13). All-cause mortality at 3 months occurred in 57 (23%) of 251 patients in the combined technique group and 48 (19%) of 247 in the contact aspiration group (OR 1·19; 0·76–1·86; p=0·45), none of which was treatment-related. The results of the VECTOR trial do not show superiority of the combined stent retriever plus contact aspiration technique over contact aspiration alone in patients with SVS-positive occlusion with respect to achieving eTICI 2c–3 within three passes. These findings support the use of either the combined technique or contact aspiration alone as the initial thrombectomy strategy in patients with acute anterior circulation stroke with SVS on pretreatment MRI. Cerenovus.

Background Acute lung injury and respiratory failure in patients in the intensive care unit (ICU) present challenges owing to varied factors. Manual suctioning, which is the current standard, burdens healthcare professionals and poses risks. The Lmeca.A1000 automatic suction device offers an innovative solution to this problem. This study aimed to evaluate the safety of this device. Methods This prospective, multicenter, randomized trial compared automatic and manual suction in ICU patients. Mucosal injury and pneumonia were assessed using bronchoscopy and monitoring. Mechanical stability and adverse events were also evaluated. Results In total, 117 critically ill adults were screened: 56 in the experimental group and 53 in the control group completing the study. No significant difference in mucosal injury was found at 3 or 7 days after treatment ( p  = 0.871, and 0.750). The incidence of VAP over 2 weeks was 5.36% in the experimental group and 1.89% in the control group, not significantly different ( p  = 0.582). Adverse events occurred in 14.3 and 13.2%, respectively, with no significant difference ( p  = 0.870). The incidence of clinical trial device malfunction within 3 days of application was 0.03% and within 2 weeks of follow-up was 0.02%. Conclusions This study evidenced the non-inferiority of the automatic suction device to the manual method in terms of safety. The adoption of an automated system could alleviate the workload of healthcare professionals while maintaining effective airway management.

Objectives This study aimed to evaluate the clinical efficacy and cost-effectiveness of using a disposable bendable negative pressure suction sheath in combination with a disposable ureteroscope for treating upper urinary tract calculi and to compare it with the conventional ureteral access sheath with a lassoed mesh basket. Methods A retrospective analysis was conducted on clinical data from patients with upper urinary tract calculi who underwent flexible ureteroscopy at a tertiary hospital in Beijing between March 2023 and March 2024. The study included two groups: 69 patients were treated with disposable bendable negative pressure suction sheaths (negative pressure group) and 83 with conventional ureteral access sheath combined with lassoed mesh baskets (conventional group). Variables analyzed included operative time, stone-free rate, length of postoperative hospital stay, postoperative complication rate, and hospitalization cost. Result The operative time for the negative pressure group was 119.8 ± 10.4 min, which was longer than that in the conventional group (93.2 ± 9.8 min). The postoperative hemoglobin drop was 5.3 ± 2.2 g/L in the negative pressure group and 4.7 ± 1.2 g/L in the conventional group. The hospitalization cost for the negative pressure group was ¥28,273 ± 5389, which was significantly lower than that for the conventional group (¥30,786.1 ± 4055). The stone-free rate at 1 week postoperatively was 84.1% (58/69) in the negative pressure group, which was significantly higher than that in the conventional group (68.7%). However, there was no statistically significant difference in stone-free rate at 1 month postoperatively between the two groups. Conclusions The use of a disposable ureteroscope with a bendable negative pressure suction sheath can improve short-term postoperative stone-free rate. However, this approach may increase surgical complexity, extend operative time, and heighten the risk of intraoperative bleeding. This procedure is recommended to be performed by physicians with extensive experience in flexible ureteroscopy to ensure safety and efficacy.

Background and Objective: This pilot study aimed to evaluate the outcomes of a novel large-bore cannula aspiration technology developed in our laboratory in comparison to phacofragmentation for addressing complete lens dislocation. Patients and Methods: Thirty-seven eyes with complete lens dislocation were randomly assigned to two groups. In both groups, standard 3-port pars plana vitrectomy (PPV) was performed to remove the vitreous. The dislocated lens was removed by phacofragmentation or the large-bore cannula aspiration technology, based on the random grouping. The “cannula” aspiration instrument was made of the trocar of a 20-G vein detain needle. After the suction line was twisted off, the “cannula” was connected to the proximal end of the suction line. Nineteen eyes were treated with this novel large-bore cannula aspiration technology and the remaining 18 eyes were operated with phacofragmentation to extract the dislocated lenses. Patients were followed up for ≥ 6 months. Several relevant indicators were compared between the two groups, including intraocular pressure (IOP), the change in IOP from preoperative to postoperative measurements, and the incidence of postoperative complications. Results: There were no significant differences in demographic and baseline characteristics between the two groups. Mean duration of surgery was comparable between the two groups. Three eyes in the phacofragmentation group had scleral burns, whereas no scleral burns were observed in the aspiration group. In terms of IOP, the phacofragmentation group exhibited lower IOP compared to the aspiration group on both the first and second days postsurgery (P < .01). Additionally, during the same postoperative period, the difference in IOP between preoperative and postoperative was significantly smaller in the aspiration group compared to the phacofragmentation group (P < .01). However, IOP levels were comparable between the two groups 1 week after surgery. Conclusion: This pilot study demonstrated that the new large-bore cannula aspiration technology can be effectively used for lens extraction. The large-bore cannula aspiration technology avoids the use of ultrasonic energy, thereby eliminating the direct risk of thermal scleral injury and potential retinal damage from ultrasound shockwaves. Thus, this new large-bore cannula aspiration technology can be further explored for complete lens dislocation surgery.

Pain during endotracheal aspiration (ETA) is frequent in critically ill patients. Managing pre-emptive analgesia before procedures remains a crucial aspect of care. We compared pupillometry to standard clinical practice for assessing preemptive-analgesia administration and pain before ETA according to Behavioural Pain Scale (BPS), the Behavioural Pain Indicator Scale (ESCID), and the Pupillary Dilation Reflex (PDR). A multicentre parallel-group, controlled trial with balanced (1:1) randomization. Sedated, mechanically ventilated patients aged ≥ 18 with baseline BPS = 3, ESCID = 1, and RASS scores between −1 and −4 were included. Control group: preemptive-analgesia was administered according to nurse criteria. In the experimental group, preemptive analgesia was administered in patients with PDR ≥ 11.5 % after a 20 mA stimulus measured using AlgiScan®. The preemptive analgesia was fentanyl one µg/kg iv bolus. We used the Chi-square statistic to compare post-intervention pain according to BPS, ESCID, and PDR pain values. A multivariate logistic regression study adjusting for sex, BIS, RASS, APACHE II, remifentanil, and preemptive analgesia was conducted. Ninety-two patients were studied, 51 in control groups and 41 in intervention groups. Pain incidence was lower in the experimental group. Significantly, 43.9 % of patients in the experimental group were prescribed preemptive analgesia before ETA compared to 19.6 % in the control group (p = 0.03). Multivariate analysis showed significant reductions in pain in the group that received preemptive-analgesia before ETA guided by pupillometry across BPS [OR = 0.34 (95 % CI: 0.12–0.99), p = 0.048], ESCID [OR = 0.29 (95 % CI: 0.09–0.88), p = 0.030] and PDR [OR = 0.27 (95 % IC: 0.08–0.86), p = 0.027] compared to standard clinical practice. Preemptive analgesia monitored with pupillometry group had a lower percentage of patients with pain than those who received analgesia based on standard clinical practice. This effect was independent of the sex, patient severity, BIS score, remifentanil use, or preemptive- analgesia. The requirement for preemptive analgesia before aspiration, evaluated through routine clinical practice, was lower than detected by pupillometric monitoring of patients. The use of pupillometry to monitor preemptive analgesia reduced pain after secretion aspiration. Pupillometry would be an effective tool to individualize the need for preemptive analgesia before potentially painful interventions, applicable to all patients regardless of sex, severity, or sedation level.

Background The principles of chest drainage have not changed significantly since 1875 when Bülau introduced the idea of underwater drainage tube which became a trademark of thoracic surgery. We performed a prospective, randomized trial comparing omitting pleural drain (drainless group) versus drainage with small low suction drain (drainage group) strategies of thoracic surgery when the visceral pleura remains intact. Aiming to investigate whether these approaches represent safe treatment options. Methods A multi-center, prospective, parallel group, randomized, controlled trial enrolling patients after thoracic procedures in which visceral pleura remained intact at the end of surgery between August 2020 and September 2023. After completion of the procedure a suction-seal test was conducted on all patients. If suction-seal test was positive to confirm absence of air leak, patients were randomized to either receive low auto-suction drain as a solo pleural drain (drainage group) or not to receive drain (drainless group). Results During the study period, 111 patients were recruited. Eleven patients had negative Suction-seal test and were excluded by inserting a traditional underwater seal. The remaining 100 patients were randomly assigned to either drainage group with low suction drain (Fig.  1 ) ( n  = 50) or drainless group ( n  = 50). Conclusion The results of this study suggest that either omitting drain or inserting a low auto suction drain safely substitutes the one-way valve when the visceral pleura remains intact. Omitting drain or inserting portable small caliber drain encourages early mobilization and is associated with shorter hospital stay.

Purpose To assess the safety and efficacy of super-mini PCNL (SMP, 14 Fr) when compared to standard PCNL (sPCNL, 24–30 Fr) in the management of renal calculi of size ranging from 1.5 to 3 cm. Methods From February 2021 to January 2022, a total of 100 patients were randomized to either SMP group or sPCNL group in a 1:1 ratio (50 in each group) using computer-generated simple randomization. Demographic data, stone characteristics, operative times, perioperative complications, blood transfusions, postoperative drop in haemoglobin, postoperative pain, duration of hospital stay and stone-free rates were compared between the two groups. Results Mean stone volume (2.41 cm 2 vs 2.61 cm 2 ) and stone-free rates (98% vs 94%, p  = 0.14) were similar in both the SMP and sPCNL groups, respectively. The SMP group had significantly longer mean operative times (51.62 ± 10.17 min vs 35.6 ± 6.8 min, p  = 0.03). Intraoperative calyceal injury (1/50 vs 7/50, p  = 0.42) and mean postoperative drop in haemoglobin (0.8 ± 0.7 g/dl vs 1.2 ± 0.81, p  = 0.21) were lower in the SMP group, but not statistically significant. SMP group showed significantly lower mean postoperative pain VAS scores (5.4 ± 0.7 vs 5.9 ± 0.9, p  = 0.03) and mean duration of hospital stay (28.38 ± 3.6 h vs 39.84 ± 3.7 h, p  = 0.0001). Complications up to Clavien grade 2 were comparable, with grade ≥ 3 complications higher in the standard group, but not statistically significant. Conclusion Super-mini PCNL is equally effective as standard PCNL in treating renal calculi up to 3 cm, with significantly reduced postoperative pain and duration of hospital stay and lower risk of Clavien grade ≥ 3 complications, although with higher operative times.

The study compares knowledge, skills, anxiety, satisfaction and self-confidence regarding suctioning between students trained using a partial task trainer with moulage and those using a low-fidelity simulator. Moulage application in simulation has been used in nursing skills training, such as intravenous therapy, pressure ulcer and burn care, but not for suctioning. A randomized controlled study with pre-test, post-test design. The study conducted in a nursing school in Turkey with 77 nursing intern students from 2020 to 2022. Students completed a two-hour theoretical course and four-hour skills training. The experimental group practiced with a task trainer with transparent lungs and moulage, while the control group used a low-fidelity simulator. Pretest suctioning knowledge scores were similar between experimental and control groups (10.54 ± 3.81 vs. 10.85 ± 2.96; p > 0.05). Posttest knowledge scores showed no significant difference (11.48 ± 3.47 vs. 10.35 ± 3.98; p > 0.05). On the other hand, the experimental group had higher skills scores (36.37 ± 2.69 vs. 29.17 ± 4.78; p < 0.001), greater anxiety before skill training (59.83 ± 8.96 vs. 59.72 ± 7.99; p < 0.05), evaluation (63.51 ± 9.32 vs. 58.77 ± 9.39; p < 0.05), higher satisfaction (4.69 ± 0.46 vs. 4.37 ± 0.74; p < 0.05) and self-confidence in learning (4.60 ± 0.46 vs. 4.23 ± 0.69; p < 0.05). Moulage significantly enhanced students' skill performance, satisfaction and self-confidence. Although knowledge scores were similar between groups, the experimental group experienced higher anxiety levels before training and evaluation, likely reflecting greater engagement and careful application of skills. These results suggest that students were engaged in learning and applied the skills more carefully. Moulage, which enhances fidelity, should be incorporated into nursing curricula to improve students' learning experiences and outcomes. •Suctioning skills are often taught with low-fidelity or task trainer simulators.•This study shows task trainers with moulage enhance skills and confidence more effectively.•Integrating moulage in training boosts realism and student satisfaction in clinical practice.

This study aimed to evaluate the effect of closed versus open endotracheal tube suction in reducing ventilator-associated pneumonia in mechanically ventilated neonates. In this open-label, parallel-group, randomized controlled trial with allocation concealment, ventilated neonates (≥ 28 weeks and ≥ 800 g) were either allocated to the closed-suction group ( n  = 41) or open-suction group ( n  = 39). The ventilator circuit of the babies enrolled in the closed-suction group was attached to the closed-suction catheter on the requirement of their first suction, and it was changed after every 48 h or earlier if visibly soiled whereas babies enrolled in the open-suction group were suctioned with a new suction catheter each time they require suction. The primary outcome was the incidence of VAP per 1000 days. Baseline maternal and neonatal characteristics were comparable between the two groups. The proportion of neonates with VAP in the closed-suction group was 3 (7.3%) and 1 (2.6%) in the open-suction group with an RR of 2.8 (95% CI : 0.30–26.28) and a p -value of 0.35. The incidence of VAP in the closed-suction group was 3.9 per 1000 ventilator days and 1.3 per 1000 ventilator days in the open-suction group. The incidence of clinical VAP/1000 ventilator days was 33.63 ± 22.96 in the closed-suction group and 28.67 ± 12.32 in the open-suction group with a mean difference of 5 (95% CI : − 3.26 to 13.26) and p -value of 0.24. Conclusion : In a unit with a low incidence of VAP, the effect of the endotracheal suction method alone did not impact the occurrence of VAP in the study population. Clinical trial registration : CTRI/2020/03/023679; Date: 17.02.2020. What is Known: • Better physiological stability of the closed-suctioning method on short-term measures including noticeably fewer episodes of hypoxia, a smaller drop in TcPO2 levels, and less variability in heart rate and bradycardia episodes. What is New: • In a unit with a low incidence of VAP in the neonates, randomized control trial studying the effect of the endotracheal suction method alone did not impact the occurrence of VAP amongst the study population.

Mechanical thrombectomy is now the standard of care for acute ischemic stroke patients with large vessel occlusions, and can be performed with several devices and techniques. One of these techniques, direct aspiration (DA), consists of navigating a large-bore catheter up to the face of the clot and initiating forceful suction. This comprehensive review has three objectives: (1) to describe the direct aspiration technique; (2) to present the available evidence regarding predictive factors of DA success and performance compared with other techniques; and (3) to discuss the forthcoming improvements in distal aspiration.