Estudo Comparativo entre Receptores de Desfibriladores Subcutâneos e Transvenosos em Relação à Tolerância ao Procedimento de Implante e Percepção da Qualidade de Vida

BackgroundThe totally subcutaneous implantable cardioverter-defibrillator (S-ICD) is a safe alternative to the conventional transvenous ICD (TV-ICD) system to prevent sudden death.ObjectiveTo compare the impact of the type of ICD system and surgical technique on patients’ quality of life, as well as the severity of discomfort and pain, between S-ICD and TV-ICD recipients.MethodsConsecutively implanted patients with an S-ICD system were matched with patients with a TV-ICD system. In addition, patients undergoing S-ICD implantation after removal of a TV-ICD due to complications were included. Quality of life (measured with the 12-item short-form health survey) and severity of pain and discomfort were evaluated. Statistical significance was defined as p < 0.05.ResultsA total of 64 patients implanted with S-ICD or TV-ICD under local anesthesia and conscious sedation were analyzed. Patients with S-ICD and TV-ICD systems did not differ significantly in quality of life scores. S-ICD patients had a higher level of perioperative pain; no differences were found regarding severity of intraoperative pain. The magnitude of aesthetic discomfort and sleep disturbances did not differ between groups. An S-ICD was implanted in 7 additional patients after removal of a TV-ICD. All but one of these patients recommended the S-ICD system.ConclusionsThe type of ICD system and the surgical technique have negligible impact on patients’ quality of life. These results suggest that conscious sedation, provided by an experienced electrophysiology team, could be considered as an alternative to general anesthesia to manage patients undergoing S-ICD implantation.     

Regulation of human bone marrow stromal cell proliferation and differentiation capacity by glucocorticoid receptor and AP‐1 crosstalk

Although marrow adipocytes and osteoblasts derive from a common bone marrow stromal cells (BMSCs), the mechanisms that underlie osteoporosis‐associated bone loss and marrow adipogenesis during prolonged steroid treatment are unclear. We show in human BMSCs (hBMSCs) that glucocorticoid receptor (GR) signaling in response to high concentrations of glucocorticoid (GC) supports adipogenesis but inhibits osteogenesis by reducing c‐Jun expression and hBMSC proliferation. Conversely, significantly lower concentrations of GC, which permit hBMSC proliferation, are necessary for normal bone mineralization. In contrast, platelet‐derived growth factor (PDGF) signaling increases both JNK/c‐Jun activity and hBMSC expansion, favoring osteogenic differentiation instead of adipogenesis. Indeed, PDGF antagonizes the proadipogenic qualities of GC/GR signaling. Thus our results reveal a novel c‐Jun‐centered regulatory network of signaling pathways in differentiating hBMSCs that controls the proliferation‐dependent balance between osteogenesis and adipogenesis. © 2010 American Society for Bone and Mineral Research.     

Classification of paroxysmal events and the four‐dimensional epilepsy classification system

This educational review describes the classification of paroxysmal events and a four‐dimensional epilepsy classification system. Paroxysmal events are classified as epileptic and non‐epileptic paroxysmal events. Non‐epileptic events are, in turn, classified as psychogenic and organic paroxysmal events. The following four dimensions are used to classify epileptic paroxysmal events: ictal semiology, the epileptogenic zone, etiology, and comorbidities. Efforts are made to keep these four dimensions as independent as possible. The review also includes 12 educational vignettes and three more detailed case reports classified using the 2017 classification of the ILAE and the four‐dimensional epilepsy classification. In addition, a case is described which is classified using the four‐dimensional epilepsy classification with different degrees of precision by an emergency department physician, a neurologist, and an epileptologist. [Published with video sequences on www.epilepticdisorders.com ]     

Factors related to compliance with the COVID-19 health regulations among young people

The coronavirus pandemic has affected all facets of our lives and all ages and social strata worldwide. Measures have been taken to protect against the spread of the virus, such as more rigorous hand hygiene, the use of face masks and social distancing. However, the focus has often been on young people, who have been seen as a group lacking sufficient respect for government-imposed measures. This review outlines the preventive measures that have been taken in different countries and discusses their specific impact on young people and adolescents, taking into account the developmental stage and concrete needs of this age group. It summarizes those studies that have provided information on compliance with preventive measures by young people and adolescents, concluding that although compliance levels among this age group are lower than among older adults, the general view of youths as non-compliant is not consistent with real, objective data. The review also summarizes different views regarding the possible reasons for this lower level of compliance, taking into account both social (gender and age) and personal factors (personality, empathy, prosociality, self-control, cognitive styles and motivations), and discusses the practical implications of these findings for the future.     

Analysis of the Part Distortions for Inconel 718 SLM: A Case Study on the NIST Test Artifact

The present paper evaluates the misalignment and geometry distortion of the standard National Institute of Standards and Technology (NIST) test artifact in Inconel 718 alloy, when several layers with and without supports are employed to manufacture it by the Selective Laser Melting (SLM) process. To this end, a coordinate-measuring machine (CMM) is used to measure the geometrical distortion in each manufacturing configuration, following the same measurement protocol. The results show that the laser path strategy favors a thermal gradient which, consequently, induces geometrical distortions in the part. To prove this hypothesis, a numerical simulation is performed to determine the thermal gradient and the pattern of the residual stresses. It was found that the geometrical distortion certainly depends on the position of the feature position and laser strategy, where thermal cycles and residual thermal stresses had an impact in the end-part geometry, especially if a high strength-to-weight ratio commonly used in aeronautics is present.