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1.
Zhonghua Yan Ke Za Zhi ; 56(10): 730-734, 2020 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-33059417

RESUMO

Keratoprosthesis implantation as an effective therapeutic method has been a treatment strategy in end-stage corneal blindness, contributing to restore vision and reduce the prevalence of blindness, but it has been restricted because of its high surgical technique and devastating complications. There are a large number of patients with corneal blindness in China, and the rate of high-risk or end-stage corneal blindness is high. It is of great significance to improve the understanding of the indications and contraindications of different kinds of keratoprostheses, as well as relevant technologies and knowledge, cope with the problems and challenges in the development period, and conduct safe and efficient clinical applications and related research, so that the technology of keratoprosthesis implantation in our country can go to the world steadily. (Chin J Ophthalmol, 2020, 56: 730-734).


Assuntos
Doenças da Córnea , China , Córnea/cirurgia , Doenças da Córnea/cirurgia , Humanos , Próteses e Implantes , Implantação de Prótese
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4753-4757, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019053

RESUMO

Sonomyography (ultrasound imaging) offers a way of classifying complex muscle activity and configuration, with higher SNR and lower hardware requirements than sEMG, using various supervised learning algorithms. The physiological image obtained from an ultrasound probe can be used to train a classification algorithm which can run on real time ultrasound images. The predicted values can then be mapped onto assistive or teleoperated robots. This paper describes the classification of ultrasound information and its subsequent mapping onto a soft robotic gripper as a step toward direct synergy control. Support Vector Classification algorithm has been used to classify ultrasound information into a set of defined states: open, closed, pinch and hook grasps. Once the model was trained with the ultrasound image data, real time input from the forearm was used to predict these states. The final predicted state output then set joint stiffnesses in the soft actuators, changing their interactions or synergies, to obtain the corresponding soft robotic gripper states. Data collection was carried out on five different test subjects for eight trials each. An average accuracy percentage of 93% was obtained averaged over all data. This real-time ultrasound-based control of a soft robotic gripper constitutes a promising step toward intuitive and robust biosignal-based control methods for robots.


Assuntos
Membros Artificiais , Robótica , Algoritmos , Força da Mão , Implantação de Prótese
3.
Vestn Oftalmol ; 136(6): 19-25, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33084275

RESUMO

Palpebral eyelid weight implants are currently considered as the gold standard method for lagophthalmos correction. Manufactured from different precious metals, they have both benefits and drawbacks. The article presents the results of an experimental morphological study of biointegration of different eyelid weight implants used for correction of paralytic lagophthalmos. PURPOSE: To investigate biointegration properties of implants made of gold, platinum and platinum-gold alloy. MATERIAL AND METHODS: The study enrolled 4 Chinchilla rabbits (8 eyelids). Palpebral implants manufactured of gold, platinum and platinum-gold alloy were placed into the eyelids of the experimental animals. The morphological examination was performed 1 and 6 months after the implantation using paraffin sections. RESULTS: Light microscopy revealed that the implant beds were surrounded by pronounced fibrovascular capsule of uneven thickness over the whole follow-up. The capsule formed after the placement of an implant made of gold and platinum alloy was more loose. However, the emerging connective tissue bridges of the capsule contributed to its immobilization in the tissues and lower risk of extrusion. No signs of an inflammatory and/or allergic reaction were observed in any of the cases. CONCLUSION: The obtained results show that implants made of a 90/10% platinum-gold alloy and 999.9 fine platinum have similar biointegration in terms of morphological features during 6 months of the follow-up period.


Assuntos
Doenças Palpebrais , Paralisia Facial , Animais , Doenças Palpebrais/etiologia , Doenças Palpebrais/cirurgia , Pálpebras/cirurgia , Paralisia Facial/cirurgia , Próteses e Implantes , Implantação de Prótese , Coelhos
4.
J Med Life ; 13(3): 336-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072205

RESUMO

Implant-prosthetic rehabilitation registers multiple variants, but their short- and long-term evolution has been a frequent concern. This study aimed to evaluate the peri-implant bone resorption at the level of the tilted implants in the SKY fast & fixed restorations, with reference to clinical and treatment parameters. An observational study was conducted on a convenience sample of patients with implant-prosthetic rehabilitation in one or both jaws, according to the SKY fast & fixed protocol (Bredent, Germany). Bone resorption was assessed on panoramic radiography. Other data were collected from the patient's medical records. Thirty tilted implants were analyzed, 12 of which were in the maxilla and 18 in the mandible. After the follow-up period, both bone resorption (maximum 7 mm) and bone apposition (maximum 8 mm) were observed. There was a tendency for the resorption to be more pronounced in the mandible, in patients where tooth loss was due to periodontal disease, and when implants with length less than 16 mm were used. Resorption was statistically significantly lower when bone addition materials and membranes were used at the extraction socket, and when SKY fast & fixed rehabilitation was performed in both jaws. SKY fast & fixed implant-prosthetic technique, which involves applying a small number of implants, and a fixed prosthesis corresponding to a shortened dental arch, is a viable method of treatment that outcomes the need for complex and expensive surgical interventions, and proves to be beneficial in maintaining the optimal parameters of bone support.


Assuntos
Reabsorção Óssea/etiologia , Próteses e Implantes/efeitos adversos , Implantação de Prótese , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade
5.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(5): 964-970, 2020 Oct 18.
Artigo em Chinês | MEDLINE | ID: mdl-33047738

RESUMO

OBJECTIVE: To evaluate the digital workflow coupling conic retention for the immediate restoration of adjacent posterior implants. METHODS: The patients with adjacent teeth missing in the posterior jaw seeking for implant restoration in the Department of Implantology, Peking University School and Hospital of Stomatology from March, 2017 to February, 2018 were recruited. After implant placement and commercial conic retention coping delivery, the patient had an intraoral scan for digital impression, and the computer-assisted design/computer-assisted manufacturing (CAD/CAM) technology was used for the fabrication of the immediate splinted prosthesis, which was made of polymethyl methacrylate (PMMA) and loaded immediately after delivery. Six months later, all the temporary prostheses were replaced by the permanent ones made of monolithic zirconia with CAD/CAM technology as well. The parallel periapical films were taken for the temporary and permanent prostheses post-delivery. The clinical effect of this workflow was evaluated by indices including the survival rates of implants and prostheses, the change of marginal bone level, and the implant-related and prosthesis-related complications; before the final restoration, the Visual Analogue Score (VAS) was used to evaluate the satisfaction of the patients. RESULTS: Ten patients (4 males and 6 females, 55.5 years old for average) were recruited. Totally 34 implants were placed; 14 prostheses were fabricated, temporary and permanent, respectively. After an observation period from 4 to 14 months, the survival rate for implants and prostheses were both 100%; the marginal bone level of the implants were (1.06±0.97) mm and (0.96±0.82) mm, immediate post-operation and 6 months later, respectively. The difference was not statistically significant (P>0.05). Neither implant- nor prostheses- related complications were observed. And the VAS of the patients' satisfaction was 87.2. CONCLUSION: For the adjacent posterior implants, the immediate prostheses manufactured by digital workflow, coupling conic retention, were clinically feasible and patient-satisfactory.


Assuntos
Desenho Assistido por Computador , Fluxo de Trabalho , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Próteses e Implantes , Implantação de Prótese
6.
Medicine (Baltimore) ; 99(33): e21729, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872056

RESUMO

To evaluate the safety and efficacy [intraocular pressure (IOP)-lowering effect and medication use] of a single trabecular microbypass stent (iStent; Glaukos Corp, San Clemente, CA) for medically controlled open-angle glaucoma.This retrospective case series included 42 eyes of 34 patients with medically controlled open-angle glaucoma with IOP less than 21 mm Hg. Clinical outcomes analyzed were IOP, medication use, corrected distance visual acuity (CDVA), and surgical complications. Surgical success was defined according to 4 criteria: IOP < 21 mm Hg without medication; IOP < 18 mm Hg without medication; IOP < 15 mm Hg without medications; and IOP < 18 mm Hg with or without medication. Patients were followed for a minimum of 6 months postoperatively.Mean IOP was reduced from 15.8 ±â€Š2.8 mm Hg to 14.5 ±â€Š2.8 mm Hg (P < .001), while mean number of medications decreased from 2.2 ±â€Š1.2 to 0.8 ±â€Š1.1 at final visit (P < .001). Surgical success rates were 78.6%, 61.9%, 57.1%, and 97.6% at 6 months and 78.6%, 59.5%, 52.4%, and 95.2% at final visits according to criteria A, B, C, and D. Meanwhile, 59.5% of patients were medication-free at their final visit. The relative risk of surgical failure by Criteria B and C was 4.337 (95% confidence interval: 1.799-10.454) and 3.717 (95% confidence interval: 1.516-9.116) times greater in the higher-medication group (3 or more preoperative medications), respectively. CDVA was significantly improved from 0.41 ±â€Š0.10 to 0.09 ±â€Š0.07 LogMAR in the combined phacoemulsification and iStent implantation group (P < .001). There was no case whose vision was threatened (vision loss of 2 or more lines) or who showed severe complications after surgery.Single trabecular microbypass stent implantation was effective in reducing IOP and medication usage in patients with open-angle glaucoma with a low preoperative IOP. Our results imply that it is more difficult to achieve low target IOP control in eyes with higher numbers of preoperative medications.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Idoso , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Pressão Intraocular , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese/instrumentação , República da Coreia/epidemiologia , Estudos Retrospectivos , Stents , Acuidade Visual
7.
Khirurgiia (Mosk) ; (8): 17-22, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869610

RESUMO

OBJECTIVE: To evaluate the effectiveness of surgical treatment of post-burn defects of face and cranial vault. MATERIAL AND METHODS: There were 65 patients with post-burn defects of face and cranial vault. Mean age of patients was 38.5 years (min 17 years, max 67 years). Soft tissue reconstruction was performed by using of local tissues, combined plasty, balloon dermotension aand free flaps on microvascular anastomoses. Osteoectomy and sequestrectomy were carried out if it was necessary. Implants were used to eliminate through skull defects. RESULTS: Balloon dermotension with expanders and plasty with local tissues ensure skull reconstruction in the vast majority of patients. Through bone defects required reconstruction of the cranial vault with various implants. CONCLUSION: The proposed surgical approach ensures correction of severe functional and cosmetic disorders caused by post-burn skull defects, elimination of bone damage, restoration of normal skin of the face and cranial vault.


Assuntos
Queimaduras/cirurgia , Traumatismos Craniocerebrais/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Adolescente , Adulto , Idoso , Queimaduras/complicações , Traumatismos Craniocerebrais/etiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/cirurgia , Retalhos de Tecido Biológico , Humanos , Microcirurgia , Pessoa de Meia-Idade , Implantação de Prótese , Estudos Retrospectivos , Crânio/lesões , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/cirurgia , Adulto Jovem
8.
Ann Surg ; 272(5): 696-702, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32889869

RESUMO

OBJECTIVE: The aim of this study was to compare the efficacy and safety of 12-month implantation of a duodeno-jejunal bypass liner (DJBL) with conventional medical care in patients with metabolic syndrome (MS). SUMMARY BACKGROUND DATA: DJBL is an endoscopic device for treating obesity and related disorders. The persistence of favorable results after 6 months has not been tested in a controlled study. METHODS: We conducted a multicenter randomized controlled trial, stratified by center and diabetes status. The primary endpoint was the remission of MS at 12 months. The secondary endpoints included body mass index (BMI), glucose control, blood pressure, and lipids, assessed at 12 months after implantation, and again, at 12 months after the removal of the DJBL. Up to 174 subjects were planned to be randomized into either the DJBL or the control arm at a 2:1 ratio, respectively. Study enrollment was discontinued by the Scientific Monitoring Committee due to the early termination of the ENDO trial (NCT01728116) by the US Food and Drug Administration. The study was terminated after withdrawal of the device's European Conformity marking by the European Medicines Agency, and an interim analysis was performed. RESULTS: A total of 82 patients were enrolled (67.5% female, 48.8% with diabetes). At 12 months after randomization, the primary endpoint was met in 6 (12%) DJBL patients and 3 (10%) controls (P = 0.72). Patients in the DJBL group experienced greater BMI loss [mean adjusted difference (95% confidence interval, CI) -3.1 kg/m (-4.4 to -1.9) kg/m, P < 0.001] and HbA1c change [mean adjusted difference -0.5% (95% CI -0.9 to -0.2); P < 0.001] than those in the control group. No difference remained statistically significant at 12 months after the removal of the DJBL. In the DJBL group, 39% of patients experienced at least one device-related serious adverse event, which was classified as Grade III Dindo-Clavien in 22%, and required premature device explantation in 16%. CONCLUSIONS: The present study showed a transient clinical benefit of DJBL, which was only apparent at 1 year, when the device was still in situ, and was obtained at the risk of serious device-related adverse events in 39% of patients. These results do not support the routine use of DJBL for weight loss and glucose control in patients with MS.


Assuntos
Cirurgia Bariátrica/instrumentação , Duodeno/cirurgia , Jejuno/cirurgia , Síndrome Metabólica/cirurgia , Próteses e Implantes , Endoscopia Gastrointestinal , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Implantação de Prótese , Indução de Remissão , Perda de Peso
9.
J Otolaryngol Head Neck Surg ; 49(1): 59, 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32778168

RESUMO

With the COVID-19 pandemic, there has been significant changes and challenges in the management of oncology patients. One of the major strategies to reduce transmission of the virus between patients and healthcare workers is deferral of follow-up visits. However, deferral may not be possible in total laryngectomy patients. Urgent procedures may be necessary to prevent complications related to ill-fitting tracheoesophageal puncture (TEP) voice prostheses, such as aspiration or loss of voicing. In this paper, we describe the Princess Margaret Cancer Center's approach to managing this unique patient population.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Neoplasias Laríngeas/cirurgia , Laringectomia/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico , Laringectomia/métodos , Laringe Artificial , Masculino , Ontário , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Implantação de Prótese/métodos , Implantação de Prótese/estatística & dados numéricos , Medição de Risco
10.
J Card Surg ; 35(10): 2825-2828, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32789877

RESUMO

Infectious complications following left ventricular assist device implantation can carry significant morbidity and mortality. The main tenet of treatment is source control which entails local wound care, intravenous antimicrobial therapy, surgical debridement, and at times, soft tissue flap coverage. The mode of therapy depends on the severity, etiology, and location of infection as well as the clinical status of the patient. We describe a case of a 46-year-old male who underwent left ventricular assist device placement complicated by pump thrombosis, recurrent infection, and hardware exposure who was successfully treated with a novel method of staged, soft tissue reconstruction.


Assuntos
Antibacterianos/administração & dosagem , Coração Auxiliar/efeitos adversos , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Retalhos Cirúrgicos , Tecido Conjuntivo/cirurgia , Desbridamento , Formas de Dosagem , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Resultado do Tratamento
11.
PLoS One ; 15(8): e0237616, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790803

RESUMO

Patients with large iris defects not only suffer from functional disadvantages but also from aesthetic limitations. The aim of this study was to evaluate the aesthetic outcome of iris reconstruction using an artificial iris (AI). In this study, 82 eyes of 79 consecutive patients with mostly traumatic partial or total aniridia that underwent iris reconstruction surgery using a custom-made silicone AI (HumanOptics, Erlangen, Germany). Pre- and postoperative photographs of 66 patients were analysed subjectively and objectively. Subjective evaluation was based questionnaires. Objective evaluation included measurement of pupil centration and iris colour analysis. Averaged hues from iris areas were transferred to numerical values using the LAB-colour-system. Single parameters and overall difference value (ΔE) were compared between AI and remaining iris (RI), as well as AI and fellow eye iris (FI). Patients, eye doctors and laymen rated the overall aesthetic outcome with 8.9 ±1.4, 7.7 ±1.1 and 7.3 ±1.1 out of 10 points, respectively. Mean AI decentration was 0.35 ±0.24 mm. Better pupil centration correlated with a higher overall score for aesthetic outcome (p<0.05). The AI was on average 4.65 ±10 points brighter than RI and FI. Aniridia treatment using a custom-made artificial iris prosthesis offers a good aesthetic outcome. Pupil centration was a key factor that correlated with the amount of aesthetic satisfaction. The AI was on average slightly brighter than the RI and FI.


Assuntos
Aniridia/terapia , Órgãos Artificiais/estatística & dados numéricos , Iris/cirurgia , Implantação de Prótese , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Am J Cardiol ; 128: 113-119, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650903

RESUMO

The Center for Medicare & Medicaid Services has identified readmission as an important quality metric in assessing hospital performance and value of care. The aim of this study was to quantify the impact of "care fragmentation" on transcatheter aortic valve implantation (TAVI) outcomes. Readmission to nonindex hospitals was defined as any hospital other than the hospital where the TAVI was performed. In this multicenter, population-based, nationally representative study, a nationally weighted cohort of US adult patients who underwent TAVI in the National Readmission Database between 01/01/2010 and 9/31/2015 were analyzed. Patient characteristics, trends, and outcomes after 90-day nonindex readmission were evaluated. Thirty-day metric was used as a reference group for comparison. A weighted total of 51,092 patients met inclusion criteria. Overall, the 90-day readmission rate after TAVI was 27.6% (30-day reference group: 17.4%), and 42% of these readmissions were to nonindex hospitals. Noncardiac causes accounted for most nonindex readmissions, but major cardiac procedures were more likely performed at index hospitals during readmission within 90 days. Despite the high co-morbidity burden of patients readmitted to nonindex hospitals, unadjusted and risk-adjusted all-cause mortality, readmission length of stay and total hospital costs following nonindex readmission were lower compared with index readmission at 90 days. In conclusion, in this real world, nationally representative cohort of TAVI patients in the United States, care fragmentation remains prevalent and represent an enduring, residual target for future health policies. Although the impactful readmissions may be directed toward index hospitals, concerted efforts are needed to address mechanisms that increase care fragmentation.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/estatística & dados numéricos , Centers for Medicare and Medicaid Services, U.S. , Comorbidade , Angiografia Coronária/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Pneumopatias/epidemiologia , Masculino , Análise Multivariada , Marca-Passo Artificial , Readmissão do Paciente/tendências , Pericardiocentese/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
13.
Am J Cardiol ; 128: 16-27, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650911

RESUMO

Left ventricular assist devices (LVADs) use in treatment of stage D heart failure (HF) has evolved and expanded in the past decade. There is paucity of data on LVAD utilization in patients with age ≥65 years with multiple co-morbidities. We aimed to investigate utilization trends, outcomes, and rates and predictors of readmissions in patients receiving LVADs with age ≥65 years (AO) and comparing them with patient age <65 years (AY). We analyzed hospitalization data from the Nationwide Inpatient Sample from 2007 to 2015 to evaluate LVAD utilization trends and outcomes between the 2 patient cohorts. We also queried the Nationwide Readmission Database from 2014 to third quarter of 2015 to identify trends and compare etiologies of readmissions. Implants in AO patients increased from 20% (154) of the total LVADs implanted in 2007 to 33.2% (1,215) in 2014 and 31.8% (910) through September 2015 (p < 0.01). Over the study period there was a steady and significant increase in the mean Elixhauser scores in elderly patients who underwent LVAD implantation from 15.4 in 2007 to 24.54 in 2015 (p < 0.01). Despite this finding, the mean LOS in the AO cohort decreased from 56.0 days in 2007 to 33.8 days in 2015 (p < 0.001). Furthermore, the in-hospital mortality associated with LVAD implantation among the AO group gradually decreased over the study time period (39% in 2007 to 12.2% in 2015, p < 0.001). The overall readmission rate was not significantly different between AO versus AY group (28% vs 33%, p = 0.2). The most common cause in both groups was gastrointestinal bleed but it was significantly higher in AO group (24.3% vs 11.3%, p = 0.01). In conclusion, patients age ≥65 years with multiple co-morbidities are receiving increasing number of LVADs with improved survival outcomes. Their 30-day readmissions are comparable to the younger patients.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Mortalidade Hospitalar/tendências , Readmissão do Paciente/tendências , Lesão Renal Aguda/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos Hospitalares/tendências , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Complicações Pós-Operatórias/epidemiologia , Implantação de Prótese , Choque Cardiogênico/epidemiologia
14.
PLoS One ; 15(6): e0234342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32603326

RESUMO

OBJECTIVE: Considering the high rejection rates of upper limb prostheses, it is important to determine which prosthesis fits best the needs of each user. The introduction of the multi-grip prostheses hands (MHP), which have functional advantages but are also more expensive, has made prosthesis selection even harder. Therefore, we aimed to identify user opinions on factors determining prosthesis choice of persons with major unilateral upper limb defects in order to facilitate a more optimal fit between user and prosthesis. METHODS: A qualitative meta-synthesis using a 'best-fit framework' approach was performed by searching five databases (PROSPERO registration number: CRD42019126973). Studies were considered eligible if they contained qualitative content about adults with major unilateral upper limb defects experienced in using commercially available upper limb prostheses and focused on upper limb prosthesis users' opinions. Results of the meta-synthesis were validated with end-users (n = 11) in a focus group. RESULTS: Out of 6247 articles, 19 studies were included. An overview of six main themes ('physical', 'activities and participation', 'mental', 'social', 'rehabilitation, cost and prosthetist services' and 'prosthesis related factors') containing 86 subthemes that could affect prosthesis choice was created. Of these subthemes, 19 were added by the focus group. Important subthemes were 'work/school', 'functionality' and 'reactions from public'. Opinions of MHP-users were scarce. MHPs were experienced as more dexterous and life-like but also as less robust and difficult to control. CONCLUSION: The huge number of factors that could determine upper limb prosthesis choice explains that preferences vary greatly. The created overview can be of great value to identify preferences and facilitate user-involvement in the selection process. Ultimately, this may contribute to a more successful match between user and prosthesis, resulting in a decrease of abandonment and increase of cost-effectiveness.


Assuntos
Amputados/psicologia , Membros Artificiais/psicologia , Desenho de Prótese/psicologia , Adulto , Amputados/reabilitação , Membros Artificiais/ética , Membros Artificiais/tendências , Grupos Focais , Humanos , Desenho de Prótese/economia , Implantação de Prótese , Participação dos Interessados
15.
Arch Cardiovasc Dis ; 113(6-7): 461-472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32653240

RESUMO

Heart failure affects more than 30 million people worldwide and its prevalence is constantly rising. In 2020, heart transplantation is the only curative treatment, but left ventricular assistance devices (LVADs) are fully integrated into the decision algorithm for management of patients with advanced heart failure, with more than 20,000 devices implanted worldwide in the last decade. Intended to support cardiac output, LVADs remove the blood from the left ventricle and eject it into the proximal aorta. Whereas first-generation LVADs were pulsatile, second- and third-generation LVADs are more reliable, but create a laminar flow, with reduced (or absent) blood flow pulsatility. Concomitantly, several new adverse events, some of them lethal, appeared when continuous-flow LVADs started to be implanted, including acquired von Willebrand disease, gastrointestinal bleeding and aortic valve fusion or regurgitation. This review aims to apply models describing pulsatility (such as the Windkessel effect applied by Frank, Guyton's continuity model of venous return and Sunagawa's left ventricular-arterial coupling) to LVADs, to better understand the physiopathology in patients using continuous-flow devices. This review also covers the means of exploring pulsatility and adverse events associated with a reduction in pulsatility, as well as the possible ways for restoring pulsatility in patients implanted with an LVAD.


Assuntos
Insuficiência Cardíaca/terapia , Coração Auxiliar , Hemodinâmica , Implantação de Prótese/instrumentação , Função Ventricular Esquerda , Animais , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Modelos Cardiovasculares , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/mortalidade , Fluxo Pulsátil , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 29(8): 104974, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689589
17.
Spine (Phila Pa 1976) ; 45(15): 1024-1029, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675601

RESUMO

STUDY DESIGN: Retrospective analysis using data from RCTs. OBJECTIVE: This study aimed to report on the incidence of radiological adjacent segment degeneration (ASD) in patients with cervical radiculopathy due to a herniated disc that were randomized to receive cervical arthroplasty or arthrodesis. SUMMARY OF BACKGROUND DATA: Cervical disc prostheses were introduced to prevent ASD in the postsurgical follow-up. However, it is still a controversial issue. METHODS: Two hundred fifty-three patients were included in two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF), or without intervertebral cage (ACD) for one-level disc herniation. Neutral lateral radiographs were obtained preoperatively, at 1- and 2-year follow-up after surgery. Radiological ASD was evaluated on X-ray and defined by a decrease in disc height and the presence of anterior osteophyte formation on both the superior and the inferior level in relation to the target level. RESULTS: Radiological ASD was present in 34% of patients at baseline and increased to 59% at 2-year follow-up in the arthrodesis groups (ACD and ACDF combined), and to 56% in the arthroplasty group. Progression of radiological ASD was present in 29% of patients in the arthrodesis group and in 31% of patients in the arthroplasty group for 2-year follow-up. CONCLUSIONS: Radiological ASD occurs in a similar manner in patients who were subjected to arthrodesis in cervical radiculopathy and in patients who received arthroplasty to maintain motion. Current data tend to indicate that the advantage of cervical prosthesis in preventing radiological ASD is absent. LEVEL OF EVIDENCE: 2.


Assuntos
Artroplastia/tendências , Vértebras Cervicais/cirurgia , Discotomia/tendências , Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral/cirurgia , Implantação de Prótese/tendências , Adulto , Artroplastia/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/prevenção & controle , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos
18.
Am Heart J ; 226: 222-231, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32629295

RESUMO

BACKGROUND: A randomized, sham-controlled trial in patients with heart failure (HF) and left ventricular ejection fraction (LVEF) ≥40% demonstrated reductions in pulmonary capillary wedge pressure (PCWP) with a novel transcatheter InterAtrial Shunt Device (IASD). Whether this hemodynamic effect will translate to an improvement in cardiovascular outcomes and symptoms requires additional study. STUDY DESIGN AND OBJECTIVES: REDUCE Elevated Left Atrial Pressure in Patients with Heart Failure II (REDUCE LAP HF-II) is a multicenter, prospective, randomized, sham-controlled, blinded trial designed to evaluate the clinical efficacy of the IASD in symptomatic HF and elevated left atrial pressures. Up to 608 HF patients age ≥ 40 years with LVEF ≥40%, PCWP ≥25 mm Hg during supine ergometer exercise, and PCWP ≥5 mm Hg higher than right atrial pressure will be randomized 1:1 to the IASD versus sham control. Key exclusion criteria include hemodynamically significant valvular disease, evidence of pulmonary arterial hypertension, and right heart dysfunction. The primary endpoint is a hierarchical composite, analyzed by the Finkelstein-Schoenfeld methodology, that includes (1) cardiovascular mortality or first nonfatal ischemic stroke through 12 months; (2) total (first plus recurrent) HF hospitalizations or healthcare facility visits for intravenous diuretics up to 24 months, analyzed when the last randomized patient completes 12 months of follow-up; and (3) change in Kansas City Cardiomyopathy Questionnaire overall summary score from baseline to 12 months. Follow-up echocardiography will be performed at 6, 12, and 24 months to evaluate shunt flow and cardiac chamber size/function. Patients will be followed for a total of 5 years after the index procedure. CONCLUSIONS: REDUCE LAP-HF II is designed to evaluate the clinical efficacy of the IASD device in patients with symptomatic HF with elevated left atrial pressure and LVEF ≥40%.


Assuntos
Insuficiência Cardíaca/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Cateterismo Cardíaco , Método Duplo-Cego , Insuficiência Cardíaca/fisiopatologia , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Função Ventricular Esquerda
19.
World Neurosurg ; 139: 762-774, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32689697

RESUMO

Though frequently effective in the management of medically refractory seizures, epilepsy surgery presents numerous challenges. Selection of the appropriate candidate patients who are likely to benefit from surgery is critical to achieving seizure freedom and avoiding neurocognitive morbidity. Identifying the seizure focus and mapping epileptogenic networks involves an interdisciplinary team dedicated to formulating a safe and effective surgical plan. Various strategies can be employed either to eliminate the epileptic focus or to modulate network activity, including resection of the focus with open surgery or laser interstitial thermal therapy; modulation of epileptogenic firing patterns with responsive neurostimulation, deep brain stimulation, or vagus nerve stimulation; or non-invasive disconnection of epileptic circuits with focused ultrasound, which is also discussed in greater detail in the subsequent chapter in our series. We review several challenges of epilepsy surgery that must be thoughtfully addressed in order to ensure its success.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Seleção de Pacientes , Fatores Etários , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Eletroencefalografia , Encefalite/cirurgia , Técnicas de Ablação Endometrial , Lateralidade Funcional , Neuroimagem Funcional , Humanos , Neuroestimuladores Implantáveis , Imagem por Ressonância Magnética , Magnetoencefalografia , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons , Implantação de Prótese , Encaminhamento e Consulta , Tomografia Computadorizada de Emissão de Fóton Único , Falha de Tratamento , Esclerose Tuberosa/cirurgia
20.
World Neurosurg ; 139: 750-761, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32689696

RESUMO

The diagnostic and surgical management of epilepsy has made enormous strides over the past 3 decades, concomitant with advances in technology and electrophysiologic understanding of neuronal connectivity. Distinct zones have been identified within this network that each communicate and play a role in the genesis of seizures. Invasive and noninvasive modalities for defining the epileptogenic lesion or region have been able to more accurately determine which patients are optimal candidates for treatment when their seizures are refractory to conventional conservative management. Ablative, palliative, and disconnecting procedures have been developed as alternatives for traditional open resection techniques, and in recent studies, they have shown excellent seizure control and mitigation of complications. In this review, we discuss the evolution of these advancements in the management of epilepsy and provide an overview of current and future neurosurgical therapeutic modalities.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Implantação de Prótese , Técnicas de Ablação , Lobectomia Temporal Anterior , Estimulação Encefálica Profunda , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/terapia , Eletrocorticografia , Eletroencefalografia , Neuroimagem Funcional , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Neuroestimuladores Implantáveis , Terapia a Laser , Imagem por Ressonância Magnética , Magnetoencefalografia , Tomografia por Emissão de Pósitrons , Radiocirurgia , Procedimento de Encéfalo Dividido , Tomografia Computadorizada de Emissão de Fóton Único , Estimulação do Nervo Vago
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