Annals of the New York Academy of Sciences
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Ann. N. Y. Acad. Sci. · Nov 2014
ReviewDevelopment of the Trevo ProVue Retriever for intracranial clot removal in acute ischemic stroke.
It is estimated that 15 million people worldwide have a stroke each year. Of the estimated 795,000 strokes that occur in the United States annually, the majority are ischemic strokes resulting from an obstruction within a vessel supplying blood to the brain. The treatment goal for these patients is to restore blood flow as quickly as possible. ⋯ Food and Drug Administration clearance in 2012, the Trevo® Retriever is a stent-like structure to be deployed at the site of an occlusion to allow the occluding thrombus to integrate into the device for subsequent removal and restoration of blood flow. The subsequent generation of the device, the ProVue Retriever, is fully radiopaque and designed to provide physicians with maximal information about the interaction of the device with the clot, providing enhanced feedback during the procedure. In this brief historical review, the development pathway, clinical experience, and future directions of the Trevo devices are summarized.
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Ann. N. Y. Acad. Sci. · Nov 2014
ReviewDevelopment of the subcutaneous implantable cardioverter-defibrillator for reducing sudden cardiac death.
Implantable cardioverter-defibrillators (ICDs) detect ventricular arrhythmias responsible for causing sudden cardiac arrest and then deliver a high-voltage defibrillation shock to terminate the arrhythmia and restore normal cardiac function. Conventional transveneous ICD (TV-ICD) systems require one or more leads to be implanted into the heart through the venous anatomy. While TV-ICDs are well tolerated by most patients, the invasive approach can be associated with severe complications, including systemic infection, cardiac injuries, and lead failures. ⋯ Advances in defibrillation research and far-field sensing combined to enable development of the commercial S-ICD system. An investigation device exemption (IDE) clinical investigation followed, with FDA approval in September 2012. Evaluation of the long-term performance of the S-ICD system continues, with two independent postmarket registries and a prospective randomized head-to-head trial versus the transvenous ICD.
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Discovery of the neuromuscular effects of botulinum toxin began in the early 19th century and has continued to evolve. Currently, onabotulinumtoxinA is approved by the U. S. ⋯ OnabotulinumtoxinA significantly reduced the number of headache days per 28-day cycle relative to placebo at week 24 (change from baseline: -8.4 days for onabotulinumtoxinA versus -6.6 days for placebo; P < 0.001, pooled data). OnabotulinumtoxinA improved health-related quality of life and had an acceptable safety profile. OnabotulinumtoxinA is the only approved treatment specifically for CM prevention and represents a safe and effective therapeutic for chronic migraineurs.
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Ann. N. Y. Acad. Sci. · Nov 2014
ReviewDeath and consciousness--an overview of the mental and cognitive experience of death.
Advances in resuscitation science have indicated that, contrary to perception, death by cardiorespiratory criteria can no longer be considered a specific moment but rather a potentially reversible process that occurs after any severe illness or accident causes the heart, lungs, and brain to stop functioning. The resultant loss of vital signs of life (and life processes) is used to declare a specific time of death by physicians globally. When medical attempts are made to reverse this process, it is commonly referred to as cardiac arrest; however, when these attempts do not succeed or when attempts are not made, it is called death by cardiorespiratory criteria. ⋯ Recollections reported by millions of people in relation to death, so-called out-of-body experiences (OBEs) or near-death experiences (NDEs), are often-discussed phenomena that are frequently considered hallucinatory or illusory in nature; however, objective studies on these experiences are limited. To date, many consistent themes corresponding to the likely experience of death have emerged, and studies have indicated that the scientifically imprecise terms of NDE and OBE may not be sufficient to describe the actual experience of death. While much remains to be discovered, the recalled experience surrounding death merits a genuine scientific investigation without prejudice.
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Ann. N. Y. Acad. Sci. · Sep 2014
ReviewThe risk/benefit of predicting a post-antibiotic era: is the alarm working?
There have been concerns about antimicrobial resistance since the first widespread use of antibiotics in humans. More recently, this concern has grown and become the focus of clinical, scientific, and political activity. In part, the political interest is a consequence of publicizing a bleak picture of a post-antibiotic world. ⋯ Many governments now use a risk assessment approach to identify security concerns, based on reasonable worst-case scenarios. There is no doubt that for effective policy-based action to occur, antimicrobial resistance needs to be seen as a national and international security priority, particularly as the major cost of inaction will mostly be felt in the future. We conclude that presenting the evidence in a manner that is used to encourage prioritization of security policy is not only justified, it is essential to drive action in this area.