A cracking complication: Displacement of existing clavicle fracture complicating subcutaneous implantable cardioverter defibrillator implantation

An 18 year old male with an incompletely healed clavicle fracture presented with unexplained syncope. Subsequent investigations were consistent with a diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). A subcutaneous implantable cardioverter-defibrillator (S-ICD) was successfully implanted and defibrillation threshold (DFT) testing performed as per standard protocol. Shortly following the procedure, the patient complained of pain and swelling over the left clavicle. A radiograph revealed aggravation and displacement of the underlying clavicle fracture. Surgical reduction and internal fixation was performed one week later.     

Azygos Vein Lead Implantation For High Defibrillation Thresholds In Implantable Cardioverter Defibrillator Placement

Evaluation of defibrillation threshold is a standard of care during implantation of implantable cardioverter defibrillator. High defibrillation thresholds are often encountered and pose a challenge to electrophysiologists to improve the defibrillation threshold. We describe a case series where defibrillation thresholds were improved after implanting a defibrillation lead in the azygos vein.     

Shoulder Joint Dislocation as an Unusual Complication of Defibrillation Threshold Testing Following Subcutaneous Implantable Cardioverter-Defibrillator Implantation

A 53-year-old man underwent implantation of a totally subcutaneous ICD (S-ICD; Boston Scientific). He was positioned supine, with the left arm abducted, externally rotated (i.e. palm up) and strapped to the arm extender. The generator was placed in the left mid-axillary line along the 5th-6th intercostal spaces and the defibrillation coil was tunneled anterior to the sternum. Defibrillation threshold (DFT) testing with 65 Jcaused a forceful pectoralis twitch. The patient woke up with a painful anteriorly dislocated left shoulder. Glenohumeral dislocation due to DFT testing has not been previously reported. It is likely that this complication is specific to the S-ICD implantation, and is related to positioning with the arm abducted, externally rotated, and immobilized, and use of greater defibrillation energy with current pathway through the bulk of the pectoralis muscle.Precautions may include extending the arm palm down, strapping the arm loosely, and adduction of the arm for DFT testing.     

Electromagnetic Interference in a Private Swimming Pool: Case report

Although current lead design and filtering capabilities have greatly improved, Electromagnetic Interference (EMI) from environmental sources has been increasingly reported in patients with Cardiac Implantable Electronic Device (CIED) [1]. Few cases of inappropriate intracardiac Cardioverter Defibrillator (ICD) associated with swimming pool has been described [2]. Here we present a case of 64 year old male who presented with an interesting EMI signal that was subsequently identified to be related to AC current leak in his swimming pool.     

A Novel Solution for the High Defibrillation Threshold in Patients with a DF-4 Lead: Adding a High Voltage Adaptor/Splitter

A high defibrillation threshold occurs in approximately 6% of implants. The defibrillation threshold can be improved by addition of a defibrillation lead. However, the DF-4 high energy ICD header precludes the addition of a defibrillation lead. Here we report on use of a new high voltage adaptor/splitter that enables the addition of an extra defibrillation lead.     

Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients: clinical considerations and the importance of shared decision-making

Netherlands Heart Journal - Implantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are...     

Atrial sensor,remote monitoring and new anticoagulant drugs: Identification and treatment of a patient with unknown and asymptomatic atrial flutter

This case report describes how new tools and technologies can drive a different approach in the management of arrhythmic patients. An unknown and asymptomatic atrial flutter was detected by the atrial sensor mounted in a single lead implantable cardioverter defibrillator. Moreover daily remote monitoring of the device allowed early notification and prompt clinical reaction. Anticoagulant therapy onset, radiofrequency ablation and the following anticoagulant therapy removal were driven by the device data transmissions.     

State of the art of ICD programming: Lessons learned and future directions

The lifesaving benefits of implantable cardioverter defibrillator (ICD) therapy are more and more weighted against possible harm (e.g. unnecessary device therapy, procedural complications, device malfunction etc.) which might have adverse effects on patients’ perceived health status and quality of life. Hence, there has been an increasing interest in the optimisation of ICD programming to prevent inappropriate and appropriate but unnecessary device therapy. The purpose of the current report is to give an overview of research into the optimisation of ICD programming and present the design of the on-going ENHANCED-ICD study. The ENHANCED-ICD study is a prospective, safety monitoring study enrolling 60 primary and secondary prophylactic ICD patients at the University Medical Center Utrecht. Patients implanted with any type of ICD with SmartShock technology^TM, and between 18–80 years of age, were eligible to participate. In all patients a prolonged detection of 60/80 intervals was programmed. The primary objective of the study is to investigate whether enhanced programming to further reduce ICD therapies is safe. The secondary objective is to examine the impact of enhanced programming on (i) antitachycardia pacing and shocks (both appropriate and inappropriate) and (ii) quality of life and distress. The first results of the ENHANCED-ICD study are expected in 2015.     

桃小食心虫的发育起点温度和有效积温

在17～29℃、RH80%±7%和光周期L:D=15:9的条件下,测定了桃小食心虫Carposina sasakii Matsumura各虫态的发育历期,计算了桃小食心虫卵、幼虫、蛹和全世代的发育起点温度和有效积温。结果表明,各虫态的发育历期随着温度的升高而缩短,各虫态的发育速率与温度之间具有良好的线性关系。桃小食心虫卵、幼虫、结茧前期、蛹及生殖前期的发育起点温度分别为10.02、9.44、10.58、10.09和9.51℃,有效积温分别为87.3、238.6、10.7、156.9和31.6日·度,全世代的发育起点温度和有效积温分别为9.22℃和543.2日·度。     

新疆葡萄斑叶蝉若虫的发育起点温度和有效积温

室内饲养观察表明 ,5月 1日从吐鲁番地区田间采集的葡萄斑叶蝉ZyginaapicalisNawa越冬代成虫存活时间长 ,室内饲养仍然可存活 45d以上 ;在适宜温度下 ,单雌繁殖后代 5 0～ 60头 ;在 1 9～ 3 1℃ 5个温度处理中 ,若虫发育历期在 1 2 6～ 2 1 1d之间 ;2 2～ 2 8℃是发育的适温范围 ,以 2 8℃为最佳发育温度。若虫发育起点温度为 5 2 ,有效积温为 3 0 7 1日·度。     

大鼠脊神经压迫后早期痛阈与神经损伤程度的联系

目的观察大鼠脊神经压迫后早期痛阈改变与神经损伤程度的联系。方法雄性SD大鼠32只,随机分为4组（每组n=8）：正常组,假手术组,70 g压迫组和180 g压迫组。正常组不作任何处理,作为对照,假手术组模型制作过程和其它两个模型组相同,但不做神经压迫,70 g压迫组和180 g压迫组分别用70 g或180 g血管夹压迫大鼠右侧颈7脊神经15 min,制作神经急性压迫损伤模型。于术前2 d和术后1、35、、7 d测右侧前足机械性痛阈和热痛阈,术后7 d处死大鼠取右侧颈7脊神经,HE染色病理分级和扫描电镜观察,比较各组痛阈改变以及神经损伤程度的变化。结果与术前相比较,正常组和假手术组术后机械性痛阈和热痛阈无明显变化（P〉0.05）;与术前以及正常组和假手术组相比,70 g压迫组术后1～7 d机械性痛阈和热痛阈明显降低（P〈0.05）,180 g压迫组术后1 d痛阈无明显变化（P〉0.05）,术后3～7 d明显升高（P〈0.05）。正常组和假手术组均未出现神经损伤病理变化,而70 g压迫组和180g压迫组出现不同程度的神经损伤,损伤病理分级180 g压迫组高于70 g压迫组（P〈0.05）。结论70 g或180 g血管夹压迫大鼠颈7脊神经后大鼠痛阈降低或升高,其机制可能与不同的压力导致不同的神经损伤程度有关。     

Threshold temperature and heat unit requirements for the development of the granary weevil,Sitophilus granarius (L.)

The objective of the present investigation was to determine the effects of temperature on the granary weevil, Sitophilus granarius L., in the laboratory so that forecasting models based on heat accumulation units could be developed for the pest. Development of S. granarius reared on wheat grains was studied at three constant temperatures (15, 20 and 25?°C) and relative humidity of 70?±?5%. The developmental time was significantly decreased with the increase in temperature. The developmental threshold temperatures estimated for egg, larva, pupa and from egg to adult were 7.79, 7.31, 14.08 and 9.97?°C, respectively. Based on these thresholds, the developmental stages, respectively, needed 92.75, 393.78, 45.04 and 562.36?day degrees to complete their development. Also, about nine generations were calculated for the pest per year under Assiut prevailing conditions. It seems that temperature of 25?°C is the most favourable developmental temperature.     

The meanings of weaning: Growth,lactation, and life history

Hooded seal pups are suckled for a total of four days; chimpanzees and elephants sometimes are suckled for as long as eight years. This enormous range suggests considerable diversity in reproductive strategies. Lactation represents early maternal effort, whereas weaning is the infant's transition to nutritional independence. Weaning behavior is thus important from two interconnected perspectives: that of the infant during this transition and that of the mother with the cessation of lactation and the resumption of her reproductive capacity. What controls such diversity in the duration of lactation? What are the consequences of this diversity for mothers in terms of reproduction and for infants in terms of their growth and survival? How are differences in lactation reflected in behavioral interactions? The answers to these questions involve consideration of weaning and growth, and have implications for life histories.     

Magnetic Resonance Imaging Conditional Pacemakers: Rationale, Development and Future Directions

Pacemakers and other cardiac implantable electronic devices (CIEDs) have long been considered an absolute contraindication to magnetic resonance imaging (MRI), a crucial and growing imaging modality. In the last 20 years, protocols have been developed to allow MR scanning of CIED patients with a low complication rate. However, this practice has remained limited to a relatively small number of centers, and many pacemaker patients continue to be denied access to clinically indicated imaging. The introduction of MRI conditional pacemakers has provided a widely applicable and satisfactory solution to this problem. Here, the interactions of pacemakers with the MR environment, the results of MR scanning in patients with conventional CIEDs, the development and clinical experience with MRI conditional devices, and future directions are reviewed.     

Sulfur Solutions: Advancing High Voltage and High Energy Lithium Batteries with Organosulfur Electrolytes

Achieving energy densities exceeding 350 Wh kg⁻¹ while operating at elevated voltages (>4.5 V vs Li/Li⁺) is attainable through judicious selection of electrochemical pairs at the cathode and anode. However, current state-of-the-art electrolytes exhibit limited stability when exposed to systems operating at or above 4.3 V. This limitation contributes to the degradation of electrode materials and raises critical safety concerns, impeding the commercialization of such systems. Consequently, there has been a notable surge in research efforts aimed at developing innovative electrolyte compositions capable of supporting high-voltage lithium-ion batteries (LIBs). A substantial portion of this research has focused on the family of organosulfur molecules, which possess high oxidative stability. Organosulfur salts also facilitate the formation of dense, ionically conductive solid electrolyte interfaces (SEI) and demonstrate excellent solubility. This article provides a comprehensive overview of the field of organosulfur electrolyte components for their applications in energy storage, encompassing solvents, alternative conducting salts, and additives. It emphasizes the idea that the deliberate design of electrolyte compositions is instrumental in controlling electrode passivation, with organosulfur-based structures historically proving advantageous in every aspect of the electrolyte. Crucially, it should be noted that many of these components are commercially available, holding significant implications for industrial applications.     

建立NGAL诊断阈值有利于临床判断和发现急性肾功能损伤

为探讨中性粒细胞相关载脂蛋白(neutrophil gelatinase-associated lipocalin, NGAL)检测在肝胆疾病患者继发急性肾功能损伤(acute kidney injury, AKI)中的诊断性能,本研究回顾性收集了476例肝胆疾病患者与225例健康受试者作为实验组,根据血清中性粒细胞相关载脂蛋白(NGAL)、血清肌酐(serum creatinine,s Cr)、尿素(Urea)、半胱氨酸蛋白酶抑制剂C (cystatin C, CysC)、估算肾小球滤过率(estimating glomerular filtration rate, eGFR)水平和尿量,分为急性肾功能损伤(AKI)组和高风险(high-risk, HR)组、低风险(low-risk,LR)组和对照(health control, HC)组,进而建立上述血清指标在急性肾功能损伤(AKI)诊断性能最大时的判断界值;随后,选取145例肝胆疾病患者作为验证组,以评估各观察指标对肝胆疾病继发急性肾功能损伤(AKI)的诊断性能。结果表明:本实验组中各亚组间所观察指标之血清水平均有统计学差异(p<0.05)。中性粒细胞相关载脂蛋白(NGAL)诊断性能最大时的判断界值为205.2μg/L。验证组患者各指标阳性检出率,在低风险(LR)亚组中中性粒细胞相关载脂蛋白(NGAL)均高于其它指标(p<0.05),但在高风险(HR)亚组中中性粒细胞相关载脂蛋白(NGAL)仅高于血清肌酐(sCr)(p<0.05),而与半胱氨酸蛋白酶抑制剂C (CysC)和估算肾小球滤过率(eGFR)无统计学差异(p>0.05);再经分层风险分析各指标预测高风险(HR)亚组患者急性肾功能损伤(AKI)发生的能力,中性粒细胞相关载脂蛋白(NGAL)的优势比(OR=21.0 (2.3, 192.8)),是半胱氨酸蛋白酶抑制剂C(CysC)或估算肾小球滤过率(eGFR)(OR (95%CI)=3.3 (0.7, 15.3))的6.4倍。本研究初步结论表明,肝胆疾病患者诊断急性肾功能损伤(AKI)时应考虑中性粒细胞相关载脂蛋白(NGAL)肝脏合成代谢的作用。因此实验室应建立适宜的中性粒细胞相关载脂蛋白(NGAL)诊断阈值以有利于临床准确判断及早期发现急性肾功能损伤(AKI)。     

The Hsp90 Capacitor,Developmental Remodeling,and Evolution: The Robustness of Gene Networks and the Curious Evolvability of Metamorphosis

ABSTRACT

Genetic capacitors moderate expression of heritable variation and provide a novel mechanism for rapid evolution. The prototypic genetic capacitor, Hsp90, interfaces stress responses, developmental networks, trait thresholds and expression of wide-ranging morphological changes in Drosophila and other organisms. The Hsp90 capacitor hypothesis, that stress-sensitive storage and release of genetic variation through Hsp90 facilitates adaptive evolution in unpredictable environments, has been challenged by the belief that Hsp90-buffered variation is unconditionally deleterious. Here we review recent results supporting the Hsp90 capacitor hypothesis, highlighting the heritability, selectability, and potential evolvability of Hsp90-buffered traits. Despite a surprising bias toward morphological novelty and typically invariable quantitative traits, Hsp90-buffered changes are remarkably modular, and can be selected to high frequency independent of the expected negative side-effects or obvious correlated changes in other, unselected traits. Recent dissection of cryptic signal transduction variation involved in one Hsp90-buffered trait reveals potentially dozens of normally silent polymorphisms embedded in cell cycle, differentiation and growth control networks. Reduced function of Hsp90 substrates during environmental stress would destabilize robust developmental processes, relieve developmental constraints and plausibly enables genetic network remodeling by abundant cryptic alleles. We speculate that morphological transitions controlled by Hsp90 may fuel the incredible evolutionary lability of metazoan life-cycles.     

Magnetic resonance imaging,pacemakers and implantable cardioverter-defibrillators: current situation and clinical perspective

New developments and expanding indications have resulted in a significant increase in the number of patients with pacemakers and internal cardioverterdefibrillators (ICDs). Because of its unique capabilities, magnetic resonance imaging (MRI) has become one of the most important imaging modalities for evaluation of the central nervous system, tumours, musculoskeletal disorders and some cardiovascular diseases. As a consequence of these developments, an increasing number of patients with implanted devices meet the standard indications for MRI examination. Due to the presence of potential life-threatening risks and interactions, however, pacemakers and ICDs are currently not approved by the Food and Drug Administration (FDA) for use in an MRI scanner. Despite these limitations and restrictions, a limited but still growing number of studies reporting on the effects and safety issues of MRI and implanted devices have been published. Because physicians will be increasingly confronted with the issue of MRI in patients with implanted devices, this overview is given. The effects of MRI on an implanted pacemaker and/or ICDs and vice versa are described and, based on the current literature, a strategy for safe performance of MRI in these patients is proposed. (Neth Heart J 2010;18:31-7.)