PubMed · 13577175
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G W HYATT. Human arterial procurement and processing.. https://pubmed.ncbi.nlm.nih.gov/13577175/
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A new exponentially weighted moving average (EWMA) control chart well suited for 'online' routine surveillance of medical procedures is introduced. The chart is based on inter-event counts for failures recorded when the failures occur. The method can be used for many types of hospital procedures and activities, such as problems or errors in surgery, hospital-acquired infections, erroneous handling or prescription of medicine, deviations from scheduled treatments causing inconveniences for patients. The construction, the use and the effectiveness of the control chart are demonstrated by two well-known examples about wound infection in orthopaedic surgery and neonatal arterial switch surgery. The method is easy to implement and apply, it illustrates, estimates and tests the current failure rate. Comparisons with two examples from the literature indicate that its ability to quickly detect an increased failure rate is comparable to that of other well-established methods.
Apart from long-term central venous catheterisation, the insertion of an arteriovenous graft (AVG) remains the only option to allow continued haemodialysis when the patient's superficial veins have been exhausted. Although, expanded PTFE has become the graft of choice for haemodialysis access throughout the world, many other organic or semi-organic materials are currently available for AVG construction. These are less prone to steal syndrome, easier to handle, more resistant to infection and may have similar, if not better, long term patencies.
Uterine spiral arteries play a vital role in supplying nutrients to the placenta and fetus, and for this purpose they are remodelled into highly dilated vessels by the action of invading trophoblast (physiological change). Knowledge of the mechanisms of these changes is relevant for a better understanding of pre-eclampsia and other pregnancy complications which show incomplete spiral artery remodelling. Controversies still abound concerning different steps in these physiological changes, and several of these disagreements are highlighted in this review, thereby suggesting directions for further research. First, a better definition of the degree of decidua- versus trophoblast-associated remodelling may help to devise a more adequate terminology. Other contestable issues are the vascular plugging and its relation with oxygen, trophoblast invasion from the outside or the inside of the vessels (intravasation versus extravasation), the impact of haemodynamics on endovascular migration, the replacement of arterial components by trophoblast, maternal tissue repair mechanisms and the role of uterine natural killer (NK) cells. Several of these features may be disturbed in complicated pregnancies, including the early decidua-associated vascular remodelling, vascular plugging and haemodynamics. The hyperinflammatory condition of pre-eclampsia may be responsible for vasculopathies such as acute atherosis, although the overall impact of such lesions on placental function is far from clear. Several features of the human placental bed are mirrored by processes in other species with haemochorial placentation, and studying such models may help to illuminate poorly understood aspects of human placentation.