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Pain Practice : the Official Journal of... Jul 2022Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part,...
Spinal cord stimulation (SCS) is effective for the treatment of chronic intractable pain of the trunk and limbs. The mechanism of action may be based, at least in part, upon the gate control theory; however, new waveforms may suggest other mechanisms. Although benefits of the SCS technology generally outweigh the complications associated with SCS, some complications such as infection and skin erosion over the implant can result in device removal. Additional reasons for device removal, such as pocket pain and battery depletion, have driven technological innovations including battery-free implants and device miniaturization. The neurostimulation system described here was specifically designed to address complications commonly associated with implantable batteries and/or larger implantable devices. The benefits of the small size are further augmented by a minimally invasive implant procedure. Usability data show that patients found this novel neurostimulation system to be easy to use and comfortable to wear. What is more, clinical data demonstrate that the use of this system provides statistically significant reduction in pain scores with responder rates (defined as ≥50% reduction in pain) of 78% in the low back and 83% in the leg(s). Advances in miniaturization technology arose from the considerable shrinkage of the integrated circuit, with an increase in performance, according to Moore's law (1965). However, commensurate improvements in battery technology have not maintained a similar pace. This has prompted some manufacturers to place the battery outside, against the skin, thereby allowing a massive reduction in the implant volume, with the hopes of fewer device-related complications.
Topics: Chronic Pain; Humans; Pain Management; Spinal Cord; Spinal Cord Stimulation; Treatment Outcome
PubMed: 35509116
DOI: 10.1111/papr.13124 -
World Journal of Cardiology Mar 2022Cardiovascular implantable electronic devices (CIEDs) are implanted in an increasing number of patients each year, which has led to an increase in the risk of CIED...
BACKGROUND
Cardiovascular implantable electronic devices (CIEDs) are implanted in an increasing number of patients each year, which has led to an increase in the risk of CIED infection. Antibacterial CIED envelopes locally deliver antibiotics to the implant site over a short-term period and have been shown to reduce the risk of implant site infection. These envelopes are derived from either biologic or non-biologic materials. There is a paucity of data examining patient risk profiles and outcomes from using these envelope materials in the clinical setting and comparing these results to patients receiving no envelope with their CIED implantation.
AIM
To evaluate risk profiles and outcomes of patients who underwent CIED procedures with an antibacterial envelope or no envelope.
METHODS
After obtaining Internal Review Board approval, the records of consecutive patients who underwent a CIED implantation procedure by a single physician between March 2017 and December 2019 were retrospectively collected from our hospital. A total of 248 patients within this period were identified and reviewed through 12 mo of follow up. The CIED procedures used either no envelope ( = 57), a biologic envelope (CanGaroo, Aziyo Biologics) that was pre-hydrated by the physician with vancomycin and gentamicin ( = 89), or a non-biologic envelope (Tyrx™, Medtronic) that was coated with a resorbable polymer containing the drug substances rifampin and minocycline by the manufacturer ( = 102). Patient selection for receiving either no envelope or an envelope (and which envelope to use) was determined by the treating physician. Statistical analyses were performed between the 3 groups (CanGaroo, Tyrx, and no envelope), and also between the No Envelope and Any Envelope groups by an independent, experienced biostatistician.
RESULTS
On average, patients who received any envelope (biologic or non-biologic) were younger (70.7 ± 14.0 74.9 ± 10.6, = 0.017), had a greater number of infection risk factors (81.2% 49.1%, < 0.001), received more high-powered devices (37.2% 5.8%, = 0.004), and were undergoing more reoperative procedures (47.1% 0.0%, < 0.001) than patients who received no envelope. Between the two envelopes, biologic envelopes tended to be used more often in higher risk patients (84.3% 78.4%) and reoperative procedures (62.9% 33.3%) than non-biologic envelopes. The rate of CIED implant site pocket infection was low (any envelope 0.5% no envelope 0.0%) and was statistically equivalent between the two envelope groups. Other reported adverse events (lead dislodgement, lead or pocket revision, device migration or erosion, twiddler's syndrome, and erythema/fever) were low and statistically equivalent between groups (biologic 2.2%, non-biologic 3.9%, no envelope 1.8%).
CONCLUSION
CIED infection rates for biologic and non-biologic antibacterial envelopes are similar. Antibacterial envelopes may benefit patients who are higher risk for infection, however additional studies are warranted to confirm this.
PubMed: 35432770
DOI: 10.4330/wjc.v14.i3.177 -
Cureus Feb 2022Introduction Implantation of cardiac implantable electronic devices (CIEDs) is an art of science. As the volume of implantation has increased worldwide, so has the rate...
Introduction Implantation of cardiac implantable electronic devices (CIEDs) is an art of science. As the volume of implantation has increased worldwide, so has the rate of complications. Infection, fibrosis, lead and device erosion, lead displacement, right ventricle perforation, lead fracture, and insulation break are the common complications in the implantation process. This exposes the patient for reopening and threatens the implantation for further complication due to infection, fibrosis of veins, failure to retrieve the implanted wire, and failure to re-implant the device on the same site. We slightly changed our implantation technique to preserve the implantation site for future implantation and reduce the rate of complication in the index implantation. Methods This randomized control trial was conducted from January 2016 to September 2019 at Hayatabad Medical Complex Peshawar, Pakistan. A consecutive sampling technique was used to obtain a sample size of 602 patients keeping a 95% confidence interval and a 5% margin error. We adopted a strategy to take prick, for implantation of devices, inside the pocket, which reduces the number of sutures, hastens the procedure, prevents erosion, and minimizes the chance of subclavian crush syndrome and insulation break. We also selected the minimum possible length of leads. This will possibly decrease the chances of cumbersome fibrosis around the lead and device and will make future implantation convenient. Results There was a total of 602 procedures in the study period. About 253 (42%) procedures were done in the newly adopted strategy and 349 (58%) were performed in the conventional way. Our complication rate grossly reduces in the novel way of implantation in which we took our prick inside the pocket. Conclusion A slight modification in the implantation of CIEDs not only prevents the rate of complication in the index implantation but will also possibly preserve the site for future implantation.
PubMed: 35350505
DOI: 10.7759/cureus.22259 -
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 -
Journal of Cardiovascular Development... Mar 2022We reported the novel use of a taurolidine-containing antimicrobial solution in the successful salvage of a partially exposed and polymicrobially infected cardiac...
We reported the novel use of a taurolidine-containing antimicrobial solution in the successful salvage of a partially exposed and polymicrobially infected cardiac implantable electronic device pulse generator in a frail patient unfit for lead extraction. The old, salvaged device was entirely internalized, and there were no signs of recurrent infection at 9 months follow-up.
PubMed: 35323629
DOI: 10.3390/jcdd9030081 -
Frontiers in Cardiovascular Medicine 2022A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and...
BACKGROUND
A pocket hematoma is a well-recognized complication that occurs after pacemaker or defibrillator implantation. It is associated with increased pocket infection and hospital stay. Patients suffering from atrial fibrillation and undergoing cardiovascular electronic implantable device (CIED) surgery are widely prescribed and treated with direct oral anticoagulants (DOACs). In this study, the use of a novel compression device was evaluated to examine its ability to decrease the incidence of pocket hematomas following device implantation with uninterrupted DOACs.
METHODS
A total of 204 participants who received DOACs and underwent CIED implantation were randomized into an experimental group (novel compression device) and a control group (elastic adhesive tape with a sandbag). The primary outcome was pocket hematoma, and the secondary outcomes were skin erosions and patient comfort score. Grade 3 hematoma was defined as a hematoma that required anticoagulation therapy interruption, re-operation, or prolonged hospital stay.
RESULTS
The baseline characteristics of both groups had no significant differences. The incidence of grades 1 and 2 hematomas was significantly lower in the compression device group than in the conventional pressure dressing group (7.8 vs. 23.5 and 2.0 vs. 5.9%, respectively; < 0.01). Grade 3 hematoma occurred in 2 of 102 patients in the experimental group and 7 of 102 patients in the control group (2.0 vs. 6.9%; = 0.03). The incidence rates of skin erosion were significantly lower, and the patient comfort score was much higher in the compression device group than in the control group ( < 0.01). Multivariable logistic regression analysis showed that the use of novel compression device was a significant protective factor for pocket hematoma (OR = 0.42; 95% CI, 0.29-0.69, = 0.01).
CONCLUSIONS
The incidence of pocket hematomas and skin erosions significantly decreases when the proposed compression device is used for patients undergoing device implantation with uninterrupted DOACs. Thus, the length of hospital stay and re-operation rate can be reduced, and patient comfort can be improved.
CLINICAL TRIAL REGISTRATION
http://www.chictr.org.cn, identifier: ChiCTR2100049430.
PubMed: 35282349
DOI: 10.3389/fcvm.2022.817453 -
Anais Da Academia Brasileira de Ciencias 2022The majority of ornithogenic soils studied in Antarctica focus on the influence of penguins, wherever little reports evaluated the influence of flying birds on soil...
The majority of ornithogenic soils studied in Antarctica focus on the influence of penguins, wherever little reports evaluated the influence of flying birds on soil genesis. This study aimed to characterize the morphologic, chemic, physic, mineralogic, and micromorphologic ornithogenic soil pockets influenced by flying birds in Snow Island, Maritime Antarctica. Fifteen soil pockets were selected, described, sampled and analyzed, these sites constitute the main areas with intense long-term terrestrial biological activity in Snow Island. In order to investigate the impact of phosphatization, we compared the soil pockets with the surrounding soils and soils affected by penguins. Zone of phosphatization have a high concentration of P, K, and Ca. The XRD patterns for the clay fraction of ornithogenic soils show that phosphate minerals are the main crystalline phases (leucophosphite, minyulite, fluorapatite, and apatite). We show that even under typical periglacial conditions, sites influenced by flying birds present active chemical weathering processes. The phosphatization release exchangeable bases and accelerate mineralogical and micromorphological transformations in soils. Under the current global warming trend and expected sea-level rise, the ornithogenic environments are susceptible to accelerated erosion rates and a great part of these hotspots may be lost for the open sea.
Topics: Animals; Antarctic Regions; Birds; Soil
PubMed: 35170669
DOI: 10.1590/0001-3765202220210595 -
International Journal of Cardiology Feb 2022Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Subcutaneous (S-ICD) and transvenous (TV-ICD) implantable cardioverter-defibrillator devices effectively reduce the incidence of sudden cardiac death in patients at a high risk of ventricular arrhythmias. This study aimed to evaluate the safe replacement of TV-ICD with S-ICD based on updated recent evidence.
METHODS
We systematically searched EMBASE, JSTOR, PubMed/MEDLINE, and Cochrane Library on 30 July 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
We identified 26 studies that examined 7542 (58.27%) patients with S-ICD and 5400 (41.72%) with TV-ICD. The findings indicated that, compared to patients with TV-ICD, patients with S-ICD had a lower incidence of defibrillation lead failure (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01-0.98; p = 0.05), lead displacement or fracture (OR, 0.25; 95% CI, 0.12-0.86; p = 0.0003), pneumothorax and/or hemothorax (OR: 0.22, 95% CI 0.05, 0.97, p = 0.05), device failure (OR: 0.70, 95% CI 0.51, 0.95, p = 0.02), all-cause mortality (OR: 0.44 [95% CI 0.32, 0.60], p < 0.001), and lead erosion (OR: 0.01, 95% CI 0.00, 0.05, p < 0.001). Patients with TV-ICD had a higher incidence of pocket complications than patients with S-ICD (OR, 2.13; 95% CI, 1.23-3.69; p = 0.007) and a higher but insignificant incidence of inappropriate sensing (OR, 3.53; 95% CI, 0.97-12.86; p = 0.06).
CONCLUSIONS
The S-ICD algorithm was safer and more effective than the TV-ICD system as it minimized the incidence of pocket complications, lead displacement or fracture, inappropriate sensing, defibrillation lead failure, pneumothorax/hemothorax, device failure, lead erosion, and all-cause mortality. Future studies should explore the scope of integrating novel algorithms with the current S-ICD systems to improve cardiovascular outcomes.
Topics: Arrhythmias, Cardiac; Death, Sudden, Cardiac; Defibrillators, Implantable; Humans; Incidence; Treatment Outcome
PubMed: 34801615
DOI: 10.1016/j.ijcard.2021.11.029 -
Indian Journal of Plastic Surgery :... Sep 2021Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free...
Infection of cardiac implantable electrical devices (CIEDs) may lead to serious complications. Complete CIED explantation is expensive, requires expertise, not free from complications, and may not be an option in patients with device dependence. To highlight that carefully selected infected CIEDs can be salvaged by placing the device in a subpectoral pocket below the pectoralis major muscle. We conducted a retrospective descriptive observational study. Twelve patients (10 male and two female) with erosion, exposure or infection of infraclavicular, subcutaneously placed CIED were treated over a 30-month period between July 2018 and December 2020. The technique involved debridement and excision of a peridevice capsule, creating a subpectoral pocket beneath the pectoralis major muscle, and placing the CIED in a new pocket with total muscle coverage and closure of skin without tension. Twelve patients ( = 10; = 2) with a mean age of 65 years (range, 46-82 years) presented with infection of CIED within 9 months of implantation. None had sepsis or endocarditis. In nine patients, CIEDs were successfully salvaged with relocation to subpectoral pocket. Mean follow-up was 20 months (range, 8-30 months). Three out of 12 developed reinfection that ultimately required CIED explantation. There was no mortality. In the absence of sepsis or endocarditis, infected CIEDs may be attempted at salvage by subpectoral pocket placement. This obviates the need for potentially risky explantation or replacement of expensive CIEDs.
PubMed: 34667522
DOI: 10.1055/s-0041-1735417 -
JGH Open : An Open Access Journal of... Aug 2021This paper reports the proceedings from the first consensus meeting on the management of mild-to-moderate gastroesophageal reflux disease (GERD) in the Southeast Asian...
This paper reports the proceedings from the first consensus meeting on the management of mild-to-moderate gastroesophageal reflux disease (GERD) in the Southeast Asian (SEA) region. Seventeen statements were drawn up by a steering committee that focused on epidemiology, mechanism of action, diagnostic investigations, and treatment. Voting on the recommendations used the Delphi method with two rounds of voting among the 10 panel members. The consensus panel agreed that GERD is mostly a mild disease in the SEA region with predominantly non-erosive reflux disease (NERD). Complicated GERD and Barrett's esophagus are infrequently seen. The panel recommended endoscopy in patients with alarm or refractory symptoms but cautioned that the incidence of gastric cancer is higher in SEA. pH and impedance measurements were not recommended for routine assessment. The acid pocket is recognized as an important pathogenic factor in GERD. Lifestyle measures such as weight reduction, avoidance of smoking, reduction of alcohol intake, and elevation of the head of the bed were recommended but strict avoidance of specific foods or drinks was not. Alginates was recommended as the first-line treatment for patients with mild-to-moderate GERD while recognizing that proton-pump inhibitors (PPIs) remained the mainstay of treatment of GERD. The use of alginates was also recommended as adjunctive therapy when GERD symptoms were only partially responsive to PPIs.
PubMed: 34386592
DOI: 10.1002/jgh3.12602