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A profile on the CardioMEMS HF system in the management of patients with early stages of heart failure: an update. CardioMEMS HF系统在早期心力衰竭患者管理中的概况:最新进展
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2228683
Rohit Vyas, Mitra Patel, Samer J Khouri, George V Moukarbel
ABSTRACT Introduction Over the past decade, there have been noteworthy advances in the evaluation and treatment of heart failure (HF). Despite an improved understanding of this chronic disease, HF is still one of the leading causes of morbidity and mortality in the United States and worldwide. Decompensation and rehospitalization of HF patients remain an integral problem in disease management, with significant economic implications. Remote monitoring systems have been developed to detect HF decompensation early and address it before hospitalization. The CardioMEMS HF system is a wireless pulmonary artery (PA) monitoring system that detects changes in PA pressure and transmits data to the healthcare provider. As changes in PA pressures occur early during HF decompensation, the CardioMEMS HF system allows providers to institute timely changes in HF medical therapies to alter the course of the decompensation. The use of the CardioMEMS HF system has been shown to reduce HF hospitalization and improve quality of life. Areas Covered This review will focus on the available data supporting the expanded utilization of the CardioMEMS system in patients with HF. Expert Opinion The CardioMEMS HF system is a relatively safe and cost-effective device that reduces the incidence of HF hospitalization and qualifies as intermediate-to-high value medical care.
导读:在过去的十年中,心力衰竭(HF)的评估和治疗取得了显著的进展。尽管对这种慢性疾病的认识有所提高,心衰仍然是美国和世界范围内发病率和死亡率的主要原因之一。心衰患者的失代偿和再住院仍然是疾病管理中不可或缺的问题,具有重要的经济意义。开发了远程监测系统,以便及早发现HF失代偿并在住院前予以处理。CardioMEMS HF系统是一种无线肺动脉(PA)监测系统,可检测PA压力的变化并将数据传输给医疗保健提供者。由于心绞痛压力的变化发生在HF失代偿的早期,CardioMEMS HF系统允许提供者及时改变HF药物治疗,以改变失代偿的过程。使用CardioMEMS心衰系统已被证明可减少心衰住院并改善生活质量。涵盖领域:本综述将侧重于支持CardioMEMS系统在心衰患者中扩大应用的现有数据。专家意见:CardioMEMS心衰系统是一种相对安全且具有成本效益的设备,可降低心衰住院发生率,具有中高价值医疗保健的资格。
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引用次数: 0
Anterior Segment Optical Coherence Tomography in Pediatric Ocular Pathology: Imaging Study of 115 eyes. 前段光学相干断层扫描在儿童眼部病理学中的应用:115只眼的影像学研究。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2223966
Sana Nadeem

Objective: To assess the pediatric anterior segment characteristics in ocular pathology using spectral domain optical coherence tomography (SD-OCT).

Methods: This case series follows 115 eyes of 78 children (2-17 years) with anterior segment pathology in an academic facility. The anterior segment OCT (AS-OCT) analysis was done using the Optopol Revo 80 high-resolution SD-OCT using an imaging adapter. All pathological features visible on imaging were observed, studied, tabulated, and analyzed.

Results: The average age was 11.84 years, with 44 males and 34 females. The primary clinical diagnosis was cataract in 40 (34.8%) eyes, followed by corneal disease in 28 (24.3%) eyes, glaucoma in 18 (15.7%) eyes, and trauma in 15 (13%) eyes. Systemic diseases were associated with 20.9% of the cases. The most common imaging pathology observed was lens opacification in 43 (37.4%), increased reflectivity of the cornea in 31 (28.2%), corneal stromal thinning in 34 (29.6%), increased corneal thickness in 28 (24.3%), a shallow anterior chamber in 17 (14.8%), and cells in the anterior chamber in 18 (15.7%) eyes, along with a multitude of other findings.

Conclusion: This study demonstrates that anterior segment OCT is a useful non-contact technique for the detailed anatomic and pathologic assessment of pediatric ocular diseases.

目的:利用光谱域光学相干断层扫描(SD-OCT)评价儿童眼部前段的病理特征。方法:本病例系列随访了一个学术机构115眼78名儿童(2-17岁)的前节病理。前段OCT (AS-OCT)分析使用Optopol Revo 80高分辨率SD-OCT进行,并使用成像适配器。观察、研究、制表和分析成像上可见的所有病理特征。结果:平均年龄11.84岁,男44例,女34例。临床主要诊断为白内障40眼(34.8%),其次为角膜病变28眼(24.3%),青光眼18眼(15.7%),外伤15眼(13%)。全身性疾病占20.9%。最常见的影像学病理表现为晶状体混浊43例(37.4%),角膜反射率增加31例(28.2%),角膜基质变薄34例(29.6%),角膜厚度增加28例(24.3%),前房浅17例(14.8%),前房细胞增生18例(15.7%),并伴有大量其他表现。结论:本研究表明,前段OCT是一种有用的非接触技术,可用于儿童眼部疾病的详细解剖和病理评估。
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引用次数: 0
Device profile of the Orchid safety release valve for the prevention of accidental catheter dislodgement. 兰花安全释放阀的装置外形,用于防止导管意外脱位。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2216383
Nancy Moureau

Introduction: More than 4 out of 5 patients in acute care require intravenous catheters. Complications of catheter dislodgement and failure are commonly reported at rates of 15-69% causing interrupted treatment and greater resource consumption when catheter replacement is required.

Areas covered: This manuscript outlines unmet needs in the prevention of catheter dislodgement and how a novel safety release device (Orchid SRV™, Linear Health Sciences) might address these gaps based on available evidence.

Expert opinion: Healthcare initiatives focus on reducing complications and associated costs with the delivery of intravenous treatments. Tension-activated safety release valve devices, attached to intravenous tubing, are a new feature that adds a level of safety to intravenous catheters to reduce mechanical catheter dislodgement when a pull force of greater than 3 pounds is applied. Incorporating a tension-activated accessory into and between existing intravenous tubing and the catheter and extension set protects the catheter from dislodgement. Flow continues until excessive pull force separates and closes the flow pathway in both directions, while the SRV provides a quick replacement to reestablish flow. The safety release valve is used to prevent accidental catheter dislodgement, limit tubing contamination, and avoid more serious complications while maintaining a functional catheter.

简介:超过4 / 5的急症患者需要静脉留置导管。导尿管脱位和失败的并发症发生率通常为15-69%,导致治疗中断,需要更换导尿管时资源消耗更大。涵盖领域:本文概述了预防导管脱位的未满足需求,以及一种新型安全释放装置(Orchid SRV™,Linear Health Sciences)如何根据现有证据解决这些差距。专家意见:医疗保健举措的重点是减少静脉注射治疗的并发症和相关费用。张力激活安全释放阀装置,附在静脉导管上,是一项新功能,增加了静脉导管的安全性,以减少在施加大于3磅的拉力时机械导管脱位。将张力激活的附件纳入现有静脉导管和导管之间,并保护导管不脱位。流体会继续流动,直到过大的拉力分离并关闭两个方向的流动通道,而SRV提供了快速的替换以重新建立流动。安全释放阀用于防止意外的导管脱位,限制导管污染,在保持导管功能的同时避免更严重的并发症。
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引用次数: 0
inHEART Models software - novel 3D cardiac modeling solution. inHEART Models软件-新颖的三维心脏建模解决方案。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-18 DOI: 10.1080/17434440.2023.2247983
Leah A John, Brett Tomashitis, Zain Gowani, Dan Levin, Chau Vo, Ian John, Jeffrey R Winterfield

Introduction: Advanced cardiac imaging is an important component in pre-procedural planning for ventricular tachycardia (VT) ablations. inHEART's proprietary software, inHEART Models, and its academic version, Multimodality Platform for Specific Imaging in Cardiology (MUSIC), provide detailed characterization of anatomical structures and scars.

Areas covered: This review highlights the current overview of the market and offers insight into inHEART Models and MUSIC and its application during VT ablations with supporting case examples. An overview of the clinical profile and regulatory status of inHEART Models, and other competing technologies, such as Automatic Detection of Arrhythmia Substrate (ADAS) 3D software and Catheter Precision's View into Ventricular Onset (VIVO), are also discussed.

Expert opinion: inHEART and MUSIC utilization has increased over the last few years and continues to establish its presence as an important aspect of VT ablations. Its unique proprietary software sets itself apart from others in the field. The introduction of dual source-photon counting detector computed tomography (PCD-CT) is expected to make significant advancements in the field and take imaging to a new level. inHEART's continued research in cardiac imaging and digital technology is expected to increase as is its global presence in the electrophysiology (EP) community.

引言:高级心脏成像是室性心动过速(VT)消融术前计划的重要组成部分。inHEART的专有软件inHEART Models及其学术版心脏病特异性成像多模态平台(MUSIC)提供了解剖结构和疤痕的详细特征。所涵盖的领域:本综述重点介绍了当前的市场概况,并提供了对inHEART模型和MUSIC及其在室性心动过速消融过程中的应用的见解,以及支持性案例。还讨论了inHEART模型的临床概况和监管状况,以及其他竞争技术,如心律失常底物自动检测(ADAS)3D软件和Catheter Precision的心室发病视图(VIVO)。专家意见:inHEART和MUSIC的使用在过去几年中有所增加,并继续将其作为室性心动过速消融的一个重要方面。其独特的专有软件使自己在该领域与众不同。双源光子计数探测器计算机断层扫描(PCD-CT)的引入有望在该领域取得重大进展,并将成像提升到一个新的水平。inHEART在心脏成像和数字技术方面的持续研究预计将增加,其在电生理学(EP)领域的全球影响力也将增加。
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引用次数: 0
Telemedicine for hypertension management: a paradigm shift from telemonitoring to digital therapeutics. 高血压管理的远程医疗:从远程监测到数字治疗的范式转变。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-07-28 DOI: 10.1080/17434440.2023.2242270
Stefano Omboni
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引用次数: 0
Sex differences in 123I-mIBG scintigraphy imaging techniques in patients with heart failure. 心力衰竭患者123I-mIBG闪烁成像技术的性别差异。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-07-24 DOI: 10.1080/17434440.2023.2239139
Miriam Conte, Maria Silvia De Feo, Viviana Frantellizzi, Arianna Di Rocco, Alessio Farcomeni, Flaminia De Cristofaro, Ricci Maria, Antonio Rosario Pisani, Giuseppe Rubini, Giuseppe De Vincentis

Background: 123I-mIBG-scintigraphy could be a useful stratifying tool for patients with heart failure (HF). The purpose of this retrospective study is to evaluate whether there are differences between men and women with HF in terms of the prediction of cardiac arrhythmic events (AE).

Research and methods: A total of 306 patients, before implantable-cardioverter-defibrillator (ICD) implantation, were evaluated. They underwent 123I-mIBG-scintigraphy and an evaluation of the results was performed after 85 months of follow-up. Early and late planar and SPECT cardiac images were acquired. Heart-to-mediastinum ratio (HM) for planar images and the sum of the segmental scores (SS) for SPECT were calculated.

Results: In the general population, age, early SS (ESS), late SS (LSS), and ejection fraction (EF) were statistically significant for the prediction of AE at Cox regression, while early and late HM (eHM,lHM) were not significative for the prediction of AE. Population was divided into females and males and univariate analysis was conducted separately for the two cohorts: no significant variables for prediction of AE were found in females. For males, ESS, LSS, EF, and late HM were statistically significant predictors of AE. The overall survival was similar in males and females, but the risk of AE is lower in males than in females.

Conclusions: 123I-mIBG represents a more effective tool for the prediction of AE in male patients than in women.

背景:123I mIBG闪烁显像可能是心力衰竭(HF)患者的一种有用的分层工具。本回顾性研究的目的是评估男性和女性HF患者在预测心律失常事件(AE)方面是否存在差异。研究和方法:在植入心律转复除颤器(ICD)之前,共对306名患者进行了评估。他们接受了123I mIBG闪烁扫描,并在85岁后对结果进行了评估 随访数月。采集早期和晚期平面和SPECT心脏图像。计算平面图像的心纵隔比(HM)和SPECT的节段评分之和(SS)。结果:在一般人群中,年龄、早期SS(ESS)、晚期SS(LSS)和射血分数(EF)在Cox回归预测AE方面具有统计学意义,而早期和晚期HM(eHM,lHM)对预测AE没有统计学意义。将人群分为女性和男性,并分别对两个队列进行单变量分析:在女性中未发现预测AE的显著变量。对于男性,ESS、LSS、EF和晚期HM是AE的统计学显著预测因素。男性和女性的总生存率相似,但男性发生AE的风险低于女性。结论:123I-mIBG是预测男性患者AE的一种比女性患者更有效的工具。
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引用次数: 0
A contemporary systematic review of the complications associated with SURGICEL. 外科手术并发症的当代系统综述。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-04 DOI: 10.1080/17434440.2023.2242776
Matthew Masoudi, Jacob Wiseman, Sam M Wiseman

Background: This review aims to summarize the findings from recent literature (2010-2022) reporting on complications that resulted from the surgical use of SURGICEL for intraoperative hemostasis.

Methods: A literature search was conducted using the MEDLINE (OVID), Embase, and Cochrane Central Register of Controlled Trials - CENTRAL (OVID) databases. The studies were sorted into case reports and other study types for data extraction. Covidence was used for data extraction and statistics were descriptive.

Results: Of the total 560 articles screened, 73 papers were selected for a full-text review and 70 studies were included in this review. A total of 7,242 participants were included in the studies (case studies n = 93, others n = 7149). 67/70 of the included studies reported complications when SURGICEL was used intraoperatively. Reported complications included: SURGICEL induced masses (granulomas, abscesses, hematomas, cysts) (n = 25), hemorrhagic complications (n = 12), masses misdiagnosed as tumors, cardiovascular, nervous system, and hepatobiliary complications, pain, and infections. Other complications included: fistulas, erectile dysfunction, chorioamnionitis, swelling, urinary leak, renal failure, and anaphylaxis.

Conclusions: Publications reporting on complications associated with the use of SURGICEL intraoperatively have continued to emerge. Future studies should compare how the types and rates of complications compare between SURGICEL and alternative hemostatic agents.

背景:本综述旨在总结最近文献(2010-2022)中关于外科手术使用SURGICEL进行术中止血引起并发症的研究结果。方法:使用MEDLINE(OVID)、Embase和Cochrane对照试验中央登记册-Central数据库进行文献检索。这些研究被分类为病例报告和其他研究类型,用于数据提取。Covidence用于数据提取,统计数据具有描述性。结果:在筛选的560篇文章中,73篇论文被选为全文综述,70项研究被纳入本综述。共有7242名参与者被纳入研究(案例研究 = 93,其他n = 7149)。67/70的纳入研究报告了术中使用SURGICEL时的并发症。报告的并发症包括:外科手术引起的肿块(肉芽肿、脓肿、血肿、囊肿)(n = 25),出血性并发症(n = 12) ,肿块被误诊为肿瘤、心血管、神经系统和肝胆并发症、疼痛和感染。其他并发症包括:瘘管、勃起功能障碍、绒毛膜羊膜炎、肿胀、尿漏、肾衰竭和过敏反应。结论:关于术中使用SURGICEL并发症的报道不断出现。未来的研究应该比较SURGICEL和替代止血剂之间并发症的类型和发生率的比较。
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引用次数: 0
HOPE for a better selection of patients for cardiac contractility modulation. 希望能更好地选择心脏收缩力调节的患者。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 DOI: 10.1080/17434440.2023.2217329
Daniele Masarone, Ishu Rao, Giuseppe Pacileo
Cardiac contractility modulation (CCM) is an innovative devicebased therapy for the treatment of patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) and reduced ejection fraction (HFrEF) with a narrow QRS complex (and therefore with no indication for cardiac resynchronization therapy). The CCM therapy is based on the delivery, by an impulse pocket generator (Optimizer Smart®), of high-voltage (≈7.5 V) and long-duration (≈20 ms) biphasic electrical signals to the septal wall of the right ventricle during the absolute refractory period of the myocardium [1]. Therefore, these signals do not cause a novel myocardial contraction, but induce an improvement in calcium handling and, consequently, an increase in myocardial contractility [2]. Besides improving calcium handling, CCM therapy induces several positive effects (Table 1) that affects the entire biology of the failing myocardium [3–5]. In randomized controlled trials, CCM therapy improves functional capacity (i.e. VO2 peak at cardiopulmonary exercise test) [6]; also, in a real-world registry, CCM therapy is associated with a lower rate of HF-related hospitalizations [7]. In addition, CCM therapy induces both left and right ventricular reverse remodeling [8–10]. Based on the results of these randomized clinical trials, the Optimizer Smart® system has been approved in countries covered by CE markings since October 2016 and granted United States Food and Drug Administration (FDA) approval in March 2019. As with all device-based therapies for HF, appropriate patient selection is crucial for increasing the possibility of clinical and echocardiographic response. Because no practical guidance on proper patient selection for CCM therapy is currently provided by the European Society of Cardiology and the American College of Cardiology/American Heart Association guidelines [11,12], we proposed the HOPE algorithm as a simple tool for screening and selecting outpatients with HFrEF/HFmrEF in which CCM therapy is more likely to be effective (Figure 1).
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引用次数: 1
The current state, challenges, and future directions of deep brain stimulation for obsessive compulsive disorder. 强迫症脑深部刺激的现状、挑战和未来方向。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-09-07 DOI: 10.1080/17434440.2023.2252732
Lauren Fanty, Jun Yu, Nita Chen, Drew Fletcher, Grace Hey, Michael Okun, Josh Wong

Introduction: Obsessive-compulsive disorder (OCD) is clinically and pathologically heterogenous, with symptoms often refractory to first-line treatments. Deep brain stimulation (DBS) for the treatment of refractory OCD provides an opportunity to adjust and individualize neuromodulation targeting aberrant circuitry underlying OCD. The tailoring of DBS therapy may allow precision in symptom control based on patient-specific pathology. Progress has been made in understanding the potential targets for DBS intervention; however, a consensus on an optimal target has not been agreed upon.

Areas covered: A literature review of DBS for OCD was performed by querying the PubMed database. The following topics were covered: the evolution of DBS targeting in OCD, the concept of an underlying unified connectomic network, current DBS targets, challenges facing the field, and future directions which could advance personalized DBS in this challenging population.

Expert opinion: To continue the increasing efficacy of DBS for OCD, we must further explore the optimal DBS response across clinical profiles and neuropsychiatric domains of OCD as well as how interventions targeting multiple points in an aberrant circuit, multiple aberrant circuits, or a connectivity hub impact clinical response. Additionally, biomarkers would be invaluable in programming adjustments and creating a closed-loop paradigm to address symptom fluctuation in daily life.

引言:强迫症(OCD)在临床和病理上都是异质性的,其症状往往难以一线治疗。脑深部刺激(DBS)治疗难治性强迫症提供了一个调整和个体化神经调控靶向强迫症下异常电路的机会。DBS治疗的定制可以允许基于患者特定病理学的症状控制的精确性。在了解DBS干预的潜在目标方面取得了进展;然而,关于最佳目标的共识尚未达成。涵盖领域:通过查询PubMed数据库对DBS治疗强迫症进行文献综述。涵盖了以下主题:强迫症中DBS靶向的演变,底层统一连接组网络的概念,当前DBS靶向,该领域面临的挑战,以及在这一具有挑战性的人群中推进个性化DBS的未来方向。专家意见:为了继续提高DBS治疗强迫症的疗效,我们必须进一步探索强迫症临床特征和神经精神领域的最佳DBS反应,以及针对异常回路、多个异常回路或连接中枢中多个点的干预措施如何影响临床反应。此外,生物标志物在编程调整和创建闭环范式以解决日常生活中的症状波动方面将是非常宝贵的。
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引用次数: 0
Histological examination of tooth-derived biomaterials obtained from different devices. 从不同设备获得的牙齿衍生生物材料的组织学检查。
IF 3.1 3区 医学 Q1 Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-28 DOI: 10.1080/17434440.2023.2251891
Robert Dłucik, Bogusława Orzechowska-Wylęgała, Daniel Dłucik, Katarzyna Bogus

Aim: The aim of the present study was to investigate the histological differences between samples processed by different devices and to confirm safe clinical application of different dentin matrix obtained from three devices: BonMaker, Tooth Transformer, and Smart Dentin Grinder in regeneration of maxillary defects.

Research design: The study involved 39 patients with two-wall or three-wall defects who underwent bone augmentation procedures in the maxilla using dentin matrix grafts from the BonMaker, Tooth Transformer, and Smart Dentin Grinder devices. Histological examination was conducted on samples obtained from patients who received each device. In this article, histological samples have been selected and are presented.

Results: In all patients, bone defects were successfully augmented with ground dentin matrix. The histological examination revealed no inflammation and a good connection between the bone and dentin matrix and clinically all patients were qualified for implant placement.

Conclusions: After comparing the BonMaker, Tooth Transformer, and Smart Dentin Grinder devices in our practice, we concluded that all these systems have the potential for obtaining regenerative material from the patient's teeth.

目的:本研究的目的是研究不同设备处理的样本之间的组织学差异,并确认从BonMaker、Tooth Transformer和Smart dentin Grinder三种设备获得的不同牙本质基质在上颌缺损再生中的安全临床应用。研究设计:该研究涉及39名患有两壁或三壁缺陷的患者,他们使用BonMaker、Tooth Transformer和Smart dentin Grinder设备的牙本质基质移植物在上颌骨进行了骨增强手术。对从接受每种装置的患者身上获得的样本进行组织学检查。在这篇文章中,组织学样本已经被选择并呈现。结果:在所有患者中,骨缺损均成功地用磨碎的牙本质基质修复。组织学检查显示没有炎症,骨和牙本质基质之间有良好的连接,临床上所有患者都符合植入条件。结论:在比较了我们实践中的BonMaker、Tooth Transformer和Smart Dentin Grinder设备后,我们得出结论,所有这些系统都有可能从患者的牙齿中获得再生材料。
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引用次数: 0
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Expert Review of Medical Devices
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