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Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications. 脑脊液的机械过滤:程序、系统和应用。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2181695
Manuel Menéndez González

Introduction: Mechanical methods aimed at the filtration of the cerebrospinal fluid (CSF) are a group of therapies that have been proposed to treat neurological conditions where pathogens are present in the CSF. Even though the industry of medical devices has not been very active in this field, there is a lack of systematization of the different systems and procedures that can be applied.

Areas covered: First, we systematize the classification and definitions of procedures and systems for mechanical filtration of the CSF. Then, we made a literature review in search of clinical or preclinical studies where any system of mechanical CSF clearance was proposed or applied.

Expert opinion: We found mechanical filtration of the CSF has been explored in subarachnoid hemorrhage, CNS infections (bacterial, viral, and fungal), meningeal carcinomatosis, multiple sclerosis, autoimmune encephalitis, and polyradiculomyelitis. Brain aging and neurodegenerative diseases are additional potential conditions of interest. While there is some preliminary positive evidence for many of these conditions, more advanced systems, detailed descriptions of procedures, and rigorous validations are needed to make these therapies a reality in the next decades.

导论:针对脑脊液(CSF)过滤的机械方法是一组已被提出用于治疗脑脊液中存在病原体的神经系统疾病的疗法。尽管医疗器械行业在这一领域并不十分活跃,但缺乏可应用的不同系统和程序的系统化。涵盖的领域:首先,我们将CSF机械过滤的程序和系统的分类和定义系统化。然后,我们进行了文献综述,寻找任何提出或应用机械CSF清除系统的临床或临床前研究。专家意见:我们在蛛网膜下腔出血、中枢神经系统感染(细菌、病毒和真菌)、脑膜癌病、多发性硬化症、自身免疫性脑炎和多根脊髓炎中发现脑脊液的机械滤过。脑老化和神经退行性疾病是额外的潜在的兴趣条件。虽然这些疾病中有一些初步的积极证据,但要在未来几十年使这些疗法成为现实,还需要更先进的系统、详细的程序描述和严格的验证。
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引用次数: 2
A systematic review of follow-up results of additively manufactured customized implants for the pelvic area. 对骨盆区域增材制造定制植入物的随访结果进行系统回顾。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2183839
Jeffrey Zoltan, Diana Popescu, Seyed Hamid Reza Sanei

Introduction: While 3D printing of bone models for preoperative planning or customized surgical templating has been successfully implemented, the use of patient-specific additively manufactured (AM) implants is a newer application not yet well established. To fully evaluate the advantages and shortcomings of such implants, their follow-up results need to be evaluated.

Area covered: This systematic review provides a survey of the reported follow-ups on AM implants used for oncologic reconstruction, total hip arthroplasty both primary and revision, acetabular fracture, and sacrum defects.

Expert opinion: The review shows that Titanium alloy (Ti4AL6V) is the most common type of material system used due to its excellent biomechanical properties. Electron beam melting (EBM) is the predominant AM process for manufacturing implants. In almost all cases, porosity at the contact surface is implemented through the design of lattice or porous structures to enhance osseointegration. The follow-up evaluations show promising results, with only a small number of patients suffering from aseptic loosening, wear, or malalignment. The longest reported follow-up length was 120 months for acetabular cages and 96 months for acetabular cups. The AM implants have proven to serve as an excellent option to restore premorbid skeletal anatomy of the pelvis.

导言:虽然用于术前规划或定制手术模板的骨模型3D打印已经成功实施,但使用针对患者的增材制造(AM)植入物是一种较新的应用,尚未得到很好的建立。为了充分评价这类植入物的优缺点,需要对其随访结果进行评价。涵盖领域:这篇系统综述提供了关于AM植入物用于肿瘤重建、全髋关节置换术(包括原发性和翻修)、髋臼骨折和骶骨缺损的随访报告。专家意见:回顾表明钛合金(Ti4AL6V)由于其优异的生物力学性能是最常用的材料系统类型。电子束熔化(EBM)是制造植入物的主要增材制造工艺。在几乎所有情况下,通过设计晶格或多孔结构来实现接触面的孔隙度,以增强骨整合。随访评估显示有希望的结果,只有少数患者出现无菌性松动、磨损或不对准。报道的最长随访时间髋臼固定器为120个月,髋臼杯为96个月。AM植入物已被证明是恢复病前骨盆骨骼解剖结构的绝佳选择。
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引用次数: 2
The efficacy and safety of patient-specific instrumentation in primary total knee replacement: a systematic review and meta-analysis. 原发性全膝关节置换术中患者特异性内固定的有效性和安全性:一项系统回顾和荟萃分析。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2177152
J H Hinloopen, R Puijk, P A Nolte, J W Schoones, R de Ridder, B G Pijls

Introduction: Patient-specific instrumentation (PSI) for primary total knee arthroplasty (TKA) surgery has been shown to increase accuracy of component positioning. However, it is unclear whether this also translates to actual benefits for patients in terms of better outcomes (efficacy) or less complications such as revisions (safety). We therefore systematically reviewed the literature to determine the efficacy and safety of PSI in primary TKA.

Methods: Randomized controlled trials comparing PSI to non-PSI in primary TKA were included. A random effects model was used with meta-regression in case of heterogeneity.

Results: Forty-three studies were included with a total of 1816 TKA in the PSI group and 1887 TKA in the control group. There were no clinically relevant differences between the PSI-group and non-PSI group regarding all outcomes. There was considerable heterogeneity: meta-regression analyses showed that the year the study was published was an important effect modifier. Early publications tended to show a positive effect for PSI compared to non-PSI TKA, whereas later studies found the opposite.

Conclusion: Based on evidence of moderate certainty, our study suggested that there were no clinically relevant differences in efficacy and safety between patients treated with PSI TKA and patients treated with non-PSI TKA.

简介:原发性全膝关节置换术(TKA)手术中患者特异性内固定(PSI)已被证明可以提高部件定位的准确性。然而,目前尚不清楚这是否也转化为患者在更好的结果(疗效)或更少的并发症(如修正(安全性)方面的实际益处。因此,我们系统地回顾了文献,以确定PSI在原发性TKA中的有效性和安全性。方法:采用随机对照试验,比较原发性TKA的PSI和非PSI。在异质性的情况下,采用随机效应模型和元回归。结果:共纳入43项研究,PSI组共1816例TKA,对照组共1887例TKA。psi组和非psi组在所有结果方面没有临床相关差异。存在相当大的异质性:元回归分析显示,研究发表的年份是一个重要的影响修饰因子。与非PSI TKA相比,早期的出版物倾向于显示PSI的积极作用,而后来的研究发现相反。结论:基于中等确定性的证据,我们的研究表明,PSI TKA患者与非PSI TKA患者在疗效和安全性方面没有临床相关差异。
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引用次数: 1
Single-lead VDD pacing: a literature review on short-term and long-term performance. 单导联VDD起搏:短期和长期性能的文献综述。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2178901
Davide Antonio Mei, Jacopo Francesco Imberti, Marco Vitolo, Niccolò Bonini, Luigi Gerra, Giulio Francesco Romiti, Marco Proietti, Gregory Y H Lip, Giuseppe Boriani

Introduction: VDD pacing system was introduced more than 30 years ago. Its use is considered by the 2021 European Society of Cardiology guidelines on cardiac pacing as a potential alternative to dual chambers system for patients with atrioventricular block and normal sinus node function.

Areas covered: In this article, we performed a narrative review of current literature in order to identify the strengths and weaknesses of this pacing system. VDD system allows the maintenance of AV synchronous pacing and its hemodynamic advantages. Some disadvantages may be related to the non-negligible incidence of atrial undersensing and the possible subsequent need for upgrade to DDD system. On the other hand, shorter implantation time and lower complications rate may be advantages.

Expert opinion: In the modern pacing era, VDD pacing system struggles to find its own space. However, it may still be considered as a valuable alternative to a dual-chamber pacemaker for selected patients, in specific clinical scenarios.

简介:VDD起搏系统是30多年前推出的。2021年欧洲心脏病学会心脏起搏指南认为,对于房室传导阻滞和窦房结功能正常的患者,它是双室系统的潜在替代方案。涉及领域:在本文中,我们对当前文献进行了叙述性回顾,以确定该节奏系统的优点和缺点。VDD系统可维持房室同步起搏及其血流动力学优势。一些缺点可能与不可忽视的心房感应不足发生率和可能随后需要升级到DDD系统有关。另一方面,较短的植入时间和较低的并发症发生率可能是优势。专家意见:在现代起搏时代,VDD起搏系统努力寻找自己的空间。然而,在特定的临床情况下,它可能仍然被认为是有价值的替代双室起搏器的选择。
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引用次数: 2
Development of theranostic wound dressings: harnessing the knowledge of biospecific interactions at the biomaterial interface to promote healing and identify biomarkers. 治疗性伤口敷料的发展:利用生物材料界面上生物特异性相互作用的知识来促进愈合和识别生物标志物。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2181694
Shirin Saberianpour, Gianluca Melotto, Rachel Forss, Lucy Redhead, Jacqueline Elsom, Nadia Terrazini, Susan Sandeman, Dipak Sarker, Giselda Bucca, Andrew Hesketh, Cyril Crua, Matteo Santin
Chronic wounds are widely recognized as a global health challenge, but both our understanding of wound biology and the implementation of technological innovations for their treatment have made only limited progress in the last few decades [1]. Currently, the clinical assessment of the wound is based on the experience of the clinicians who follow recommendations taken from a range of available guidelines and choose commercially available wound dressings on the basis of their suitability to the wound conditions [2]. For example, the Wounds UK’s best practice statement on the management of chronic wounds recommends several criteria for the assessment of lesions that are mainly based on a subjective clinical inspection of the overall wound bed and peri-wound area status (e.g. inflammation), the exudate volume and viscosity, pain, and infectiongenerated malodor. Methods of wound size measurement provide quantitative data, but they suffer from limited intra-rater reliability. Likewise, the choice of the most suitable wound dressing is made with the aim of providing biological conditions favorable to healing. Despite the wide range available, wound dressings are all designed with two main characteristics: (i) an absorbent layer made of a polymeric porous hydrogel capable of absorbing excess exudate while keeping the wound moist and (ii) a film (e.g. silicon) protecting the wound from external contaminants and bacteria [3]. More advanced wound dressings include anti-microbial agents (e.g. silver nanoparticles) or growth factors known to promote healing [3]. The use of the latter is limited by their costs, need for refrigerated storage conditions, and debated healing properties. In this context, up to 42% of wounds do not heal within 6 months from the first presentation, often leading to severe complications [4]. Based on these premises, the quest for both healing-promoting wound dressings and objective parameters of wound evaluation is legitimately advocated. 2. Theranostic wound dressings
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引用次数: 1
Peregrine system infusion catheter for neurolytic renal denervation in hypertension: an overview of its safety and efficacy. 游隼系统输注导管用于高血压神经溶解性肾去神经:其安全性和有效性综述。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2183838
Adam Janas, Wojciech Wojakowski

Introduction: Resistant hypertension (HTN), despite the tremendous advances in pharmacotherapy, is a major global problem. Transcatheter renal denervation (RDN) could be a pertinent strategy for resistant HTN and patients with poor pharmacotherapy adherence. Nonetheless, the adoption of energy-based RDN in clinical practice is slow and alternative approaches are needed.

Areas covered: The review focuses on the assessment of the Peregrine System Infusion Catheters. The system is designed for chemically mediated transcatheter RDN by the infusion publications on the Peregrine system. The theoretical assumptions for chemically mediated RDN, design of the system, data from preclinical and clinical studies, and further perspectives are discussed.

Expert opinion: Peregrine System Infusion Catheters are the only catheter on the market designed for chemically mediated RDN by the infusion of the neurolytic agent. Chemical neurolysis more efficiently destroys nerves around the renal artery in comparison to energy-based catheters, due to deeper tissue penetration and circumferential distribution resulting in a wider range of effective nerve injury. Chemically mediated RDN by the infusion of the neurolytic agent (alcohol) has an excellent safety profile as confirmed in initial clinical trials which also suggested high efficacy. Currently, there is an ongoing phase III sham-control study. Other possible applications of this technology include clinical settings like heart failure or atrial fibrillation.

导言:尽管药物治疗取得了巨大进步,但顽固性高血压(HTN)仍是一个重大的全球性问题。经导管肾去神经(RDN)可能是耐药HTN和药物治疗依从性差的患者的相关策略。然而,在临床实践中采用基于能量的RDN是缓慢的,需要替代方法。涉及领域:综述的重点是对游隼系统输液管的评估。该系统是通过Peregrine系统上的输液出版物设计的化学介导的经导管RDN。讨论了化学介导RDN的理论假设、系统设计、临床前和临床研究的数据以及进一步的观点。专家意见:Peregrine系统输注导管是市场上唯一设计用于通过输注神经溶解剂化学介导的RDN的导管。与能量导尿管相比,化学神经松解术能更有效地破坏肾动脉周围的神经,这是因为化学神经松解术能穿透更深的组织,并能形成更大范围的有效神经损伤。通过输注神经溶解剂(酒精)化学介导的RDN具有极好的安全性,初步临床试验证实了这一点,这也表明了很高的疗效。目前,有一项正在进行的III期假对照研究。这项技术的其他可能应用包括临床设置,如心力衰竭或心房颤动。
{"title":"Peregrine system infusion catheter for neurolytic renal denervation in hypertension: an overview of its safety and efficacy.","authors":"Adam Janas,&nbsp;Wojciech Wojakowski","doi":"10.1080/17434440.2023.2183838","DOIUrl":"https://doi.org/10.1080/17434440.2023.2183838","url":null,"abstract":"<p><strong>Introduction: </strong>Resistant hypertension (HTN), despite the tremendous advances in pharmacotherapy, is a major global problem. Transcatheter renal denervation (RDN) could be a pertinent strategy for resistant HTN and patients with poor pharmacotherapy adherence. Nonetheless, the adoption of energy-based RDN in clinical practice is slow and alternative approaches are needed.</p><p><strong>Areas covered: </strong>The review focuses on the assessment of the Peregrine System Infusion Catheters. The system is designed for chemically mediated transcatheter RDN by the infusion publications on the Peregrine system. The theoretical assumptions for chemically mediated RDN, design of the system, data from preclinical and clinical studies, and further perspectives are discussed.</p><p><strong>Expert opinion: </strong>Peregrine System Infusion Catheters are the only catheter on the market designed for chemically mediated RDN by the infusion of the neurolytic agent. Chemical neurolysis more efficiently destroys nerves around the renal artery in comparison to energy-based catheters, due to deeper tissue penetration and circumferential distribution resulting in a wider range of effective nerve injury. Chemically mediated RDN by the infusion of the neurolytic agent (alcohol) has an excellent safety profile as confirmed in initial clinical trials which also suggested high efficacy. Currently, there is an ongoing phase III sham-control study. Other possible applications of this technology include clinical settings like heart failure or atrial fibrillation.</p>","PeriodicalId":12330,"journal":{"name":"Expert Review of Medical Devices","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9119971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of patients with bicuspid and tricuspid aortic valve in transcatheter aortic valve implantation. 经导管主动脉瓣植入术中二尖瓣与三尖瓣的比较。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-03-01 DOI: 10.1080/17434440.2023.2184686
Zhongkai Zhu, Tianyuan Xiong, Mao Chen

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgery for aortic stenosis (AS). However, there are still differences in the procedural process and outcome of bicuspid aortic valve (BAV) treated with TAVI compared with tricuspid aortic valve.

Areas covered: This review paper aims to summarize the main characteristics and clinical evidence of TAVI in patients with bicuspid and tricuspid aortic valves and compare the outcomes of TAVI procedure.

Expert opinion: The use of TAVI in patients with BAV has shown similar clinical outcomes compared with tricuspid aortic valve. The efficacy of TAVI for challenging BAV anatomies remains a concern due to the lack of randomized trials. Detailed preprocedural planning is of great importance in low-surgical-risk BAV patients. A better understanding of which subtypes of BAV anatomy are at greater risk for adverse outcomes can potentially benefit the selection of TAVI or open-heart surgery in low surgical risk AS patients.

背景:经导管主动脉瓣植入术(TAVI)已成为治疗主动脉瓣狭窄(as)安全有效的替代方法。然而,与三尖瓣主动脉瓣相比,TAVI治疗双尖瓣主动脉瓣(BAV)的手术过程和结果仍存在差异。涵盖领域:本文旨在总结二尖瓣和三尖瓣主动脉瓣患者TAVI的主要特征和临床证据,并比较TAVI手术的结果。专家意见:与三尖瓣主动脉瓣相比,在BAV患者中使用TAVI显示出相似的临床结果。由于缺乏随机试验,TAVI治疗BAV解剖的有效性仍然值得关注。详细的术前计划对低手术风险的BAV患者非常重要。更好地了解哪些BAV亚型有更大的不良后果风险,可能有利于低手术风险AS患者选择TAVI或心内直视手术。
{"title":"Comparison of patients with bicuspid and tricuspid aortic valve in transcatheter aortic valve implantation.","authors":"Zhongkai Zhu,&nbsp;Tianyuan Xiong,&nbsp;Mao Chen","doi":"10.1080/17434440.2023.2184686","DOIUrl":"https://doi.org/10.1080/17434440.2023.2184686","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgery for aortic stenosis (AS). However, there are still differences in the procedural process and outcome of bicuspid aortic valve (BAV) treated with TAVI compared with tricuspid aortic valve.</p><p><strong>Areas covered: </strong>This review paper aims to summarize the main characteristics and clinical evidence of TAVI in patients with bicuspid and tricuspid aortic valves and compare the outcomes of TAVI procedure.</p><p><strong>Expert opinion: </strong>The use of TAVI in patients with BAV has shown similar clinical outcomes compared with tricuspid aortic valve. The efficacy of TAVI for challenging BAV anatomies remains a concern due to the lack of randomized trials. Detailed preprocedural planning is of great importance in low-surgical-risk BAV patients. A better understanding of which subtypes of BAV anatomy are at greater risk for adverse outcomes can potentially benefit the selection of TAVI or open-heart surgery in low surgical risk AS patients.</p>","PeriodicalId":12330,"journal":{"name":"Expert Review of Medical Devices","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9119477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tests for the identification of reflex syncope mechanism. 鉴别反射性晕厥机制的试验。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17434440.2023.2174428
Michele Brignole, Giulia Rivasi, Artur Fedorowski, Marcus Ståhlberg, Antonella Groppelli, Andrea Ungar

Introduction: Treatment efficacy of reflex syncope is mainly related to the mechanism underlying syncope rather than its etiology or clinical presentation. The predominant mechanism underlying reflex syncope can be assigned to hypotensive or to bradycardic phenotypes.

Areas covered: Methodology and diagnostic criteria of the most useful tests for the identification of hypotensive and bradycardic phenotypes are discussed. Diagnostic tests for the hypotensive phenotype include office blood pressure measurement with active standing test, home, and wearable blood pressure monitoring, 24-h ambulatory blood pressure monitoring and tilt table test. Diagnostic tests for the bradycardic phenotype include carotid sinus massage, tilt table test and prolonged ECG monitoring.

Expert opinion: In reflex syncope, the documentation of bradycardia/asystole during a syncopal episode does not rule out the possibility that a preceding or parallel hypotensive reflex plays an important role. Similarly, even when a hypotensive mechanism is established, the possibility of an associated cardioinhibitory reflex should be investigated. Investigating the mechanism of reflex syncope is mandatory in patients with severe recurrent episodes, with the final aim to develop a personalized treatment strategy. Recent trials have demonstrated the benefits of personalized mechanism-based therapy, thus highlighting the importance of a comprehensive assessment of the mechanisms underlying syncope.

导语:反射性晕厥的治疗效果主要与晕厥的发病机制有关,而与病因或临床表现无关。反射性晕厥的主要机制可归因于低血压或心动过缓表型。涵盖的领域:方法和诊断标准的最有用的测试,以确定低血压和心动过缓表型进行了讨论。低血压表型的诊断试验包括办公室血压测量和主动站立试验,家庭和可穿戴血压监测,24小时动态血压监测和倾斜台试验。心动过缓表型的诊断试验包括颈动脉窦按摩、倾斜试验和长时间心电图监测。专家意见:在反射性晕厥中,晕厥发作时的心动过缓/心跳停止的记录不能排除先前或平行的低血压反射起重要作用的可能性。同样,即使确立了降压机制,也应调查相关的心脏抑制反射的可能性。研究反射性晕厥的发生机制对于严重复发性晕厥的患者是必要的,最终目的是制定个性化的治疗策略。最近的试验已经证明了个性化的基于机制的治疗的益处,因此强调了全面评估晕厥机制的重要性。
{"title":"Tests for the identification of reflex syncope mechanism.","authors":"Michele Brignole,&nbsp;Giulia Rivasi,&nbsp;Artur Fedorowski,&nbsp;Marcus Ståhlberg,&nbsp;Antonella Groppelli,&nbsp;Andrea Ungar","doi":"10.1080/17434440.2023.2174428","DOIUrl":"https://doi.org/10.1080/17434440.2023.2174428","url":null,"abstract":"<p><strong>Introduction: </strong>Treatment efficacy of reflex syncope is mainly related to the mechanism underlying syncope rather than its etiology or clinical presentation. The predominant mechanism underlying reflex syncope can be assigned to hypotensive or to bradycardic phenotypes.</p><p><strong>Areas covered: </strong>Methodology and diagnostic criteria of the most useful tests for the identification of hypotensive and bradycardic phenotypes are discussed. Diagnostic tests for the hypotensive phenotype include office blood pressure measurement with active standing test, home, and wearable blood pressure monitoring, 24-h ambulatory blood pressure monitoring and tilt table test. Diagnostic tests for the bradycardic phenotype include carotid sinus massage, tilt table test and prolonged ECG monitoring.</p><p><strong>Expert opinion: </strong>In reflex syncope, the documentation of bradycardia/asystole during a syncopal episode does not rule out the possibility that a preceding or parallel hypotensive reflex plays an important role. Similarly, even when a hypotensive mechanism is established, the possibility of an associated cardioinhibitory reflex should be investigated. Investigating the mechanism of reflex syncope is mandatory in patients with severe recurrent episodes, with the final aim to develop a personalized treatment strategy. Recent trials have demonstrated the benefits of personalized mechanism-based therapy, thus highlighting the importance of a comprehensive assessment of the mechanisms underlying syncope.</p>","PeriodicalId":12330,"journal":{"name":"Expert Review of Medical Devices","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9072634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Partial vs full glottic view with CMACTM D blade intubation of airway with simulated cervical spine injury: a randomized controlled trial. CMACTM - D叶片气管插管对模拟颈椎损伤的部分声门观察与全声门观察:一项随机对照试验。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17434440.2023.2174850
Chao Chia Cheong, Soon Yiu Ong, Siu Min Lim, Wan Zakaria Wan A, Marzida Mansor, Sook Hui Chaw

Purpose: A previous study reported a shorter time to tracheal intubation by reducing percentage of glottic opening (POGO) view to <50% when intubating a normal adult airway using the GlidescopeTM blade. We evaluate the efficacy of reducing POGO to <50% when intubating patients with rigid cervical immobilization using CMACTM D blade.

Methods: One hundred and four adult patients were randomized to group POGO 100% or POGO <50% . Laryngoscopy was performed by advancing tip of the D blade at vallecula. POGO 100% was achieved by exerting upward force to displace epiglottis until glottic opening from the anterior commissure to inter arytenoid notch. POGO < 50% was acquired by withdrawing the D blade tip dorsally from vallecula. The primary outcome was time to intubation.

Results: The median time (IQR) to successful intubation was 29 (25-35) seconds for group POGO < 50% and 34 (28-40) seconds for group with POGO 100% (difference in medians, 5 seconds; 95% confidence interval, 2 to 8, p = 0.003). Complications were minor.

Conclusion: Using the CMACTM D blade with a reduced POGO in patients with cervical spine immobilization resulted in faster tracheal intubation.

Trial registration: The trial is registered at ClinicalTrial.gov (CT.gov identifier: NCT04833166).

目的:先前的一项研究报道了通过减少声门开口(POGO)视野到TM刀片的百分比来缩短气管插管时间。我们评估了将POGO还原为TM D刀片的疗效。结果:POGO < 50%组插管成功的中位时间(IQR)为29(25-35)秒,POGO 100%组插管成功的中位时间(IQR)为34(28-40)秒(中位差异为5秒;95%置信区间,2 ~ 8,p = 0.003)。并发症很少。结论:颈椎固定患者使用CMACTM - D刀片降低POGO可加快气管插管速度。试验注册:该试验在ClinicalTrial.gov (CT.gov标识符:NCT04833166)上注册。
{"title":"Partial vs full glottic view with CMAC<sup>TM</sup> D blade intubation of airway with simulated cervical spine injury: a randomized controlled trial.","authors":"Chao Chia Cheong,&nbsp;Soon Yiu Ong,&nbsp;Siu Min Lim,&nbsp;Wan Zakaria Wan A,&nbsp;Marzida Mansor,&nbsp;Sook Hui Chaw","doi":"10.1080/17434440.2023.2174850","DOIUrl":"https://doi.org/10.1080/17434440.2023.2174850","url":null,"abstract":"<p><strong>Purpose: </strong>A previous study reported a shorter time to tracheal intubation by reducing percentage of glottic opening (POGO) view to <50% when intubating a normal adult airway using the Glidescope<sup>TM</sup> blade. We evaluate the efficacy of reducing POGO to <50% when intubating patients with rigid cervical immobilization using CMAC<sup>TM</sup> D blade.</p><p><strong>Methods: </strong>One hundred and four adult patients were randomized to group POGO 100% or POGO <50% . Laryngoscopy was performed by advancing tip of the D blade at vallecula. POGO 100% was achieved by exerting upward force to displace epiglottis until glottic opening from the anterior commissure to inter arytenoid notch. POGO < 50% was acquired by withdrawing the D blade tip dorsally from vallecula. The primary outcome was time to intubation.</p><p><strong>Results: </strong>The median time (IQR) to successful intubation was 29 (25-35) seconds for group POGO < 50% and 34 (28-40) seconds for group with POGO 100% (difference in medians, 5 seconds; 95% confidence interval, 2 to 8, p = 0.003). Complications were minor.</p><p><strong>Conclusion: </strong>Using the CMAC<sup>TM</sup> D blade with a reduced POGO in patients with cervical spine immobilization resulted in faster tracheal intubation.</p><p><strong>Trial registration: </strong>The trial is registered at ClinicalTrial.gov (CT.gov identifier: NCT04833166).</p>","PeriodicalId":12330,"journal":{"name":"Expert Review of Medical Devices","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9383243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Addendum. 附录。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-02-01 DOI: 10.1080/17434440.2022.2152229
Jack Kingdon, Adam Gwozdz, Rachael Morris, Stephen Black, Alberto Smith, Prakash Saha
{"title":"Addendum.","authors":"Jack Kingdon,&nbsp;Adam Gwozdz,&nbsp;Rachael Morris,&nbsp;Stephen Black,&nbsp;Alberto Smith,&nbsp;Prakash Saha","doi":"10.1080/17434440.2022.2152229","DOIUrl":"https://doi.org/10.1080/17434440.2022.2152229","url":null,"abstract":"","PeriodicalId":12330,"journal":{"name":"Expert Review of Medical Devices","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9495034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Expert Review of Medical Devices
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