Background Radial artery cannulation in young children is challenging. Here, we invented a single-operator laser-assisted ultrasound-guidance system projecting the path of the target artery on the skin surface and hypothesized that this system would improve the first-attempt success rate of radial arterial cannulation in young pediatric patients relative to traditional ultrasound guidance. Methods This single-center, prospective, parallel-group, randomized controlled study enrolled pediatric patients (n = 80, age less than two years) requiring radial artery cannulation during general anesthesia. The participants were randomized into the traditional ultrasound-guidance group or the single-operator laser-assisted ultrasound-guidance group. After inducing general anesthesia, ultrasound-guided radial artery cannulation was performed by two experienced operators. The primary outcome was the first-attempt success rate. The secondary outcomes included the procedure time to success within the first attempt, midmost rate of first attempt, first needle-tip position, and average number of adjustments. Results In total, 80 children were included in the analysis. The first-attempt success rate in the single-operator laser-assisted ultrasound-guidance group (36/40 [90%]) was significantly greater than that in the traditional ultrasound-guidance group (28/40 [70%]; absolute difference 20% (95%CI: 2.3 % to 36.6%), P = 0.025). The median procedure time to success within the first attempt was shorter in the single-operator laser-assisted ultrasound-guidance group compared with the traditional ultrasound-guidance group (31 s [27, 36 s] vs. 46 s [39, 52 s]); P < 0.001). The incidence of hematoma in the single-operator laser-assisted ultrasound-guidance group (1/40, 3%) was significantly lower than that in the traditional ultrasound-guidance group (11/40, 28%; P = 0.002). Regarding the initial needle-tip position after skin puncture, median score (4 [3,4] vs. 2 [2,3]; P < 0.001), position = 3, 4, or 5 (38 [95%] vs. 13 [33%]; P < 0.001), and position = 4 or 5 (26 [65%] vs. 5 [13%]; P < 0.001) were all in favor of single-operator laser-assisted ultrasound guidance. Conclusions Compared with traditional ultrasound guidance, the single-operator laser-assisted ultrasound-guided system is a useful add-on to the ultrasound dynamic needle-tip puncture technique. It improves the first-attempt success rate of radial artery cannulation in children younger than two years by projecting the path of the artery on the skin and provides better procedural conditions (stable ultrasound probe).
Skin wound healing is an important clinical challenge, and the main treatment points are accelerating epidermal regeneration and preventing infection. Therefore, it is necessary to develop a wound dressing that can simultaneously cure bacterial infections and accelerate wound healing. Here, we report a multifunctional composite wound dressing loaded with chitosan (CS)-binding bFGF (CSBD-bFGF) and antimicrobial peptides (P5S9K). First, CS was used as the dressing matrix material, and P5S9K was encapsulated in CS. Then, CSBD-bFGF was designed by combining recombinant DNA technology and tyrosinase treatment and modified on the dressing material surface. The results show that the binding ability of CSBD-bFGF and CS was significantly improved compared with that of commercial bFGF, and CSBD-bFGF could be controllably released from the CS dressing. More importantly, the prepared dressing material showed excellent antibacterial activity in vivo and in vitro and could effectively inhibit the growth of E. coli and S. aureus. Using NIH3T3 cells as cellular models, the results showed that the CSBD-bFGF@CS/P5S9K composite dressing was a friendly material for cell growth. After cells were seeded on the composite dressing surface, collagen-1 (COL-1) and vascular endothelial growth factor (VEGF) genes expression in cells were significantly upregulated. Finally, the full-thickness wound of the rat dorsal model was applied to analyse the tissue repair ability of the composite dressing. The results showed that the composite dressing containing CSBD-bFGF and P5S9K had the strongest ability to repair skin wounds. Therefore, the CSBD-bFGF@CS/P5S9K composite dressing has good antibacterial and accelerated wound healing abilities and has good application prospects in the treatment of skin wounds.
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