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Der Orthopade Apr 2020Fast-track concepts in hip and knee arthroplasty focus on an early and safe mobilisation after surgery using a multi-modal pain concept with local infiltration... (Review)
Review
Fast-track concepts in hip and knee arthroplasty focus on an early and safe mobilisation after surgery using a multi-modal pain concept with local infiltration anaesthesia. No drains, femoral nerve blocks or urinary catheters are used. Tranexamic acid reduces blood loss and transfusion rates. Cortisone is helpful in reducing pain, PONV and postsurgical stress response. Minimal invasive surgical techniques and the renouncement of a tourniquet lead to a better functional result and less pain. Restrictions and precautions are not evidence-based and should, therefore, be abandoned.
Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Intraoperative Care; Minimally Invasive Surgical Procedures; Pain, Postoperative; Postoperative Care; Postoperative Hemorrhage; Tranexamic Acid
PubMed: 31974634
DOI: 10.1007/s00132-020-03867-y -
Europace : European Pacing,... Oct 2022The GermAn Laser Lead Extraction RegistrY: GALLERY is a retrospective, national multicentre registry, investigating the safety and efficacy of laser lead extraction...
AIMS
The GermAn Laser Lead Extraction RegistrY: GALLERY is a retrospective, national multicentre registry, investigating the safety and efficacy of laser lead extraction procedures in Germany.
METHODS AND RESULTS
Twenty-four German centres that are performing laser lead extraction have participated in the registry. All patients, treated with a laser lead extraction procedure between January 2013 and March 2017, were consecutively enrolled. Safety and efficacy of laser lead extraction were investigated. A total number of 2524 consecutive patients with 6117 leads were included into the registry. 5499 leads with a median lead dwell time of 96 (62-141) months were treated. The mean number of treated leads per patient was 2.18 ± 1.02. The clinical procedural success rate was 97.86% and the complete lead removal was observed in 94.85%. Additional extraction tools were used in 6.65% of cases. The rate of procedural failure was 2.14% with lead age ≥10 years being its only predictor. The overall complication rate was 4.32%, including 2.06% major and 2.26% minor complications. Procedure-related mortality was 0.55%. Female sex and the presence of abandoned leads were predictors for procedure-related complications. The all-cause in-hospital mortality was 3.56% with systemic infection being the strongest predictor, followed by age ≥75 years and chronic kidney disease.
CONCLUSION
In the GALLERY, a high success- and low procedure-related complication rates have been demonstrated. In multivariate analysis, female sex and the presence of abandoned leads were predictors for procedure-related complications, while the presence of systemic infection, age ≥75 years, and chronic kidney disease were independent predictors for all-cause mortality.
Topics: Aged; Child; Defibrillators, Implantable; Device Removal; Female; Humans; Lasers, Excimer; Pacemaker, Artificial; Postoperative Complications; Registries; Renal Insufficiency, Chronic; Retrospective Studies; Treatment Outcome
PubMed: 35718878
DOI: 10.1093/europace/euac056 -
AJPM Focus Mar 2023In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such... (Review)
Review
CONTEXT
In recent years, cities across the world have seen widespread growth in unsheltered homelessness, in which a person sleeps in a place not meant for human habitation such as cars, parks, sidewalks, and abandoned buildings. It is widely understood that people experiencing homelessness have poorer health outcomes than the general population. Less is known about the health of people who are unsheltered, yet they may be exposed to greater health risks than their sheltered counterparts. The purpose of this literature review is to evaluate and summarize the evidence on unsheltered homelessness and health.
EVIDENCE ACQUISITION
A literature search was conducted using PubMed to identify publications on unsheltered homelessness and health. A total of 42 studies were included for review.
EVIDENCE SYNTHESIS
Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse than sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower healthcare utilization and often lack health insurance.
CONCLUSIONS
Evaluating the impact of shelter status on health outcomes has important implications for the allocation of housing and health services. Longitudinal studies are needed to examine the relationship between the duration of sheltered and unsheltered homelessness and health outcomes and explore the mediating mechanisms that lead to poor health among unsheltered populations. Despite these limitations, our results also suggest an urgent need to address the unique and severe challenges facing unsheltered populations and the need for intervention approaches that are sensitive to these unique disease burdens.
PubMed: 37789936
DOI: 10.1016/j.focus.2022.100043 -
Europace : European Pacing,... Dec 2023Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their... (Review)
Review
AIMS
Single-connector (DF4) defibrillator leads have become the predominantly implanted transvenous implantable cardioverter-defibrillator lead. However, data on their long-term performance are derived predominantly from manufacturer product performance reports.
METHODS AND RESULTS
We reviewed medical records in 5289 patients with DF4 leads between 2011 and 2023 to determine the frequency of lead-related abnormalities. We defined malfunction as any single or combination of electrical abnormalities requiring revision including a sudden increase (≥2×) in stimulation threshold, a discrete jump in high-voltage impedance, or sensing of non-physiologic intervals or noise. We documented time to failure, predictors of failure, and management strategies. Mean follow-up after implant was 4.15 ± 3.6 years (median = 3.63), with 37% of leads followed for >5 years. A total of 80 (1.5%) leads demonstrated electrical abnormalities requiring revision with an average time to failure of 4 ± 2.8 years (median = 3.5). Of the leads that malfunctioned, 62/80 (78%) were extracted and replaced with a new lead and in the other 18 cases, malfunctioned DF4 leads were abandoned, and a new lead implanted. In multivariable models, younger age at implant (OR 1.03 per year; P < 0.001) and the presence of Abbott/St. Jude leads increased the risk of malfunction.
CONCLUSION
DF4 defibrillator leads demonstrate excellent longevity with >98.3% of leads followed for at least 5 years still functioning normally. Younger age at implant and lead manufacturer are associated with an increased risk of DF4 lead malfunction. The differences in lead survival between manufacturers require further investigation.
Topics: Humans; Defibrillators, Implantable; Equipment Failure; Retrospective Studies
PubMed: 38000900
DOI: 10.1093/europace/euad347 -
Life (Basel, Switzerland) Mar 2024Homochirality is an obvious feature of life on Earth. On the other hand, extraterrestrial samples contain largely racemic compounds. The same is true for any common... (Review)
Review
Homochirality is an obvious feature of life on Earth. On the other hand, extraterrestrial samples contain largely racemic compounds. The same is true for any common organic synthesis. Therefore, it has been a perplexing puzzle for decades how these racemates could have formed enantiomerically enriched fractions as a basis for the origin of homochiral life forms. Numerous hypotheses have been put forward as to how preferentially homochiral molecules could have formed and accumulated on Earth. In this article, it is shown that homochirality of the abiotic organic pool at the time of formation of the first self-replicating molecules is not necessary and not even probable. It is proposed to abandon the notion of a molecular ensemble and to focus on the level of individual molecules. Although the formation of the first self-replicating, most likely homochiral molecule, is a seemingly improbable event, on a closer look, it is almost inevitable that some homochiral molecules have formed simply on a statistical basis. In this case, the non-selective leap to homochirality would be one of the first steps in chemical evolution directly out of a racemic "ocean". Moreover, most studies focus on the chirality of the primordial monomers with respect to an asymmetric carbon atom. However, any polymer with a minimal size that allows folding to a secondary structure would spontaneously lead to asymmetric higher structures (conformations). Most of the functions of these polymers would be influenced by this inherently asymmetric folding. Furthermore, a concept of physical compartmentalization based on rock nanopores in analogy to nanocavities of digital immunoassays is introduced to suggest that complex cell walls or membranes were also not required for the first steps of chemical evolution. To summarize, simple and universal mechanisms may have led to homochiral self-replicating systems in the context of chemical evolution. A homochiral monomer pool is deemed unnecessary and probably never existed on primordial Earth.
PubMed: 38541666
DOI: 10.3390/life14030341 -
Journal of Arrhythmia Apr 2022Along with the incremental cases of cardiac implantable electronic devices implantation or upgrade, the lead-related complications are also in rise year after year. The...
Along with the incremental cases of cardiac implantable electronic devices implantation or upgrade, the lead-related complications are also in rise year after year. The most common and serious lead-related complication is infection that needs a transvenous lead extraction (TLE) as the first-line therapy. TLE is also performed for abandoned leads in case of lead failure or device upgrade, and for lead-related trouble such as pain, vessel stenosis or occlusion, too many leads, tricuspid valve regurgitation, and difficulty of radiation therapy. This registration has been performed by the Japanese Heart Rhythm Society and started in July 2018. The first reported data of the Japanese Lead Extraction (J-LEX) from July 2018 to December 2019 were underestimated since the number of patients and hospitals increased gradually because of the approval process of each hospital's IRB. The TLE procedure was attempted to 1253 leads among 661 patients. Complete removal was achieved in 96.7% of the target leads and the clinical success was obtained in 98.9% of the patients. Perioperative complications were observed in 4.1% of the patients. The annual J-LEX report reflects a real-world TLE medicine in Japan and demonstrates that the clinical outcome is similar to former reports from high-volume centers in North America and European countries.
PubMed: 35387141
DOI: 10.1002/joa3.12678 -
Heliyon Sep 2019Zambia is endowed with mineral wealth that includes copper, cobalt, gold, nickel, lead, silver, uranium, zinc, and numerous precious and semi-precious stones. Mining... (Review)
Review
Zambia is endowed with mineral wealth that includes copper, cobalt, gold, nickel, lead, silver, uranium, zinc, and numerous precious and semi-precious stones. Mining activities are predominantly found on the Copperbelt and North-Western Provinces, although these minerals are dotted all over the country. Copper mining in Zambia dates back to the 1900s and this period witnessed massive investment in mine development with concomitant increase in support facilities including building of new towns, roads and other commercial infrastructure. The mining sector has therefore evoked considerable national attention for its potential to contribute towards economic growth, job creation and poverty alleviation. However, mining and mineral processing by its very nature comes with environmental costs and the effects can continue long after the mining has stopped. The aim of this article was to review the relevant publications on the impacts of air pollution arising from mining operations with respect to human health, plants, animals and infrastructure and synthesize the views of researchers and suggest any additional research required to inform policy and remedial actions. This review has revealed that there is a paucity of studies on mining-related air pollution in Zambia. The main identified air pollutants were SO and particulate matter (PM), both fine and ultrafine (PM, PM, PM and PM). The main sources of these pollutants were flue gases from smelter operations and dusts within the mines and those blown from both operational and abandoned waste rock, overburden and tailings dump sites. The identified occupational diseases for miners in Zambia were silicosis and tuberculosis, which have been compounded by the prevalence of HIV/AIDS. In the hotspot townships of air-borne exposures from smelter emissions in Mufulira, ambient air SO levels exceeded the 'safe' limits of international and National standards. Moreover, the top soils have turned acidic and have become laden with heavy metals (Pb, Zn, Cu, Co and Fe). These metals were also found in the dust deposited on leaves of crops. There were also visual signs of impaired vegetation cover and corroded housing infrastructure in the affected areas. In the vicinity of the abandoned Pb-Zn mine in Kabwe, the soils have been contaminated by heavy metals and pathological lead poisoning of children and wild mammals have occurred. The review article has further examined study gaps and suggested areas that need further research in order to address the challenges arising from the legacy of copper mining in Zambia. These include comprehensive PM characterization from mining environments, extent of occupation exposure to air pollutants, efficiency and efficacy of airborne control technologies, health risks and epidemiological studies in mining towns, and the influence of exposure to PM on pulmonary tuberculosis and HIV/aids among miners.
PubMed: 31687579
DOI: 10.1016/j.heliyon.2019.e02485 -
Animals : An Open Access Journal From... Feb 2024The historical relationship between humans and dogs has involved selective breeding for various purposes, such as hunting, guarding, and service roles. However, over... (Review)
Review
The historical relationship between humans and dogs has involved selective breeding for various purposes, such as hunting, guarding, and service roles. However, over time, there has been a shift in preferences from functionality to aesthetics, which has influenced the diverse sizes, shapes, and coats of dog breeds. This review looks at fashionable dog breeding and questions the ethics of prioritising looks over health and behaviour. It aims to alert potential owners, breeders, and regulators to the importance of considering a dog's overall well-being, not just its appearance, which has resulted in fad breeding, leading to genetic disorders, health issues, and a loss of biodiversity. Ethical concerns arise from breeding brachycephalic breeds with respiratory conditions, inbreeding causing inherited disorders, and overbreeding popular breeds while shelter dogs remain unadopted. Additionally, the impact of cosmetic surgeries on popular dog breeds, as well as the neglect of behavioural traits in favour of physical characteristics and strict breeding practices are also considered. The current breeding model can have a negative impact on the emotional and cognitive well-being of dogs, resulting in issues such as aggression, anxiety, and other behavioural problems that can significantly reduce their overall quality of life. Unregulated breeding practices and the demand for rare breeds can lead to illegal breeding, compromising animal welfare. Prospective owners, veterinarians, kennel clubs, and legislators all need to play a responsible role in protecting animals.
PubMed: 38473141
DOI: 10.3390/ani14050756 -
Cancer Epidemiology Apr 2021India has made significant improvement in childhood cancer services in last few decades. However, the outcome still remains modest as compared to global standards due to...
India has made significant improvement in childhood cancer services in last few decades. However, the outcome still remains modest as compared to global standards due to significant barriers in recognition, diagnosis and cure. Data regarding comprehensive childhood cancer burden in country is lacking due to low and urban predominant coverage of population-based cancer registry programs. The available data shows lower incidence of childhood cancer incidence especially in leukaemia and CNS tumours which may suggest poor awareness of caregivers and delayed diagnosis with many "missed cases". Incidence data are also skewed towards male preponderance which suggests gender bias in seeking healthcare. The childhood cancer services in India are predominantly restricted to few tertiary care centres in major cities. The outcome in major groups of cancer is complicated by delayed and more advanced stage of presentation and poor supportive care during intensive treatment. Treatment refusal and abandonment remains major hurdles. Last few decades saw development of dedicated paediatric oncology services and training programs in the country. The development of InPOG (Indian Paediatric Oncology group) for conducting collaborative trials will lead to adoption of uniform treatment protocols suited for the country. Financial support through the government promoted health insurance and holistic support through philanthropic organizations have improved treatment adherence and outcome. Moving forward, the focus should be on strengthening the cancer registries for capturing nationwide data, improving awareness of childhood cancer among caregivers and healthcare workers for early recognition and improving accessibility of childhood cancer care services beyond major cities.
Topics: Adolescent; Child; Child, Preschool; Female; Health Services Accessibility; Humans; Incidence; India; Infant; Infant, Newborn; Male; Neoplasms; Registries
PubMed: 32033883
DOI: 10.1016/j.canep.2020.101679 -
Frontiers in Research Metrics and... 2023Patent protection typically lasts about 20 years from the filing date and is in exchange for sufficiently disclosing the invention. The disclosure aims to enrich... (Review)
Review
Patent protection typically lasts about 20 years from the filing date and is in exchange for sufficiently disclosing the invention. The disclosure aims to enrich technical knowledge globally, promote creativity and technological innovation and contribute to sustainable socio-economic development. After this protection period, the patent expires, and in principle, any person may begin practicing the specific subject matter previously protected by the patent. Since the invention originally met all the patentability requirements, it was disclosed sufficiently to stimulate further innovation by others through a thorough understanding of existing developments in the patent literature. Thus, in addition to scholarly research articles, this makes patents potentially valuable sources of technical information in research and academia, unlocking new technology opportunities. We use the exploratory research method to study a potentially genuine and vital research stream that uncovers the overlooked yet valuable scientific and technical information sources that higher education institutions could utilize to complement academic research articles. This work establishes a necessary research agenda that critically challenges researchers to tap into the immediately available and promising technology opportunities presented by patents in the public domain. Using case studies to gain in-depth, multi-faceted explorations about the impact of these patents, we find that technologies contained in expired patents, abandoned patents, and technologies not protected by IPRs, resulting in improved research quality and increased collaboration with industry, if adequately exploited and integrated with other technologies. Moreover, this could lead to increased academic patenting and commercialization with support from the university's Technology Transfer Office.
PubMed: 37008286
DOI: 10.3389/frma.2023.1115457