Technical skills simulation in transplant surgery: a systematic review

Purpose

 Transplant surgery is a demanding field in which the technical skills of the surgeon correlates with patient outcomes. As such, there is potential for simulation-based training to play an important role in technical skill acquisition. This study provides a systematic assessment of the current literature regarding the use of simulation to improve surgeon technical skills in transplantation.

Methods

 Data were collected by performing an electronic search of the PubMed and Scopus database for articles describing simulation in transplant surgery. The abstracts were screened using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Three reviewers analyzed 172 abstracts and agreed upon articles that met the inclusion criteria for the systematic review.

Results

 Simulators can be categorized into virtual reality simulators, cadaveric models, animal models (animate or inanimate) and synthetic physical models. No virtual reality simulators in transplant surgery are described in the literature. Three cadaveric models, seven animal models and eight synthetic physical models specific to transplant surgery are described. A total of 18 publications focusing on technical skills simulation in kidney, liver, lung, pancreas, and cardiac transplantation were found with the majority focusing on kidney transplantation.

Conclusions

 This systematic review identifies currently reported simulation models in transplant surgery. This will serve as a reference for general surgery and transplant surgery professionals interested in using simulation to enhance their technical skills.

Strain variation in Bacillus cereus biofilms and their susceptibility to extracellular matrix-degrading enzymes

Bacillus cereus is a foodborne pathogen and can form biofilms on food contact surfaces, which causes food hygiene problems. While it is necessary to understand strain-dependent variation to effectively control these biofilms, strain-to-strain variation in the structure of B. cereus biofilms is poorly understood. In this study, B. cereus strains from tatsoi (BC4, BC10, and BC72) and the ATCC 10987 reference strain were incubated at 30°C to form biofilms in the presence of the extracellular matrix-degrading enzymes DNase I, proteinase K, dispase II, cellulase, amyloglucosidase, and α-amylase to assess the susceptibility to these enzymes. The four strains exhibited four different patterns in terms of biofilm susceptibility to the enzymes as well as morphology of surface-attached biofilms or suspended cell aggregates. DNase I inhibited the biofilm formation of strains ATCC 10987 and BC4 but not of strains BC10 and BC72. This result suggests that some strains may not have extracellular DNA, or their extracellular DNA may be protected in their biofilms. In addition, the strains exhibited different patterns of susceptibility to protein- and carbohydrate-degrading enzymes. While other strains were resistant, strains ATCC 10987 and BC4 were susceptible to cellulase, suggesting that cellulose or its similar polysaccharides may exist and play an essential role in their biofilm formation. Our compositional and imaging analyses of strains ATCC 10987 and BC4 suggested that the physicochemical properties of their biofilms are distinct, as calculated by the carbohydrate to protein ratio. Taken together, our study suggests that the extracellular matrix of B. cereus biofilms may be highly diverse and provides insight into the diverse mechanisms of biofilm formation among B. cereus strains.

In vitro antibacterial effects of non-thermal atmospheric plasma irradiation on Staphylococcus pseudintermedius and Pseudomonas aeruginosa

In the last decade, atmospheric plasma has been used to treating bacterial infections in humans due to its bactericidal effects; however, its efficacy in dogs is unclear. This study evaluated the in vitro bactericidal efficacy of atmospheric plasma on Staphylococcus pseudinter- medius and Pseudomonas aeruginosa, two of the most important bacterial agents isolated from canine pyodermas. Three isolates each of S. pseudintermedius and P. aeruginosa obtained from dogs with pyoderma were subjected to atmospheric plasma. The isolates from the control group were not exposed to plasma, while those from the treatment groups were exposed to plasma for 15 (7.5 J/cm2), 30 (15 J/cm2), 60 (30 J/cm2), or 90 (45 J/cm2) seconds. After each treatment, a reduction in colony formation was observed. Bacterial viability was evaluated using the LIVE/ DEAD® BacLight™ Bacterial Viability Kit. The antibacterial effects were evaluated with Image J software and significance was assessed statistically in comparison to the control group. The bactericidal effect of atmospheric plasma against both bacteria increased significantly in a time-dependent manner. These results demonstrate the bactericidal capacity of atmospheric plasma, and suggest that it could serve as an alternative treatment method for canine pyoderma. Further studies are needed to evaluate the safety and efficacy of atmospheric plasma in dogs.

Anti-obesity effects of Korean red ginseng extract in healthy beagles

The aim of this study was to evaluate the safety and anti-obesity effects of the Korean red ginseng extract in dogs. To this end, we fed healthy beagles a Korean red ginseng diet and/or snack for 8 weeks. The dogs were submitted to a thorough physical examination, complete blood count, serum biochemistry analysis, analysis of adipose tissue activity, and body fat-content analysis by computed tomography (CT). At the end of the study period, the dogs that were fed the ginseng extract-diet/snack showed a significant decrease in body weight, body condition score and leptin levels relative to the baseline value. The CT findings revealed a decrease in body fat content in dogs fed the ginseng extract diet but not in those fed the ginseng-extract snack. The results of blood analysis did not show any meaningful changes in any of the dogs. All dogs tolerated the diet/snack well, and there were no adverse events. Our results suggest that the Korean red ginseng extract diet can potentially serve as an anti-obesity diet for reducing fat mass in dogs.

Anti-pruritic effect of topical capsaicin against histamine-induced pruritus on canine skin

Several human studies have reported that capsaicin has anti-pruritic effects. Moreover, sever- al concentrations of topical capsaicin have been used to alleviate itch. The aim of this study was to investigate the anti-pruritic effect of capsaicin against histamine-induced pruritus compared with that of topical steroid or vehicle in 15 healthy beagles. Fifteen dogs were divided into three groups (n = 5 each), and treated topically with one of the following on the left side of the neck: capsaicin, positive control (steroid), or negative control (vehicle). Each treatment was performed twice daily for 8 days. All dogs were injected with histamine intradermally before treatment and on the 2nd, 4th, 6th, and 8th days of the treatment to evoke itch. Pruritus, wheal, and erythema intensity were assessed at each evaluation; cutaneous temperature was also recorded. On the final day, skin biopsy was conducted for histopathological evaluation for all dogs. The severity of pruritus was lesser in the capsaicin-treated group compared with the negative control group on day 8 (p⟨0.05). In the capsaicin and steroid groups, wheal size, erythema index, and cutaneous temperature also decreased compared with pretreatment. Histopathological evaluation showed that the capsaicin-treated group had a higher number of inflammatory cells in the dermis com- pared to the vehicle control group; however, the steroid-treated group showed less severe inflam- matory reactions than the vehicle control group. These results suggest that capsaicin cannot reduce inflammation but may play a helpful role in reducing pruritus in dogs.

Phase transitions in a programmable quantum spin glass simulator

Understanding magnetic phases in quantum mechanical systems is one of the essential goals in condensed matter physics, and the advent of prototype quantum simulation hardware has provided new tools for experimentally probing such systems. We report on the experimental realization of a quantum simulation of interacting Ising spins on three-dimensional cubic lattices up to dimensions 8 × 8 × 8 on a D-Wave processor (D-Wave Systems, Burnaby, Canada). The ability to control and read out the state of individual spins provides direct access to several order parameters, which we used to determine the lattice's magnetic phases as well as critical disorder and one of its universal exponents. By tuning the degree of disorder and effective transverse magnetic field, we observed phase transitions between a paramagnetic, an antiferromagnetic, and a spin-glass phase.

Multidrug Resistance, Biofilm Formation, and Virulence of Escherichia coli Isolates from Commercial Meat and Vegetable Products

Escherichia coli is an important food safety and public health concern because of its pathogenicity and potential for antimicrobial resistance. E. coli isolates as food contaminants and their antimicrobial resistance, biofilm-forming ability, and virulence genes were analyzed to identify the potential of E. coli in food as a major transmission route for antimicrobial resistance and infectious agents. Among the 709 samples of minced meat and fresh vegetable products tested, 18.6% were positive for E. coli. One hundred nine (29.2%) out of 383 E. coli isolates were resistant to 1 or more of the 25 tested antimicrobials. Among the isolates from minced pork, the highest rate of resistance was observed for tetracycline (52.8%), followed by ampicillin (41.6%). The highest resistance rates against tetracycline were coincident with the high amount of tetracycline sold for veterinary use. Because penicillin is the most frequently used antimicrobial in humans, with 4.52 defined daily doses per 1000 people per day, the high rate of resistance to ampicillin (41.6%) supported the potential risk of E. coli food contaminants. However, only 1.3% of the isolates possessed the virulence genes commonly involved in foodborne outbreaks of E. coli. Sixty-seven isolates (17.5%) were multidrug-resistant (MDR), and the highest MDR was observed against 14 antimicrobials. Most of the MDR E. coli isolates showed biofilm-forming ability. Therefore, these isolates will have additional protection from environmental stresses, including antimicrobials. Given the importance of E. coli to food safety and public health, our results on the prevalence of antimicrobial resistance and virulence factors provide useful information for risk management options to protect public health.

A modified-live porcine reproductive and respiratory syndrome virus (PRRSV)-1 vaccine protects late-term pregnancy gilts against heterologous PRRSV-1 but not PRRSV-2 challenge

The objective of this study was to determine the efficacy of a commercially available porcine reproductive and respiratory syndrome virus (PRRSV)-1 modified-live virus (MLV) vaccine against PRRSV-1 and PRRSV-2 challenge in late-term pregnancy gilts. Gilts were vaccinated with the PRRSV-1 MLV vaccine at 4 weeks prior to breeding and then challenged intranasally with PRRSV-1 or PRRSV-2 at 93 days of gestation. After PRRSV-1 challenge, vaccinated pregnant gilts had a significantly longer gestation period, significantly higher numbers of live-born and weaned piglets and a significantly lower number of stillborn piglets at birth compared to unvaccinated pregnant gilts. No significant improvement in reproductive performance was observed between vaccinated and unvaccinated pregnant gilts following PRRSV-2 challenge. Vaccinated pregnant gilts also exhibited a significantly improved reproductive performance after challenge with PRRSV-1 compared to vaccinated pregnant gilts following PRRSV-2 challenge. The PRRSV-1 MLV vaccine was able to reduce PRRSV-1 but not PRRSV-2 viremia in pregnant gilts. Vaccinated gilts also showed a significantly higher number of PRRSV-1-specific IFN-γ-secreting cells (IFN-γ-SC) compared to PRRSV-2-specific IFN-γ-SC. The data presented here suggest that the vaccination of pregnant gilts with a PRRSV-1 MLV vaccine provides good protection against PRRSV-1 but only limited protection against PRRSV-2 challenge in late-term pregnancy gilts based on improvement of reproductive performance, reduction in viremia and induction of IFN-γ-SC.

Controlling the lectin recognition of glycopolymersviadistance arrangement of sugar blocks

Control of molecular recognitionvialiving radical polymerization.

The effect of visual field condition on kinetic in upper extremities and e.m.g in lower extremities while performing reaching in normal adults

[Purpose] The aims of this study was to investigate mean velocity and angle of shoulder joint, activation of tibialis anterior and gastrocnemius according to both eyes, dominant eye and non-dominant eye condition during reaching task in normal adults. [Subjects and Methods] Our research recruited 24 participants (male 11, female 13) in Silla University. Participants were performed reaching out movement by conditions of both eye, dominants eye, non-dominants eye. The target was placed at 45 degree diagonal direction and distance far away 130% of their arm length. Kinetic analysis of the upper extremities was investigated by QUALISYS 3-dimensional motion analysis system. Muscle activation were measured by EMG during reaching tasks. The collected data were statistically processed using the SPSS for win version 20.0. [Results] There was a significant difference of shoulder joint velocity of flexion, abduction and internal rotation according to visual field condition during reaching tasks. There was no significant difference of shoulder joint angle and muscle activation according to visual field conditions during reaching tasks. [Conclusion] In conclusion, visual field has an influence on shoulder joint velocity. Therefore, the visual field may be to play an important role in reach performance.

Empirical validation of statistical parametric mapping for group imaging of fast neural activity using electrical impedance tomography

Electrical impedance tomography (EIT) allows for the reconstruction of internal conductivity from surface measurements. A change in conductivity occurs as ion channels open during neural activity, making EIT a potential tool for functional brain imaging. EIT images can have  >10 000 voxels, which means statistical analysis of such images presents a substantial multiple testing problem. One way to optimally correct for these issues and still maintain the flexibility of complicated experimental designs is to use random field theory. This parametric method estimates the distribution of peaks one would expect by chance in a smooth random field of a given size. Random field theory has been used in several other neuroimaging techniques but never validated for EIT images of fast neural activity, such validation can be achieved using non-parametric techniques. Both parametric and non-parametric techniques were used to analyze a set of 22 images collected from 8 rats. Significant group activations were detected using both techniques (corrected p  <  0.05). Both parametric and non-parametric analyses yielded similar results, although the latter was less conservative. These results demonstrate the first statistical analysis of such an image set and indicate that such an analysis is an approach for EIT images of neural activity.

The Effects of Abdominal Hollowing in Lower-limb PNF Pattern Training on the Activation of Contralateral Muscles

[Purpose] The purpose of this study was to determine the effects of abdominal hollowing during lower-limb proprioceptive neuromuscular facilitation (PNF) training on the activation of contralateral muscles. [Subjects] Twenty male college students without symptoms or signs of muscular or nervous disease participated in this experiment after signing a consent form. [Methods] All the subjects were measured with electromyography (EMG) in a muscle activation test before and after abdominal hollowing. In the PNF program, the lower-limb pattern of PNF training, was maintained for 5 seconds, followed by a 2-minute break. This was repeated three times. The resting time between sets was 30 minutes. Surface EMG (Keypoint, Medtronic Inc., USA) was used for the measurements, and the highest value of three measurements was used in the analysis. [Result] The results revealed a significant change in the muscular activation of the opposite-side lower limbs. The muscular activations of the vastus lateralis, tibialis anterior, semitendinosus and gastrocnemius were increased significantly after the abdominal hollowing. [Conclusion] The findings suggest that abdominal hollowing in PNF pattern training can be effective at promoting muscular activation of the contralateral muscles. To promote muscular activation of the opposite side in lower-limb PNF pattern training, abdominal hollowing should be considered to improve the effect of PNF pattern training.

Semi-automatic determination of detailed vertebral shape from lumbar radiographs using active appearance models

SUMMARY

The vertebral endplates in lumbar radiographs were located by a semi-automatic annotation method using statistical shape models.

INTRODUCTION

Vertebral fractures are common osteoporotic fractures, but current quantitative detection methods (morphometry) lack specificity. We have previously developed more specific quantitative classifiers of vertebral fracture using shape and appearance models. This method has only been applied to DXA vertebral fracture assessment (VFA) images and not to spinal radiographs. The classifiers require a detailed annotation of the outline of the vertebral endplate, so we investigated the application of similar semi-automated annotation methods to lumbar radiographs as the initial step in the generalisation of the statistical classifiers used in VFA images.

METHODS

The vertebral body outlines in a training set of 670 lumbar radiographs were manually annotated by expert radiologists. This training set was used to build statistical models of vertebral shape and appearance using triplets of vertebrae. In order to segment vertebrae, the models were refitted using a sequence of active appearance models of vertebral triplets, using a miss-40-out train/test cross-validation experiment. The accuracy was evaluated against the manual annotation and analysed by fracture grade.

RESULTS

Good accuracy was obtained for normal vertebrae (0.82 mm) and fracture grades 1 and 2 (1.19 mm), but the localisation accuracy deteriorated for grade 3 fractures to 2.12 mm.

CONCLUSION

Vertebral body shape annotation can be substantially automated on lumbar radiographs. However, an occasional manual correction may be required, typically with either severe fractures, or when there is a high degree of projectional tilting or scoliosis. The located detailed shapes may enable the development of more powerful quantitative classifiers of osteoporotic vertebral fracture.

Sonographic 'molar tooth' sign in the diagnosis of Joubert syndrome

The characteristic imaging finding common to Joubert syndrome and related disorders is the 'molar tooth' sign. The prenatal diagnosis of Joubert syndrome using both ultrasound and fetal magnetic resonance imaging (MRI) in families with an affected child has been reported previously. We report two cases in which the molar tooth sign was identified by sonography at 26 + 4 weeks and at 20 + 6 weeks, respectively, prior to fetal MRI or genetic testing. In both cases the finding was subsequently confirmed on fetal MRI. As definitive prenatal genetic testing may not be conclusive in Joubert syndrome, the ability to identify the molar tooth sign sonographically before 24 weeks provides a valuable adjunct to prenatal diagnosis.

A novel method for recording neuronal depolarization with recording at 125-825 Hz: implications for imaging fast neural activity in the brain with electrical impedance tomography

Electrical impedance tomography (EIT) is a recently developed medical imaging method which has the potential to produce images of fast neuronal depolarization in the brain. Previous modelling suggested that applied current needed to be below 100 Hz but the signal-to-noise ratio (SNR) recorded with scalp electrodes during evoked responses was too low to permit imaging. A novel method in which contemporaneous evoked potentials are subtracted is presented with current applied at 225 Hz to cerebral cortex during evoked activity; although the signal is smaller than at DC by about 10×, the principal noise from the EEG is reduced by about 1000×, resulting in an improved SNR. It was validated with recording of compound action potentials in crab walking leg nerve where peak changes of -0.2% at 125 and 175 Hz tallied with biophysical modelling. In recording from rat cerebral cortex during somatosensory evoked responses, peak impedance decreases of -0.07 ± 0.006% (mean ± SE) with a SNR of >50 could be recorded at 225 Hz. This method provides a reproducible and artefact free means for recording resistance changes during neuronal activity which could form the basis for imaging fast neural activity in the brain.

Exercise effects on methylation of ASC gene

Chronic moderate exercise has been reported to reduce pro-inflammatory cytokines. To analyze the molecular mechanisms by which training exerts these effects, the epigenetic influences of age and exercise on the ASC gene, which is responsible for IL-1beta and IL-18 secretion, were investigated by ASC gene methylation. Further, the relationship between carcinogenesis and exercise, and methylation of the P15 tumor suppressive gene was also analyzed. High-intensity interval walking exercise, consisting of 3 min low-intensity walking at 40% of peak aerobic capacity followed by a 3 min high-intensity walking period above 70% of peak aerobic capacity, was continued for 6 months. Peripheral blood DNA extracts from young control (n=34), older control (n=153), and older exercise (n=230) groups were then analyzed by pyrosequencing for DNA methylation. Methylation of ASC decreased significantly with age (young control vs. older control, p<0.01), which is indicative of an age-dependent increase in ASC expression. Compared to the older control group, the degree of ASC methylation was higher in the older exercise group (older control vs. older exercise: p<0.01), and presumably lower ASC expression. Neither exercise nor age affected the methylation of the P15. In summary, chronic moderate exercise appears to attenuate the age-dependent decrease in ASC methylation, implying suppression of excess pro-inflammatory cytokines through reduction of ASC expression.

An electrode addressing protocol for imaging brain function with electrical impedance tomography using a 16-channel semi-parallel system

Electrical impedance tomography of brain function poses special problems because applied current is diverted by the resistive skull. In the past, image resolution was maximized with the use of an electrode addressing protocol with widely spaced drive electrode pairs and use of a multiplexer so that many electrode pairs could be flexibly addressed. The purpose of this study was to develop and test an electrode protocol for a 16-channel semi-parallel system which uses parallel recording channels with fixed wiring, the Kyung Hee University (KHU) Mk1. Ten protocols were tested, all addressing pairs of electrodes for recording or current drive, based on recording with a spiral, spiral with suboccipital electrodes (spiral s-o) and zig-zag configurations, and combinations of current injection from electrode pairs at 180 degrees , 120 degrees and 60 degrees . These were compared by assessing the image reconstruction quality of five simulated perturbations in a homogenous model of the human head and of four epileptic foci in an anatomically realistic model in the presence of realistic noise, in terms of localization error, resolution, image distortion and sensitivity in the region of interest. The spiral s-o with current injection at 180 degrees + 120 degrees + 60 degrees gave the best image quality and permitted reconstruction with a localization error of less than 10% of the head diameter. This encourages the view that it might be possible to obtain satisfactory images of focal abnormalities in the human brain with 16 scalp electrodes and improved instrumentation avoiding multiplexers on recording circuits.

Radial recession osteotomy for early Kienböck's disease

Between 1995 and 1999, ten patients with Lichtman stage II and III Kienböck's disease with negative ulnar variance underwent a joint-levelling radial recession osteotomy in our unit. The procedure was performed by the senior author in all cases. Eight patients were available for follow-up (average 31 months). Based on the Mayo Clinic modification of the Green wrist score, there were three excellent, three good and two fair results. Radiologically, there was improvement in lunate density in five of eight patients and evidence of healing in two of five patients with lunate fractures. We found that simple radial recession osteotomy for Lichtman stage II and III Kienböck's disease offers excellent early results.

Dehydroepiandrosterone sulfotransferase gene induction by bile acid activated farnesoid X receptor

Dehydroepiandrosterone sulfotransferase (STD) is a hydroxysteroid sulfo-conjugating enzyme with preferential substrate specificity for C-19 androgenic steroids and C-24 bile acids. STD is primarily expressed in the liver, intestine and adrenal cortex. Earlier studies have shown that androgens inhibit the rat Std promoter function through a negative androgen response region located between -235 and -310 base pair positions (Song, C. S., Jung, M. H., Kim, S. C., Hassan, T., Roy, A. K., and Chatterjee, B. (1998) J. Biol. Chem. 273, 21856-21866). Here we report that the primary bile acid chenodeoxycholic acid (CDCA) also acts as an important regulator of the Std gene promoter. CDCA is a potent inducer of the Std gene, and its inducing effect is mediated through the bile acid-activated farnesoid X receptor (FXR), a recently characterized member of the nuclear receptor superfamily. The ligand-activated FXR acts as a heterodimer with the 9-cis-retinoic acid receptor (RXR) and regulates the Std gene by binding to an upstream region at base pair positions -169 to -193. This specific binding region was initially identified by bile acid responsiveness of the progressively deleted forms of the Std promoter in transfected HepG2 hepatoma and enterocyte-like Caco-2 cells. Subsequently, the precise RXR/FXR binding position was established by protein-DNA interaction using in vitro footprinting and electrophoretic mobility shift analyses. Unlike all other previously characterized FXR target genes, which contain an inverted repeat (IR) of the consensus hexanucleotide half-site (A/G)G(G/T)TCA with a single nucleotide spacer (IR-1), the bile acid response element of the Std promoter does not contain any spacer between the two hexanucleotide repeats (IR-0). A promoter-reporter construct carrying three tandem copies of the IR-0 containing -169/-193 element, linked to a minimal thymidine kinase promoter, can be stimulated more than 70-fold in transfected Caco-2 cells upon CDCA treatment. Autoregulation of the STD gene by its bile acid substrate may provide an important contributing role in the enterohepatic bile acid metabolism and cholesterol homeostasis.

The toxR gene of Vibrio (Listonella) anguillarum controls expression of the major outer membrane proteins but not virulence in a natural host model

To examine the hypothesis that the ancestral role of the toxR gene in the family Vibrionaceae is control of the expression of outer membrane protein (OMP)-encoding genes for adaptation to environmental change, we investigated the role of the toxR gene in Vibrio anguillarum, an important fish pathogen. The toxR gene of V. angullarum (Va-toxR) was cloned from strain PT-87050 isolated from diseased ayu (Plecoglossus altivelis), and the sequence was analyzed. The toxR sequence was 63 to 51% identical to those reported for other species of the family Vibrionaceae. Distribution of the Va-toxR gene sequence in V. anguillarum strains of various serotypes was confirmed by using DNA probe and PCR methods. An isogenic toxR mutant of V. anguillarum PT-24, isolated from diseased ayu, was constructed by using an allelic exchange method. The wild-type strain and the toxR mutant did not differ in the ability to produce a protease(s) and a hemolysin(s) or in pathogenicity for ayu when examined by the intramuscular injection and immersion methods. A 35-kDa major OMP was not produced by the toxR mutant. However, a 46-kDa OMP was hardly detected in the wild-type strain but was produced as the major OMP by the toxR mutant. For the toxR mutant, the MICs of two beta-lactam antibiotics were higher and the minimum bactericidal concentration of sodium dodecyl sulfate was lower than for the wild-type strain. Analysis of the N-terminal amino acid sequences of the 35- and 46-kDa OMPs indicated that these proteins are the porin-like OMPs and are related to the toxR-regulated major OMPs of the family Vibrionaceae. The results indicate that the toxR gene is not involved in virulence expression in V. anguillarum PT-24 and that toxR regulation of major OMPs is universal in the family Vibrionaceae. These results support the hypothesis that the ancestral role of the toxR gene is regulation of OMP gene expression and that only in some Vibrio species has ToxR been appropriated for the regulation of a virulence gene(s).

The effect of the Lockit epidural catheter clamp on epidural migration: a controlled trial

We investigated the efficacy of using the Lockit epidural catheter clamp in preventing epidural catheter migration in patients receiving postoperative analgesia via an epidural infusion after major surgery. Patients were randomly allocated to receive either a standard epidural dressing, a coiled catheter with transparent adhesive dressing and tape (n = 54), or the Lockit epidural catheter clamp (n = 48). There was no movement from the insertion position in 88% of the Lockit group compared with only 28% in the standard group (p < 0.001). Outward migration of > 2 cm occurred in 26% of the standard group compared with just 6% of the Lockit group (p < 0.01). Inward migration of > 1 cm occurred in 17% of the standard group but in none of the Lockit group (p < 0.01). Catheter migration was assessed as being the cause of analgesic failure in 15% of the standard group but in only 4% of the Lockit group (p < 0.05). We conclude that the Lockit epidural catheter clamp significantly reduces catheter migration in a safe and non-invasive fashion.