Diaphragm pacing using the minimally invasive cervical approach.

CONTEXT: The implantation of commercially available phrenic nerve/diaphragm pacers has been available for more than 40 years and has enabled thousands of patients in over 40 countries to achieve freedom from invasive mechanical ventilation. OBJECTIVE: The cervical approach to implantation of these pacers is described, as are the pros and cons of using this technique compared to intrathoracic and sub-diaphragmatic. METHODS: Study design was a retrospective review of 1,522 subjects from the Avery Biomedical Devices (ABD) database who were implanted with the Avery diaphragm pacer. Long term statistics from patients implanted with diaphragm pacers are presented as well. RESULTS: 17% of cervically placed electrodes required at least one replacement compared to 18% of electrodes placed thoracically. Devices implanted cervically show no significant difference in their longevity than those implanted using the thoracic approach (P value of 0.9382 using Two-Sample t-Test). The mean longevity for both approaches was found to be 6.4 years. The majority of electrodes implanted have never required replacement. A majority of CCHS patients were implanted using the thoracic approach and only find it necessary to use the device during sleeping hours. Most of the cervically implanted patients are found to be older at the time of implantation and implanted for diagnoses that require longer daily use of the device. CONCLUSION: The cervical approach for the implantation of phrenic nerve/diaphragm pacers is the most minimally invasive, but underutilized, technique that allows for the use of local or monitored anesthesia, does not require entering any body cavities, and keeps incision size small.

Cherry Gel Supplementation Does Not Attenuate Subjective Muscle Soreness or Alter Wellbeing Following a Match in a Team of Professional Rugby Union players: A Pilot Study.

This study examined the effects of sour tart cherry juice (TC) on muscle soreness (MS) and wellbeing following a rugby union match in professional players. In a crossover design, 10 players from a senior squad in the top tier of England consumed either 2 × 30 mL servings of TC or an isocaloric cherry-flavoured control gel (CON) two days before, the day of, and two days following an 80 min match. Subjective wellbeing and MS were measured before the match (Pre), and for three days following the match (M+1, M+2, and M+3, respectively). MS was elevated from Pre at M+1 (CON, 111 ± 37 mm vs. TC 94 ± 41 mm) and M+2 (CON, 81 ± 35 mm vs. TC 72 ± 36 mm) (time effect; p = 0.0001; ηp² = 0.821) but there were no differences between TC and CON at either time point post-exercise (p = 0.807; ηp² = 0.035). Wellness scores were ~15% lower at M+1 (p = 0.023; ηp² = 0.638) but there were no differences between the two conditions at any time point (p = 0.647; ηp² = 0.160). In conclusion, tart cherry juice did not attenuate soreness or alter wellbeing in a team of professional rugby union players following a competitive match.