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Objective:To evaluate the safety of leadless pacemaker implantation in super-elderly patients.Methods:Eleven patients with average age of 90 (86, 92) years who underwent leadless pacemaker implantation in the Department of Cardiology, Peking University People′s Hospital from March 2021 to May 2022 were included. The clinical data and implantation information were collected. The complications (cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection, femoral vein hematoma) and death of patients were documented at 24 h, 3 d, and 1, 3, 6 months after pacemaker implantation.Results:There were 9 males and 2 females with the body mass index of 21(19, 23)kg/m 2. The underlying diseases were hypertension, diabetes, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, previous cerebral infarction and moderate to severe tricuspid regurgitation in 9, 9, 9, 6, 4, 4, 4 patients, respectively. The left ventricular ejection fraction was 49% (45%, 52%), the hemoglobin concentration was 118 (114, 122)g/L, 4 patients were taking anticoagulant drugs, and 6 patients were taking antiplatelet drugs. Eight patients were newly implanted with a leadless pacemaker, 2 patients were implanted after removal the old ones, and 1 case was implanted at the same time as removal. The implantation time was 45(40, 47) minutes, the X-ray exposure time was 14 (13, 15) minutes, the release time was 1 (1, 2), the threshold value was 0.50(0.38, 0.75)V/0.24 ms, the impedance was 730 (700, 770) Ω, and the perceived R-wave amplitude 8.2(6.7, 12.8) mV. During the follow-up period of 8 (6, 10) months, no patient had pacemaker dysfunction; and the threshold, R wave sensing, and impedance were stable and maintained within the normal range. No cardiac tamponade, myocardial infarction, cerebral infarction, pulmonary embolism, pacemaker reinfection or death occurred perioperatively and during the follow-up period; 1 patient had hematoma after femoral vein puncture, which improved after compression treatment. Conclusion:This single-center and small-sample study shows that leadless pacemaker implantation is safe for super-elderly patients.
ABSTRACT
OBJECTIVE：To provide reference for improving the level of pharmaceutical care in hospitals and promoting the continuous transformation and upgrading of O 2O pharmaceutical care mode in medical institutions in China. METHODS ：Using “Internet”“Network”“O2O”“Pharmaceutical care ”“Medication education ”“Chronic disease management ”“Medication consultation ” “Science popularization and education ”as keywords ，related literatures were collected from CNKI ，VIP，Wanfang and other Chinese databases during Jan. 2012-Mar. 2020. The development process ，characteristics，service content ，advantages and disadvantages of O 2O pharmaceutical care mode in China were analyzed and summarized ，and relevant suggestions were put forward. RESULTS & CONCLUSIONS ：O2O pharmaceutical care in Chinese hospitals covers prescription review and dispensing ， drug distribution ，medication consultation after visiting ，medication education ，chronic disease management ，science popularization and education ，pharmacy clinic ，etc.，realizing the whole process of closed-loop management. At present ，O2O pharmaceutical care in Chinese hospital had gradually moved from stage 1.0 to stage 2.0. Artificial intelligence technology has also been widely integrated into all aspects of pharmaceutical care ，assisting hospital pharmacists to better practice the “patient-centered”service concept，not only improving the quality and value of pharmacists ’pharmaceutical care more efficiently and accurately ，but also promoting the sinking of high-quality pharmaceutical resources and serving the grassroots. O2O pharmaceutical care shows the advantage of optimizing the allocation of pharmaceutical care resources ，expanding the scope of pharmaceutical care ，improving the relationship between doctors and patients ，diverting patients with different needs ，and promote hierarchical diagnosis and treatment. However，there are still some problems ，such as the failure to effectively cover rural patients ，the risk of patient privacy leakage ， and the lack of special quality management standards ，which hinder the further development and improvement of scale advantage of O2O pharmaceutical care. It is suggested to further improve the pharmaceutical care function of the platform ，expand the consumer population，promulgate relevant laws and regulations as soon as possible ，carry out continuing education and training for pharmacists according to the needs of patients in grassroots areas ，establish and improve relevant laws and regulations ，and improve O 2O pharmaceutical care quality management standards， so as to promote the development of O 2O pharmaceutical care mode in the hospital in China.
ABSTRACT
Diabetic retinopathy (DR) is an important cause of blindness globally, and its prevalence is increasing. Early detection and intervention can help change the outcomes of the disease. The rapid development of artificial intelligence (AI) in recent years has led to new possibilities for the screening and diagnosis of DR. An AI-based diagnostic system for the detection of DR has significant advantages, such as high efficiency, high accuracy, and lower demand for human resources. At the same time, there are shortcomings, such as the lack of standards for development and evaluation and the limited scope of application. This article demonstrates the current applications of AI in the field of DR, existing problems, and possible future development directions.