Strategies to Incorporate Left Atrial Appendage Occlusion Into Clinical Practice

AbstractThe left atrial appendage (LAA) has been identified as a predominant source of thrombus formation leading to significant thromboembolic events in patients with nonvalvular atrial fibrillation. Medical therapy to eliminate thrombus formation in the LAA has been the standard of care for several decades, but mechanical approaches designed to exclude the LAA from the circulation have recently been developed. The largest body of randomized and nonrandomized data to date has been for the Watchman device (Boston Scientific, Natick, Massachusetts), which was recently approved by the Food and Drug Administration for selected patients in the United States. There are no current guidelines or guidance for institutions and operators looking to become involved in this therapy. This perspective is aimed at exploring these issues and providing necessary information and guidance to these programs and operators to help ensure a successful launch of a LAA occlusion program and optimize patient selection, procedural performance, and outcome

RESOURCEFUL SELECTION-BASED DESIGN OF WIRELESS UNITS FOR GRANARY MONITORING SYSTEMS

The effectiveness of any granary system is grossly dependent up on the efficiency of its monitoring and control measures. The granary monitoring systems presently in use in mo st developing countries are based on wired networks with inevitable disadvantages that include high installation and mai ntenance costs. Most wireless granary monitoring systems previously developed were achieved without resort to resourcefu lness of the composite units of the system. However, record information on the selection of best comparative compone nts for wireless granary monitoring systems is not readily available. This paper designed a wireless sensor integrated sys tem from comparison and selection of resourceful component units for monitoring temperature, humidity and light variations in stored bulk grains. The resulting composite units of the developed system were products of the best paramet ers trade-off in the selection of components and protocols. The sensing unit consists of the selected Grove-DHT22 Temperatu re/Humidity sensor with calibrated, linearized and stable digital signals output via 1-wire bus and a cheap low-power Gro ve-GL5528 light sensor. The resulting network had no hierarchy or parent-child relationship constraint. The low-powe r sleep configuration possibility of the sensor node was cyclic and synchronize

Acute aortic syndromes: pathophysiology and management.

The acute aortic syndromes carry significant morbidity and mortality, especially when detected late. Symptoms may mimic myocardial ischemia, and physical findings may be absent or, if present, can be suggestive of a diverse range of other conditions. Maintaining a high clinical index of suspicion is crucial in establishing the diagnosis. All patients with suspected aortic disease and evidence of acute ischemia on electrocardiogram should undergo diagnostic imaging studies before thrombolytics are administered. The demonstration of an intimal flap separating 2 lumina is the basis for diagnosis. Tear detection and localization are very important because any therapeutic intervention aims to occlude the entry tear. The goals of medical therapy are to reduce the force of left ventricular contractions, decrease the steepness of the rise of the aortic pulse wave, and reduce the systemic arterial pressure to as low a level as possible without compromising perfusion of vital organs. Surgical therapy still remains the gold standard of care for type A aortic dissection, whereas in type B dissection, percutaneous aortic stenting and fenestration techniques have been developed and are sometimes used in conjunction with medical therapy in certain situations

First-in-Man Large-Field Intravascular Ultrasound-Guided Transcatheter Aortic Valve Replacement

First-in-Man Large-Field Intravascular Ultrasound-Guided Transcatheter Aortic Valve Replacemen