Unexpected inhibition of bradycardia pacing due to oversensing in ICD lead fracture associated with spurious tachyarrhythmia detection and discharges

Ιn a 76-year old man with a dual-chamber ICD implanted five years ago, dizzy spells and significant bradycardia on Holter were not initially recognized as inhibition of bradycardia pacing, due to oversensing. Hospital admission was deemed necessary only after repetitive ICD shocks attributed to right ventricular pace-sense lead fracture. The need to ensure adequate ICD antibradycardia backup pacing in pacing-dependent patients when deleterious sensing errors occur, cannot be overemphasized.     

Overcoming barriers to active interventions for genetic diversity

As a result of processes such as habitat loss and overharvest, many species persist in small, isolated populations that experience reduced fitness, decreased evolutionary potential, and increased extinction risk. The goal of species conservation is to restore genetic diversity and adaptive potential caused by isolation and small population size. For populations trapped in an extinction vortex, habitat protection may be inadequate for successful conservation. Alternative actions such as deliberate admixture by introducing individuals from related subspecies may be necessary to recover population fitness. While there is precedent for such actions, admixture temporarily disrupts the taxonomic integrity of a species. Concerns for the taxonomic integrity or “naturalness” of a species may prevent the use of active interventions that involve admixture and transient hybrid gene pools even though extinction may be imminent. We explore the cultural barriers to using tools such as genetic rescue and make suggestions for overcoming those barriers. We focus mainly on examples from animals, but the same evolutionary processes are ongoing in other life forms and are subject to the same cultural barriers.     

Overcoming obstacles to developing new analgesics

Despite substantial investment by the pharmaceutical industry over several decades, there has been little progress in developing new, efficacious and safe analgesics. As a result, many large pharmaceutical companies are leaving the area of pain medication. Nevertheless, the chances of success could increase if analgesic drug development strategy changed. To achieve such a paradigm shift we must understand why development of drugs for pain relief is so challenging.