Utility of risk scores to predict adverse events in cardiac lead extraction

Introduction: Increasing device implantations, patient comorbidities, and longer life expectancy contribute to an increased need for lead extraction. Even if transvenous lead extraction (TLE) is a highly successful procedure, some serious procedural complications are reported. In order to identify those patients who are at higher risk, risk stratification scores were proposed.

Areas covered: The major obstacles to lead extractions are represented by the body’s response to the foreign implanted material and by the following development of fibrotic reaction between the lead and the vascular system. Several clinical factors and device features are associated with major complications and worse outcomes. Although different multiparametric scores predicting the safety and the efficacy of TLE procedures were reported, none of these scores were prospective evaluated.

Expert commentary: A correct risk stratification is needed in order to refer complex patients to centers with proven experience and avoid futile procedures. Furthermore, the identification of high-risk patients allows to perform the extraction procedure in the operating room instead of electrophysiology lab. Albeit some risk scores able to predict adverse event in cardiac lead extraction were described, there are still several limitations to their use and reproducibility.     

米非司酮片配伍欧维婷软膏在绝经后妇女取环中的作用

目的 探讨米非司酮片配伍欧维婷软膏在绝经后妇女取环中的效果。方法 将300例绝经后要求取环的妇女随机分为欧维婷组(实验组一)、欧维婷配伍米非司酮组(实验组二)和米非司酮组(对照组)各100例。实验组一术前7d予以欧维婷软膏0.5g/d,睡前阴道上药;实验组二术前7d予以每日欧维婷软膏0.5g,睡前阴道上药,并于术前3d分别于每日6Am及18Pm各口服米非司酮25mg;对照组仅术前3d在每日6Am及18Pm各口服米非司酮25mg,观察3组术中宫颈软化情况、手术时间、取环成功率、疼痛程度、阴道出血量及药物副反应。结果欧维婷组和欧维婷配伍米非司酮组与单用米非司酮组相比在宫颈软化程度、取环成功率、手术时间、疼痛程度及药物副反应等均有显著性差异(P<0.05)。结论 欧维婷软膏配伍米非司酮片有协同增效作用,应用于绝经后妇女取环安全、有效,成功率高,是一种值得临床推广使用的方法。     

Punishing parents: Child removal in the context of drug use

New amendments to child welfare policy in New South Wales turn a spotlight on parents who use drugs and raise concerns about adequate provision of services for families facing issues with alcohol and other drug use. Sections of the new legislation are explicitly focused on parents who use illicit drugs, expanding the reach of child protection services over expectant parents during pregnancy. This targeting of women who are ‘addicted’ highlights the ambiguous scientific and moral attention to drug use in pregnancy. It also raises practical questions about the potential for the legislation to increase stigma towards drug use and disproportionately affect vulnerable and disadvantaged families. [Olsen A. Punishing parents: Child removal in the context of drug use. Drug Alcohol Rev 2015;34:27–30]     

2种方法治疗良性前列腺增生并电切镜进镜困难患者的比较

比较2种方法在治疗良性前列腺增生（BPH）行经尿道前列腺等离子电切术中电切镜置入困难患者的临床疗效。选择2007年9月至2014年1月曲靖市第二人民医院泌尿外科收治的BPH患者行经尿道前列腺等离子电切术中发现电切镜进镜困难患者90例,随机分成观察组和对照组,每组45例。观察组采用去除外鞘电切术联合耻骨上膀胱微穿刺负压引流治疗,对照组采用扩张尿道和（或）尿道外口剖开,再置入电切镜行电切术治疗。2组手术均取得成功,平均手术时间、出血量无显著性差异（P＞0。05）,观察组术后平均住院时间、继发尿道狭窄的发生率均小于对照组（分别为P＜0.05、P＜0.01）。去除外鞘电切术联合耻骨上膀胱微穿刺负压引流在治疗BPH并电切镜进镜困难患者可降低术后继发尿道狭窄发生率,减少术后住院时间,临床疗效较好。     

Effect of clot removal on cerebrovascular contraction after subarachnoid hemorrhage in the monkey: Pharmacological study

Summary Clot removal at early surgery has been reported to be clinically effective for the prevention of cerebral vasospasm following subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. We examined the most efficacious timing of mechanical clot removal on pharmacological responses in a monkey SAH model. Cynomolgus monkeys (Macaca fascicularis) were randomized into five groups: sham-operated, clot removal in which the clot was removed 48, 72, or 96h after SAH, and clot groups. An autologous blood clot was placed around the bilateral major cerebral arteries after craniectomy to mimic the hemorrhage. Seven days after the SAH, proximal and successively distal parts of the middle cerebral arteries were cut into rings for isometric tension measurement. The contractile responses to potassium chloride, 5-hydroxytryptamine, norepinephrine, adenosine triphosphate, prostaglandin F₂, and hemoglobin were greater in the proximal parts than in the distal parts in each group. Compared with the sham-operated group, the responses of the clot-removal and clot groups to the drugs were progressively attenuated. The maximum responses to 5-hydroxytryptamine in the proximal parts and to adenosine triphosphate in the distal parts started to decrease, significantly, in the clot-removal group 48h after SAH, while most of the responses to the other agonists began to decrease in the clot-removal groups later than 72h after SAH. These results suggest that the attenuation of cerebrovascular contractile responses 7 days after SAH is pharmacologically inevitable, even if the clot is removed as early as 48h after the SAH. Clot removal may thus be recommended within 48h after SAH to ameliorate the severity of cerebral vasospasm following SAH.     

Endovascular Treatment for Lower Extremity Deep Vein Thrombosis: An Overview

Lower extremity deep vein thrombosis (DVT) is a serious medical condition that can result in local pain and gait disturbance. DVT progression can also lead to death or major disability as a result of pulmonary embolism, postthrombotic syndrome, or limb amputation. However, early thrombus removal can rapidly relieve symptoms and prevent disease progression. Various endovascular procedures have been developed in the recent years to treat DVT, and endovascular treatment has been established as one of the major therapeutic methods to treat lower extremity DVT. However, the treatment of lower extremity DVT varies according to the disease duration, location of affected vessels, and the presence of symptoms. This article reviews and discusses effective endovascular treatment methods for lower extremity DVT.     

阴离子交换树脂除210Bi技术在90Sr分析中的应用

目的 为了克服现有分析标准推荐的硫化铋沉淀法除铋存在的弊端,提升分析结果质量。方法 基于201×7阴离子交换树脂设计了除铋实验流程,并通过加标样品和国际原子能机构（IAEA）国际比对样品分析予以验证。结果 采用阴离子交换树脂进行除铋。在锶、钇、铋去除实验中,锶和钇的化学回收率可分别达到（98.6±0.8）%和（98.5±0.7）%,且未发现有Bi₂S₃沉淀生成;在加标土壤分析中,所得到的分析结果与理论值的相对标准偏差为-2.97%~5.94%,优于标准除铋方法的3.96%~17.80%;采用IAEA国际比对样品进行验证,⁹⁰Sr的报出值与目标值的相对标准偏差介于3.40%~7.09%,结果均可接受。结论 阴离子交换树脂对铋能够实现很好的定量去除,同时不吸附锶和钇。另外,阴离子交换树脂的除铋溶液体系与⁹⁰Sr分析时的解吸体系相同,无需转换体系即可实现快速除铋的目的。与现行标准分析方法相比,基于阴离子交换树脂定量除铋是可行的且更优,能够满足⁹⁰Sr常规分析工作需求。     

Substantial regional differences in the biomechanical behavior of molar treated with selective caries tissue removal technique: a finite element study

ObjectivesSelective caries removal (SCR) is recommended over non-selective removal for managing deep carious lesions to avoid pulp exposure and maintain pulp vitality. During SCR, residual carious dentin is left behind and sealed beneath the restoration. The biomechanical effects of such residual lesions on the restored tooth remain unclear and were assessed using finite element modeling (FEM).MethodsBased on μ-CT images of a healthy permanent human third molar, we developed five finite element models. Generic class I and II cavity restorations were modeled where residual lesions of variable sizes were either left or fully removed on occlusal and proximal surfaces. The cavities were restored with adhesive composite. All 3D-FE models were compared with a model of a healthy, non-treated molar. A vertical load of 100 N was applied onto the occlusal surface.ResultsRegardless of the lesion size, in molars with occlusal lesions higher mean stresses were predicted along the filling-lesion interface than in all other models. The smallest occlusal lesion (Ø₁ = 1 mm) resulted in the highest maximum stresses at the filling-lesion interface with large stress concentrations at the filling walls indicating failure risk. In conclusion, lesion site and extent are influencing parameters affecting the filling-lesion interactions and thus the biomechanical behavior of the tooth after SCR.SignificanceRetaining carious lesions around the pulpal floor affects the deformation and stress states in tooth-filling complexes. The higher stresses observed in molars with occlusal lesions may affect restoration stability and longevity. Suprisingly, more extended occlusal lesions may provide a more favorable tooth performance than less extended ones. In contrast, in molars with proximal lesions the residual lesion had only limited effect on the tooth’s biomechanical condition.     

Cell surface engineering of microorganisms towards adsorption of heavy metals

Abstract

Heavy metal contamination has become a worldwide environmental concern due to its toxicity, non-degradability and food-chain bioaccumulation. Conventional physical and chemical treatment methods for heavy metal removal have disadvantages such as cost-intensiveness, incomplete removal, secondary pollution and the lack of metal specificity. Microbial biomass-based biosorption is one of the approaches gaining increasing attention because it is effective, cheap, and environmental friendly and can work well at low concentrations. To enhance the adsorption properties of microbial cells to heavy metal ions, the cell surface display of various metal-binding proteins/peptides have been performed using a cell surface engineering approach. The surface engineering of Gram-negative bacteria, Gram-positive bacteria and yeast towards the adsorption of heavy metals are reviewed in this article. The problems and future perspectives of this technology are discussed.     

Minimally invasive removal of a deep-positioned cannulated screw from the femoral neck: A case report

BACKGROUNDClinical femoral neck fracture is common. Based on patient age and fracture type, different surgical methods can be selected, including cannulated screw fixation of the femoral neck and artificial total hip joint or semi-hip joint replacement. When patients with femoral neck fracture are treated with cannulated screw fixation, a cannulated screw may be positioned too deep. The excessively deep-placed screw is difficult to remove and causes major trauma to the patient.CASE SUMMARYA patient with poliomyelitis and femoral neck fracture was treated with a cannulated screw that was placed too deep. A self-made auxiliary tool (made of a steel sternal wire) was used to remove the cannulated screw near the pelvic cavity.CONCLUSIONThe depth of the cannulated screw can be estimated before screw placement using an improved hollow screwdriver with a scale mark, thus improving the safety of screw placement and facilitating clinical use.