Effect of needle orientation during arteriovenous access puncture on needed compression time after hemodialysis: A randomized controlled trial

Background

There are two techniques for puncturing an arteriovenous fistula: one where the needle is inserted bevel up and then rotated to a bevel down position, and another where the needle is inserted bevel down. The aim of this study was to compare these two methods of needle insertion on minimum compression time required for hemostasis after needle removal.

Methods

This was a prospective, randomized, cross-over, blinded, single-center, routine care study. Each patient's average post-dialysis puncture site compression time was determined during a 2-week baseline period while using bevel-up access puncture. Subsequently, minimum post-dialysis puncture-site compression time was determined during each of two sequential follow-up periods, during which fistula puncture was done with needles inserted bevel up or down, respectively. The order of treatments (bevel up or bevel down insertion) was randomized. During each follow-up period, the minimum compression time necessary to avoid bleeding on needle removal was determined by progressively shortening the compression time. Puncture-associated pain was also assessed as prepump and venous pressures and ability to achieve desired blood flow rate during the dialysis session.

Results

Forty-two patients were recruited. The baseline compression time after needle removal averaged 9.99 ± 2.7 min During the intervention periods, the minimum compression time was on average 10.8 min (9.23–12.4) when the access needles had been inserted bevel down versus 11.1 min (9.61–12.5) when the access needles had been inserted bevel up (p = 0.72). There was no difference in puncture-associated pain between the two insertion techniques, and no difference in prepump or venous pressures or ability to achieve the desired blood flow rate during the dialysis session.

Conclusion

Bevel-up and bevel-down needle orientation during arteriovenous fistula puncture are equivalent techniques in terms of achieving hemostasis on needle removal, and puncture-associated pain.     

Lysosomes Targeting pH Activable Imaging-Guided Photodynamic Agents

Photodynamic therapy (PDT) is a photochemistry-based medical treatment combining light at a specific wavelength and a photosensitizer (PS) in the presence of oxygen. Application of PDT as a conventional treatment is limited and clearly the approval in clinics of new PS is challenging. The selective accumulation of the PS in the targeted malignant cells is of paramount importance to reduce the side effects that are typical of the current worldwide approved PS. Here we report a new series of aniline- and iodine-substituted BODIPY derivatives ( 1 – 3 ) as promising lysosome-targeting and pH-responsive theranostic PS, which displayed a significant in vitro light-induced cytotoxicity, efficient imaging properties and low dark toxicity (for 2 and 3 ). These compounds were obtained in few reproducible synthetic steps and good yields. Spectroscopic and electrochemical measurements along with computational calculations confirmed the quenching of the emissive properties of the PS, while both fluorescence and ¹O₂ emission were obtained only under acidic conditions inducing amine protonation. The pK_a values and pH-dependent emissive properties of 1 – 3 being established, their cellular uptake and activation in the lysosomal vesicles (pH≈4-5) were confirmed by their co-localization with the commercial LysoTracker deep red and light-induced cytotoxicity (IC₅₀ between 0.16 and 0.06 μM) against HeLa cancer cells.     

Artificial neural network to predict the power number of agitated tanks fed by CFD simulations

The power consumption of the agitator is a critical variable to consider in the design of a mixing system. It is generally evaluated through a dimensionless number known as the power number $N_p$. Multiple empirical equations exist to calculate the power number based on the Reynolds number $Re$ and dimensionless geometrical variables that characterize the tank, the impeller, and the height of the fluid. However, correlations perform poorly outside of the conditions in which they were established. We create a rich database of 100 k computational fluid dynamics (CFD) simulations. We simulate paddle and pitched blade turbines in unbaffled tanks from $Re$ 1 to 100 and use an artificial neural network (ANN) to create a robust and accurate predictor of the power number. We perform a mesh sensitivity analysis to verify the precision of the $N_p$ values given by the CFD simulations. To sample the 100 k mixers by their geometrical and physical properties, we use the Latin hypercube sampling (LHS) method. We then normalize the data with a MinMax transformation to put all features in the same scale and thus avoid bias during the ANN's training. Using a grid search cross-validation, we find the best architecture of the ANN that prevents overfitting and underfitting. Finally, we quantify the performance of the ANN by extracting 30% of the database, predicting the $N_p$ using the ANN, and evaluating the mean absolute percentage error. The mean absolute error in the ANN prediction is 0.5%, and its accuracy surpasses correlations even for untrained geometries.     

A Holistic Solution to Icing by Acoustic Waves: De-Icing,Active Anti-Icing,Sensing with Piezoelectric Crystals,and Synergy with Thin Film Passive Anti-Icing Solutions

Icing has become a hot topic both in academia and in the industry given its implications in transport, wind turbines, photovoltaics, and telecommunications. Recently proposed de-icing solutions involving the propagation of acoustic waves (AWs) at suitable substrates may open the path for a sustainable alternative to standard de-icing or anti-icing procedures. Herein, the fundamental interactions are unraveled that contribute to the de-icing and/or hinder the icing on AW-activated substrates. The response toward icing of a reliable model system consisting of a piezoelectric plate activated by extended electrodes is characterized at a laboratory scale and in an icing wind tunnel under realistic conditions. Experiments show that surface modification with anti-icing functionalities provides a synergistic response when activated with AWs. A thoughtful analysis of the resonance frequency dependence on experimental variables such as temperature, ice formation, or wind velocity demonstrates the application of AW devices for real-time monitoring of icing processes.     

Refining the Dynamic Network of T2SS Endopilus Tip Heterocomplex Combining cw-EPR and Nitroxide–GdIII Distance Measurements

The type 2 secretion system (T2SS) is a bacterial nanomachine composed of an inner membrane assembly platform, an outer membrane pore and a dynamic endopilus. T2SS endopili are organized into a homo-multimeric body formed by the major pilin capped by a heterocomplex of four minor pilins. The first model of the T2SS endopilus was recently released, even if structural dynamics insights are still required to decipher the role of each protein in the full tetrameric complex. Here, we applied continuous-wave and pulse EPR spectroscopy using nitroxide-gadolinium orthogonal labelling strategies to investigate the hetero-oligomeric assembly of the minor pilins. Overall, our data are in line with the endopilus model even if they evidenced conformational flexibility and alternative orientations at local scale of specific regions of minor pilins. The integration of different labelling strategies and EPR experiments demonstrates the pertinence of this approach to investigate protein–protein interactions in such multiprotein heterocomplexes.