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Submaximal oxygen uptake kinetics, functional mobility, and physical activity in older adults with heart failure and reduced ejection fraction

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Journal of Geriatric Cardiology 2016年第5期13卷 450-457页

作者： Scott L Hummel John Herald craig alpert Kimberlee A Gretebeck Wendy S Champoux Donald R Dengel Peter V Vaitkevicius Neil B Alexander Department of lnternal Medicine University of Michigan Ann Arbor MI USA VA Ann Arbor Healthcare System Ann Arbor MI USA School of Nursing University of Wisconsin-Madison Madison WI USA William Beaumont School of Medicine Oakland University Royal Oak MI USA School of Kinesiology University of Minnesota Minneapolis MN USA Aspirus Health System Ontanagon ML USA

Background Submaximal oxygen uptake measures are more feasible and may better predict clinical cardiac outcomes than maximal tests in older adults with heart failure （HF）. We examined relationships between maximal oxygen uptake, submaximal oxygen kinetics, fianctional mobility, and physical activity in older adults with HF and reduced ejection fraction. Methods Older adults with HF and reduced ejection fraction （n = 25, age 75 ：i： 7 years） were compared to 25 healthy ageand gender-matched controls. Assessments included a maximal treadmill test for peak oxygen uptake （VO2p^ak）, oxygen uptake kinetics at onset of and on recovery from a submaximal treadmill test, functional mobility testing [Get Up and Go （GUG）, Comfortable Gait Speed （CGS）, Unipedal Stance （US）], and self-reported physical activity （PA）. Results Compared to controls, HF had worse performance on GUG, CGS, and US, greater delays in submaximal oxygen uptake kinetics, and lower PA. In controls, VO2peak was more strongly associated with functional mobility and PA than submaximal oxygen uptake kinetics. In HF patients, submaximal oxygen uptake kinetics were similarly associated with GUG and CGS as VO2peak, but weakly associated with PA. Conclusions Based on their mobility performance, older HF patients with reduced ejection fraction are at risk for adverse functional outcomes. In this population, submaximal oxygen uptake measures may be equivalent to VO2 peak in predicting functional mobility, and in addition to being more feasible, may provide better insight into how aerobic function relates to mobility in older adults with HF.

关键词： Aging Congestive heart failure Mobility Oxygen uptake The elderly

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Complications associated with prone positioning in elective spinal surgery

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World Journal of Orthopedics 2015年第3期6卷 351-359页

作者： J Mason De Passe Mark A Palumbo Maahir Haque craig P Eberson Alan H Daniels Department of Orthopaedics Warren Alpert Medical School of Brown University

Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient *** many ofthese complications remain uncommon,the range of possible morbidities is wide and includes multiple organ *** visual loss(POVL)is a well described,but uncommon complication that may occur due to ischemia to the optic nerve,retina,or cerebral ***-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal *** nerve injuries,such as those caused by prolonged traction to the brachial plexus,are more commonly encountered postoperative *** complications including pressure ulcers and compartment syndrome may also occur after prone positioning,albeit *** uncommon positioning complications such as tongue swelling resulting in airway compromise,femoral artery ischemia,and avascular necrosis of the femoral head have also been *** of these are well-understood and largely avoidable through thoughtful attention to *** complications,such as POVL,remain incompletely understood and thus more difficult to predict or ***,the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.

关键词： Spine Patient positioning Prone position Complications Prevention and control

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