Pacemaker Electrode Repositioning Using the Loop-Snare Technique

Using a percutaneous femoral vein approach under fluoroscopic control, a malpositioned ventricular pacemaker electrode was released from the right ventricular wall by hooking the lead with a deflecting wire inserted into a RIM catheter. A closed loop was formed by tightening the handle of the wire allowing the electrode to be dislodged and pulled into the inferior vena cava. The electrode was then snared using a loop formed by an exchange wire advanced through an 8 French catheter with a J-curve steamed at its tip. The electrode was advanced to the right ventricular apex and released by advancing one end of the snare wire while pulling the other end to open the loop.     

What makes a good head positioner for preventing occipital pressure ulcers

Patients who are stationary endure prolonged soft tissue distortions and deformations at contact areas between their body and the support surface, which may lead to the onset of pressure ulcers (PUs) over time. A novel technology for patient positioning employs innovation in materials science, specifically viscoelastic materials with shape memory properties that compose the Z‐Flo™ head positioner (Mölnlycke Health Care, Gothenburg, Sweden). Head positioners are generally known to reduce the occurrence of PUs in scalp tissues and the ears, but quantitative assessments of their biomechanical efficacy are missing in the literature. To determine potential differences in mechanical loads formed in the soft tissues of the back of the head while in contact with 2 head positioner types, Z‐Flo vs flat medical foam, we developed 2 comparable finite element model configurations, both including the same 3‐dimensional adult head. For both model variants, stresses in skin and fat peaked at the occiput. The skin at the back of the resting head is subjected to greater stress values with respect to fat; however, the Z‐Flo positioner reduced the exposure of both skin and fat tissues to elevated stresses considerably (by a factor of 3) compared to the medical foam support. We found the Z‐Flo device effective in reducing tissue loads at the surface of the head as well as internally in scalp tissues, with a particular strength in reducing internal tissue shear. The Z‐Flo device achieves this protective quality through highly effective immersion and envelopment of the back of the head, generated in the process of manual moulding of the device in preparation for use. Additional protection is achieved through the viscoelastic response of the filling material of this positioner, which relaxes promptly and considerably under the weight of the head (by more than 2‐fold within approximately 1 s) as opposed to the elastic recoil of the foam that pushes back on scalp tissues.     

颗粒复位法治疗20例后半规管良性发作性位置性眩晕

目的：探讨颗粒复位法对后半规管耳石引起的良性发作性位置性眩晕的治疗效果。方法：对20例急诊确诊为后半规管性良性发作性位置性眩晕的患者行颗粒复位法治疗。结果：经1次颗粒复位法治疗后，16例患者症状消失，首次治疗有效率为80％，2例经2次，1例经3次该手法治疗有效，总有效率为95％。经随访，1例复发，复发者再行颗粒复位法治疗仍有效。结论：颗粒复位法治疗后半规管良性发作性位置性眩晕简单、安全、经济、有效。     

Drug repurposing to treat asthma and allergic disorders: Progress and prospects

Allergy and atopic asthma have continued to become more prevalent in modern society despite the advent of new treatments, representing a major global health problem. Common medications such as antihistamines and steroids can have undesirable long‐term side‐effects and lack efficacy in some resistant patients. Biologic medications are increasingly given to treatment‐resistant patients, but they can represent high costs, complex dosing and management, and are not widely available around the world. The field needs new, cheap, and convenient treatment options in order to bring better symptom relief to patients. Beyond continued research and development of new drugs, a focus on drug repurposing could alleviate this problem by repositioning effective and safe small‐molecule drugs from other fields of medicine and applying them toward the treatment for asthma and allergy. Herein, preclinical models, case reports, and clinical trials of drug repurposing efficacy in allergic disease are reviewed. Novel drugs are also proposed for repositioning based on their mechanism of action to treat asthma and allergy. Overall, drug repurposing could become increasingly important as a way of advancing allergy and atopic asthma therapy, filling a need in treatment of patients today.     

Predictors of long-term effectiveness to mandibular repositioning device treatment in obstructive sleep apnea patients after 1000 days

Objective/backgroundIn obstructive sleep apnea (OSA), long-term adherence to treatment is crucial. This prospective single-center study investigated factors associated with long-term adherence to mandibular repositioning device (MRD) therapy.Patients/methodsAll OSA patients who had MRD treatment initiated in the previous year were prospectively contacted to evaluate long-term effectiveness and compliance. Long-term adherence was based on continuation of treatment (yes/no). Predictors of long-term adherence were analyzed using an adjusted multivariate analysis.ResultsMedian follow-up was 1002 days (interquartile range: 668–1345) in 279 patients (age 58 [50–64] years); 63% of patients were continuing MRD treatment with a good efficacy, tolerability and compliance over time. In some patients, relapse of nocturia was observed while efficacy was maintained for snoring and somnolence. In adjusted multivariate analysis, significant predictors of continuing MRD treatment were early ≥50% reduction in AHI (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.466–5.10; p = 0.0002) and complete symptom resolution (OR 3.83, 95% CI 1.74–8.48; p = 0.0014). In the 37% of patients who stopped MRD treatment, median treatment duration was 351 (174–752) days. The main reasons for late stopping of treatment were inefficacy (26.2%), discomfort (25.2%) and side effects (21.4%).ConclusionsAfter three years, MRD was effective for the two-thirds of OSA patients who continued treatment. Relapse of nocturia might be an early signal of MRD wear that may explain long-term cessation of treatment in some patients. Short-term control of OSA by MAD was predictive of long-term efficiency. The major criteria were a ≥50% reduction in AHI and complete symptom resolution at short-term evaluation.     

肱骨髁上骨折的两种治疗方法

目的探讨切开复位克氏针内固定和手法复位外固定两种方法对肱骨髁上骨折的治疗方法和疗效,并进行对比。方法选择本院确诊收治的住院肱骨髁上骨折患者60例随机分为两组,研究组（30例）行切开复位克氏针内固定,对照组（30例）行手法复位外固定。术后随访1-3个月,对比两组患者的手功能恢复情况。结果治疗后两组患者相比,研究组UCLA功能评分和美国肩肘外科医师评分均优于对照组,统计学差异有意义（P〈0.05）。结论两种方法相比,切开复位克氏针内固定治疗可对肱骨髁上骨折复位产生较好效果,但应注意其正确的治疗的手术经验及术后规范的功能康复锻炼。     

Identification of FDA-approved Drugs that Computationally Bind to MDM2

The integrity of the p53 tumor suppressor pathway is compromised in the majority of cancers. In 7% of cancers p53 is inactivated by abnormally high levels of MDM2 - an E3 ubiquitin ligase that polyubiquitinates p53, marking it for degradation. MDM2 engages p53 through its hydrophobic cleft, and blockage of that cleft by small molecules can re-establish p53 activity. Small molecule MDM2 inhibitors have been developed, but there is likely to be a high cost and long time period before effective drugs reach the market. An alternative is to repurpose FDA-approved drugs. This report describes a new approach, called Computational Conformer Selection, to screen for compounds that potentially inhibit MDM2. This screen was used to computationally generate up to 600 conformers of 3244 FDA-approved drugs. Drug conformer similarities to 41 computationally-generated conformers of MDM2 inhibitor nutlin 3a were ranked by shape and charge distribution. Quantification of similarities by Tanimoto combo scoring resulted in scores that ranged from 0.142 to 0.802. In silico docking of drugs to MDM2 was used to calculate binding energies and to visualize contacts between the top-ranking drugs and the MDM2 hydrophobic cleft. We present 15 FDA-approved drugs predicted to inhibit p53/MDM2 interaction.     

中药内服外治结合手法治疗神经根型颈椎病临床观察

目的:观察中药内服外治结合手法治疗神经根型颈椎病的临床疗效。方法:将80例神经根型颈椎病患者随机分为治疗组与对照组各40例,治疗组予中药内服外治(熏洗治疗)并结合手法治疗;对照组予颈椎牵引及口服扶他林肠溶片(双氯芬酸纳缓释片),两组均以2周为1个疗程,比较两组疗效。结果:治疗组治愈11例,好转28例,无效1例;对照组治愈7例,好转22例,无效11例;两组疗效经统计学处理P<0.01,差异有统计学意义。结论:中药内服外治结合手法治疗神经根型颈椎病是有效的方法。