Acerca de serpientes, agujeros permeables y demás…

  JEM Link   Los trombos en la aurícula derecha, a menudo secundarios a tromboembolismo venoso, pueden clasificarse en tres tipos: Tipo A, es decir, grandes, móviles y con elevada morbimortalidad, Tipo B, fijos, pequeños y con mínima morbimortalidad, a menudo secundarios a catéteres que tocan la aurícula, Trombos atravesando el foramen oval, también denominado embolia paradojal inminente, “straddling thrombus … Seguir leyendo

Nanoparticles Deliver siRNA to Wound Sites to Speed Up Healing (VIDEO)


Researchers at the Albert Einstein College of Medicine, a part of Yeshiva University, are using novel nanoparticles to significantly speed up the healing of wounds. They discovered that the naturally produced fidgetin-like 2 (FL2) enzyme slows down the migration of cells as they travel toward a wound site. To counteract this process, the investigators developed a silencing RNA (siRNA) drug that inhibits the gene responsible for the production of FL2.

In order to actually deliver the siRNA into the interior of cells before degrading, the researchers encapsulated it in specially designed nanoparticles that keep their cargo fresh and intact before reaching the cell and letting it flow out.

Here’s a time lapse video of burned skin healing with and without the nanoparticle delivered gene inhibitor:


From the study abstract in Journal of Investigative Dermatology:

In this study, we identify the previously uncharacterized microtubule-severing enzyme, Fidgetin-like 2 (FL2), as a fundamental regulator of cell migration that can be targeted in vivo using nanoparticle-encapsulated siRNA to promote wound closure and regeneration. In vitro, depletion of FL2 from mammalian tissue culture cells results in a more than two-fold increase in the rate of cell movement, due in part to a significant increase in directional motility. Immunofluorescence analyses indicate that FL2 normally localizes to the cell edge, importantly to the leading edge of polarized cells, where it regulates the organization and dynamics of the microtubule cytoskeleton. To clinically translate these findings, we utilized a nanoparticle-based siRNA delivery platform to locally deplete FL2 in both murine full-thickness excisional and burn wounds. Topical application of FL2 siRNA nanoparticles to either wound type results in a significant enhancement in the rate and quality of wound closure both clinically and histologically relative to controls.

Study in Journal of Investigative Dermatology: Fidgetin-Like 2: A Microtubule-Based Regulator of Wound Healing…

Source: Albert Einstein College of Medicine…

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Importance of Vital Signs during Handoff

Well, I just sent an article that how important is the role of vital signs during pre-hospital or in ED assessment. Annals of EM published an article: Communication of Vital Signs at Emergency Department Handoff: Opportunities for Improvement. In a prospective observational study, authors  observed 1,163

patients sign out during 130 ED shifts. We did not communicate hypotension in 42%, and hypoxia in 74% at our sign out. Interestingly, ED overcrowding was not associated with this communication error. We need to do a better job on sign out and at least start on reminding ourselves about vital signs!

Link to article

TraumaCAD Mobile Hip Replacement Planning for iPad Scores FDA Clearance


Voyant Health, a division of Brainlab, won FDA clearance for its TraumaCad Mobile pre-op othropedic planning and templating tool for total hip replacement procedures. The app runs on iOS devices, as well as through a browser on Mac and Windows, and any other PCs supporting HTML 5.

The software automatically aligns implants and other devices, calculating relevant distances and offsets. It works with a variety of patient markers to maintain proper calibration and comes with templates for various artificial hips, including their different parameters.

App info page: TraumaCad Mobile…

Source: Voyant Health…

The post TraumaCAD Mobile Hip Replacement Planning for iPad Scores FDA Clearance appeared first on Medgadget.

Ultrasound Guided Lp

Ultrasound guided LP


Equipment needed:

-       high-frequency (small parts linear probe) for patients with normal weight

-       low-frequency 2-4 MHZ probe (abdominal curvilinear probe) for obese patients

-       transducer gel

-       skin marking pen

-       LP tray


Positioning: left lateral decubitus or seated position



1-   Identify spinous process which signifies the midline of the spine. Probe must be in transverse position, probe marker to clinician’s left side, at level of iliac crest. Spinous process looks like cresent shape hyperechoic structure with posterior acoustic shadowing.





2-   Mark the midline with a skin marking pen at the center of the probe. Drag the probe superiorly (head) and inferiorly (feet) and again mark the midline of the spine.

3-   Rotate the transducer to the sagittal (longitudinal) plane, with probe marker pointed at patient’s head. The probe should be parallel with patients spine and in between spinous processes previously marked.  The spinous processes again appear as hyperechoic cresent shapes.






4. Mark the space between the two spinous processes which is the interspinous space, on left and right side of probe.

5. The point of intersection represent the middle of the interspace and most ideal place for LP needle insertion.



6. Proceed with LP as you usually would. Instruct patient not to move as this may obscure landmarks and skin markings.


Reference:   Written by our very own Sinai EM attending’s Suzie Bentley and Danny Duque!