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Journal of Cardiology Cases Jan 2021An 80-year-old man with a history of dilated hypertrophic cardiomyopathy received a dual-chamber pacemaker for sick sinus syndrome and atrioventricular block in February...
An 80-year-old man with a history of dilated hypertrophic cardiomyopathy received a dual-chamber pacemaker for sick sinus syndrome and atrioventricular block in February 2010. On May 30, 2019, he developed pocket erosion, with streaks of pus exuding from the pocket. The pacemaker generator was removed, although both capping leads were left buried under the skin, and a leadless pacemaker was implanted into the right ventricular (RV) apex the next day. Blood and pus cultures on July 15, 2019 indicated methicillin-resistant (MRSA). The patient was transferred to our hospital for simultaneous removal of both devices in August 2019. The RV lead and right atrial lead were extracted using a laser sheath and a mechanical sheath. A 23 Fr MICRA® sheath was inserted from the right femoral vein to accommodate an 8.5 Fr Agillis sheath. An Osypka LASSO snare catheter was advanced through the sheath to catch the distal aspect of the MICRA® body. Finally, the MICRA® device was completely removed through the sheath. Culture results for the lead tip and MICRA® were both MRSA positive. This is the first report of late-phase simultaneous infection of abandoned leads and implanted leadless cardiac pacemaker extraction. < Leadless pacemakers are becoming increasingly popular in high-risk patients due to no lead-associated complications. As a result of the incomplete removal, the remaining leads caused a drug-refractory blood stream infection, which secondarily infected the MICRA® device. Thus, an insufficiently treated pocket infection resulted in persistent methicillin-resistant bacteremia in this case.>.
PubMed: 33437338
DOI: 10.1016/j.jccase.2020.09.005 -
Genetics, Selection, Evolution : GSE Jul 2020Assessment of genetic diversity and population structure provides important control metrics to avoid genetic erosion, inbreeding depression and crossbreeding between...
BACKGROUND
Assessment of genetic diversity and population structure provides important control metrics to avoid genetic erosion, inbreeding depression and crossbreeding between exotic and locally-adapted cattle breeds since these events can have deleterious consequences and eventually lead to extinction. Historically, the Alpine Arc represents an important pocket of cattle biodiversity with a large number of autochthonous breeds that provide a fundamental source of income for the entire regional economy. By using genotype data from medium-density single nucleotide polymorphism (SNP) arrays, we performed a genome-wide comparative study of 23 cattle populations from the Alpine Arc and three cosmopolitan breeds.
RESULTS
After filtering, we obtained a final genotyping dataset consisting of 30,176 SNPs for 711 individuals. The local breeds showed high or intermediate values of genetic diversity compared to the highly selected cosmopolitan breeds. Patterns of genetic differentiation, multidimensional scaling, admixture analysis and the constructed phylogenetic tree showed convergence, which indicates the presence of gene flow among the breeds according to both geographic origin and historical background. Among the most differentiated breeds, we identified the modern Brown cattle. In spite of admixture events, several local breeds have preserved distinctive characteristics, which is probably due to differences in genetic origin and geographic location.
CONCLUSIONS
This study represents one of the most comprehensive genome-wide analysis of the Alpine cattle breeds to date. Using such a large dataset that includes the majority of the local breeds found in this region, allowed us to expand knowledge on the evaluation and status of Alpine cattle biodiversity. Our results indicate that although many of the analyzed local breeds are listed as endangered, they still harbor a large amount of genetic diversity, even when compared to some cosmopolitan breeds. This finding, together with the reconstruction of the phylogeny and the relationships between these Alpine Arc cattle breeds, provide crucial insights not only into the improvement of genetic stocks but also into the implementation of future conservation strategies.
Topics: Animals; Cattle; Evolution, Molecular; Genotype; Phylogeny; Polymorphism, Single Nucleotide
PubMed: 32664855
DOI: 10.1186/s12711-020-00559-1 -
Health and Human Rights Dec 2019Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms...
Through focusing on the neoliberal "Health Transformation Programme" launched in 2003 in Turkey, I show how reproductive law can be modified by neoliberal mechanisms that are implemented with neoconservative policies and pressures. The paper builds on original data collected in 2014 and 2015 through focus groups and interviews with health practitioners in family health centers and women receiving reproductive care in Izmir, Diyarbakir, Van, and Gaziantep. The data analysis informed by writings on the debt economy by Maurizio Lazzarato and Bifo Berardi and transnational feminist theory demonstrate that neoliberal mechanisms of "dismantling the public" interact with pronatalist policies and pressures to erode women's reproductive rights in Turkey. This has resulted in (1) indebtedness of women through out-of-pocket payments for contraception and abortion, (2) indebtedness of providers through performance measures, (3) reduction in the quality of reproductive care, and (4) reduction in access to reproductive care itself (contraception, counseling, and abortion). There is a need to pay attention to neoliberal mechanisms and the legal framings of reproductive rights to fully understand the limitations of law and counter the neoliberal and conservative assaults on women's sexual and reproductive rights.
Topics: Abortion, Induced; Adult; Contraception; Female; Focus Groups; Health Expenditures; Health Services Accessibility; Health Surveys; Humans; Interviews as Topic; Politics; Pregnancy; Reproductive Rights; Turkey; Women's Rights
PubMed: 31885436
DOI: No ID Found -
Chemosphere Jul 2022A batch experiment was conducted to observe the liberation of micro- and nano-sized plastic particles and plastic additive-originated organic compounds from poly(vinyl...
A batch experiment was conducted to observe the liberation of micro- and nano-sized plastic particles and plastic additive-originated organic compounds from poly(vinyl chloride) under radiation-free ambient conditions. The weathering of PVC films in deionized water resulted in isolated pockets of surface erosion. Additional OH from Fenton reaction enhanced PVC degradation and caused cavity erosion. The detachment of plastic fragments from the PVC film surfaces was driven by autocatalyzed oxidative degradation. Over 90% of micro-sized plastic particles were <60 μm in length. The detached plastic fragments underwent intensified weathering, which involved strong dehydrochlorination and oxidative degradation. Further fragmentation of micro-sized particles into nano-sized particles was driven by oxidative degradation with complete dehydrochlorination being achieved following formation of nanoplastics. 20 organic compounds released from the PVC films into the solutions were identified. And some of them can be clearly linked to common plastic additives. In the presence of additional OH, the coarser nanoplastic particles (>500 nm) tended to be rapidly disintegrated into finer plastic particles (<500 nm), while the finest fraction of nanoplastics (<100 nm) could be completely decomposed and disappeared from the filtrates. The micro(nano)plastics generated from the PVC weathering were highly irregular in shape.
Topics: Microplastics; Plastics; Polyvinyl Chloride; Vinyl Chloride; Water; Water Pollutants, Chemical
PubMed: 35331748
DOI: 10.1016/j.chemosphere.2022.134399 -
Scientific Reports Nov 2022The effect of gas-entrapping polydimethylsiloxane (PDMS) microstructures on the dynamics of cavitation bubbles laser-induced next to the PDMS surface is investigated and...
The effect of gas-entrapping polydimethylsiloxane (PDMS) microstructures on the dynamics of cavitation bubbles laser-induced next to the PDMS surface is investigated and compared against the cavitation dynamics next to a flat smooth boundary. Local pressure gradients produced by a cavitation bubble cause the air pockets entrapped in the PDMS microstructures to expand and oscillate, leading to a repulsion of the cavitation bubble. The microstructures were fabricated as boxed crevices via a simple and scalable laser ablation technique on cast acrylic, allowing for testing of variable structure sizes and reusable molds. The bubble dynamics were observed using high speed photography and the surrounding flows were visualized and quantified using particle tracking velocimetry. Smaller entrapped air pockets showed an enhanced ability to withstand deactivation at three stand-off distances and over 50 subsequent cavitation events. This investigation provides insight into the potential to direct the collapse of a cavitation bubble away from a surface to mitigate erosion or to enhance microfluidic mixing in low Reynolds number flows.
PubMed: 36437305
DOI: 10.1038/s41598-022-24746-w -
Frontiers in Pediatrics 2024Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially...
BACKGROUND
Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications of cholesteatoma. This study assessed the functional and anatomical results of cartilage grafting in children with severe RP of the TM.
METHODS
This was a retrospective review of 212 children from a tertiary referral center.
RESULTS
We identified significant differences in hearing results, indication criteria, and location of TM fixation between stages II and III of RP (according to Charachon). We observed a significantly higher incidence of RP in boys than in girls.
CONCLUSIONS
Cartilage tympanoplasty for retraction pocket of the tympanic membrane in children is a safe procedure with good anatomical and hearing results.
PubMed: 38425661
DOI: 10.3389/fped.2024.1314184 -
Journal of Clinical Medicine Apr 2021Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for...
Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for refractory glaucoma. The new autologous scleral pocket technique is performed by inserting the tube into the vitreous cavity without using a donor scleral patch. The purpose of this study was to evaluate the surgical results of Ahmed glaucoma valve (AGV) implantation using this technique for neovascular glaucoma (NVG), which is one of the representative refractory types of glaucoma. This observational retrospective case series included 15 consecutive eyes of 15 patients with NVG who had undergone AGV implantation at Kobe University between January 2018 and December 2019. The mean preoperative intraocular pressure (IOP) was 37.2 ± 13.8 mmHg and the glaucoma drug score was 4.2 ± 2.2. The mean IOP and glaucoma drug score at 1 year postoperatively decreased to 15.0 ± 4.6 mmHg and 1.3 ± 2.0, respectively ( < 0.001). No significant change in the corneal endothelial cell density following surgery was observed ( = 0.09); however, one patient required an additional trabeculectomy at 7 months postoperatively. No cases of tube exposure or conjunctival erosion were observed at 1 year postoperatively. These results indicated the effectiveness and safety of this technique in patients with NVG.
PubMed: 33920094
DOI: 10.3390/jcm10081606 -
Journal of Interventional Cardiac... Jul 2022Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead...
BACKGROUND
Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy, and outcome of S-ICD implantation after TLE of TV-ICD.
METHODS
The study population consisted of 36 consecutive patients with a median age of 52 (44-66) years who underwent S-ICD implantation after TLE of TV-ICD.
RESULTS
Indications for TLE were infection (63.9%) and lead malfunction (36.1%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n = 4; 11.1%), isolated pocket erosion (n = 2; 5.5%), and ineffective therapy (n = 1; 2.8%). No lead/hardware dysfunction was reported. Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF). There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥ 2 (HR 5.05; 95% CI 1.00-26.38; p = 0.04), hypertension (HR 22.72; 95% CI 1.05-26.31; p = 0.02), diabetes (HR 10.64; 95% CI 2.05-55.60; p = 0.001) and ischemic heart disease (HR 5.92; 95% CI 1.17-30.30; p = 0.01).
CONCLUSION
Our study provides evidences on the use of S-ICD as an alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidities.
PubMed: 35831772
DOI: 10.1007/s10840-022-01293-y -
Herz Feb 2021The growing problem of endocardial lead infections and lead malfunctions has increased interest in percutaneous lead-removal technology. Transvenous lead extraction...
BACKGROUND
The growing problem of endocardial lead infections and lead malfunctions has increased interest in percutaneous lead-removal technology. Transvenous lead extraction (TLE) via simple manual traction (SMT) is the first-line therapy. When SMT is not successful, TLE from the femoral vein using a gooseneck snare (GS) with a radiofrequency ablation catheter (RFAC) may be an alternative option. The aim of our study was to evaluate the success rate of transvenous extraction of chronically implanted leads via the femoral approach using a GS with RFCA in cases of failure with SMT.
METHODS
The study included 94 consecutive patients who were referred for lead extraction due to pocket erosion and infection (71 patients) and to lead malfunction (23 patients). Initially, SMT was attempted for all patients. If SMT was not successful, patients underwent TLE using a GS with RFAC.
RESULTS
Leads were extracted successfully with SMT in 34 patients (54 leads), while 60 patients (83 leads) underwent TLE using a GS with RFAC. The mean indwelling time of the leads was longer in the femoral approach with GS (87.5 ± 37.9 vs. 31.3 ± 25.8 months; p < 0.001). The procedural success rate was 96.7% in the femoral approach with GS. A preceding implantation lead duration of >51 months predicted an unsuccessful SMT necessitating alternative TLE using a GS with RFAC with 86% sensitivity and 78% specificity (p < 0.001).
CONCLUSION
Transvenous lead extraction via the femoral approach using GS with RFAC may be an alternative approach to SMT with a high success rate, especially when the indwelling time of the leads is long.
Topics: Defibrillators, Implantable; Device Removal; Femoral Artery; Humans; Pacemaker, Artificial; Retrospective Studies; Treatment Outcome
PubMed: 33009623
DOI: 10.1007/s00059-020-04987-z -
Health Economics Aug 2022We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic...
We provide time series evidence of tort reform's impact on inputs and quality in the nursing home industry. Between 2000 and 2010, 11 state reforms capped noneconomic damages for health care services. Small chain and unaffiliated nursing homes enjoyed "judgment proof standing" and were less apt to be sued, prior to reform. We find that the managers of such homes were relatively unresponsive to the implementation of state caps on noneconomic damages. Large "deep-pocketed" chain-affiliated homes lacked judgment proof standing and implemented greater reductions in their nursing inputs in the aftermath of tort relief. However, we find little evidence of service quality erosion across four measured dimensions of care outcomes. Our findings are consistent with a "defensive care" model in which large chain homes employ unproductive inputs in an effort to meet a negligence standard of care.
Topics: Humans; Liability, Legal; Malpractice; Nursing Homes; United States
PubMed: 35607270
DOI: 10.1002/hec.4528