Aims and objectives To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients. Background Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure. Design Prospective, observational study. We have complied with the STROBE checklist of items. Methods This study was conducted from July–October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables. Results A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36–73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39–149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events. Conclusions The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr. Relevance to clinical practice The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr.

ObjectivesTo clarify the key role of circulating interferon-γ (IFN-γ) and to improve the clinical efficacy of mesenchymal stem cell (MSC) transplantation (MSCT) in patients with rheumatoid arthritis (RA).MethodsStudy of wild-type or IFN-γR-/- MSCT was first evaluated in a murine model of collagen-induced arthritis (CIA) following which a phase 1/2 randomised controlled study was conducted in 63 patients with RA who responded poorly to regular clinical treatments. Subjects were randomly assigned to an MSCT monotherapy group (n=32) or an MSCT plus recombinant human IFN-γ treatment group (n=31), with 1 year of follow-up. The primary end points consisted of efficacy as assessed as good or moderate EULAR response rates and the proportion of patients at 3 months attaining American College of Rheumatology 20 (ACR20) response rates.ResultsIn the murine studies, wild-type MSCT significantly improved the clinical severity of CIA, while IFN-γR-/- MSCT aggravated synovitis, and joint and cartilage damage. Transitioning from the murine to the clinical study, the 3-month follow-up results showed that the efficacy and ACR20 response rates were attained in 53.3% patients with MSCT monotherapy and in 93.3% patients with MSCT combined with IFN-γ treatment (p<0.05). No new or unexpected safety issues were encountered in 1-year follow-up for either treatment group.ConclusionsThe results of this study show that IFN-γ is a key factor in determining the efficacy of MSCT in the treatment of RA, and that an MSC plus IFN-γ combination therapeutic strategy can greatly improve the clinical efficacy of MSC-based therapy in RA patients.

Objectives Instead of evaluating one risk factor at a time, we illustrate the utility of “field-wide meta-analyses” in considering all available data on all putative risk factors of a disease simultaneously. Study Design and Setting We identified studies on putative risk factors of pterygium (surfer’s eye) in PubMed, EMBASE, and Web of Science. We mapped which factors were considered, reported, and adjusted for in each study. For each putative risk factor, four meta-analyses were done using univariate only, multivariate only, preferentially univariate, or preferentially multivariate estimates. Results A total of 2052 records were screened to identify 60 eligible studies reporting on 65 putative risk factors. Only 4 of 60 studies reported both multivariate and univariate regression analyses. None of the 32 studies using multivariate analysis adjusted for the same set of risk factors. Effect sizes from different types of regression analyses led to significantly different summary effect sizes (P-value < 0.001). Observed heterogeneity was very high for both multivariate (median I2, 76.1%) and univariate (median I2, 85.8%) estimates. No single study investigated all 11 risk factors that were statistically significant in at least one of our meta-analyses. Conclusion Field-wide meta-analyses can map availability of risk factors and trends in modeling, adjustments and reporting, as well as the impact of differences in model specification.

The outcome of 109 patients with severe head injury was studied in relation to clinical and computed tomographic (CT) criteria on admission, after resuscitation. Age, Glasgow Coma Score (GCS) and state of pupils strongly correlated with outcome. The presence of hypothalamic disturbances, hypoxia and hypotension were associated with an adverse outcome. The CT indicators associated with poor outcome were perimesencephalic cistern (PMC) obliteration, subarachnoid haemorrhage, diffuse axonal injury and acute subdural haematoma. The prognostic value of midline shift and mass effect were influenced by concomitant presence of diffuse brain injury. For the subset of patients aged < 20 years, with GCS 6-8 and patent PMC (n = 21), 71.4% correct predictions were made for a good outcome. For the subset of patients aged > 20 years, with GCS 3-5 and partial or complete obliteration of PMC (n = 28), 89.3% correct predictions were made for a poor outcome.

No abstract

During this COVID-19 outbreak, doctors stressed the need to ensure the safety of staff during management of the airway in patients. Then some experts published a viewpoint paper entitled 'COVID-19 outbreak: less stethoscope, more ultrasound'. 1 There's nothing wrong with that. However, this viewpoint may mislead doctors to abandon their stethoscopes. The reasons to abandon were: first, many medical workers were infected during the epidemic, so they were afraid to get close to the patients. At the same time, it is not practical for medical staff to use conventional stethoscopes after wearing protective clothing; and secondly, ultrasound equipment can not only be handheld, but also provides detection data and imaging. 1 As the largest military hospital participating in the first-line treatment of COVID-19, we have been working for >60 days from the outbreak. Based on our clinical experience, we would like to emphasize: do not discard the stethoscope from your hands during the COVID-19 outbreak. The reasons are as follows. First, patients with COVID-19 are not allowed to be accompanied by their families as there is a risk of cross-infection during hospitalization. At the same time, patients are often afraid of this disease because of a higher mortality rate. They therefore need more humane care. The stethoscope can serve as a bridge between doctor and patient and is more than just an instrument for diagnosis. It allows for interaction with our patients, to listen to their histories, their lifestyles, and their bodies, at this time. Auscultation can shorten the distance between doctors and patients, which makes it easier to gain their trust and establish a better doctor-patient relationship. 2

Key Clinical MessageIntravesical instillation of Bacillus Calmette‐Guérin (BCG) has been shown to be an effective form of immunotherapy for bladder cancer. This case report describes a patient who develops systemic BCG‐osis following intravesical BCG instillation and demonstrates the importance of being aware of more severe complications associated with BCG immunotherapy.

Background:Diabetic peripheral neuropathy puts patients at increased risk of acute injury by foreign bodies and also contributes to delayed presentation and diagnosis.Case report:We describe a 57-year-old patient with poorly controlled type 1 diabetes who presented with a three-week history of worsening swelling and erythema in the metacarpophalangeal joint of his left thumb. He denied any previous trauma or injury and was initially treated with intravenous antibiotics. Subsequent imaging revealed septic arthritis and osteomyelitis secondary to a retained foreign body, which was surgically removed in theatre.Conclusion:This is the first reported case of a retained foreign body in the hand of a diabetic patient, and demonstrates the importance of early radiological imaging of peripheral limb injuries in high-risk patients.