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Nutrient stimulation of mesenteric blood flow-implications for older critically ill patients

World Journal of Critical Care Medicine 2017年第1期6卷 28-36页

作者： Thu AN Nguyen Yasmine Ali Abdelhamid Liza K Phillips leeanne s chapple Michael Horowitz Karen L Jones Adam M Deane Discipline of Acute Care Medicine University of Adelaide National Health and Medical Research Council Centre for Research Excellence in Translating Nutritional science to Good Health Endocrine and Metabolic Unit Royal Adelaide Hospital Discipline of Medicine University of Adelaide Intensive Care Unit Royal Melbourne Hospital University of Melbourne

Nutrient ingestion induces a substantial increase in mesenteric blood flow. In older persons(aged ≥ 65 years), particularly those with chronic medical conditions, the cardiovascular compensatory response may be inadequate to maintain systemic blood pressure during mesenteric blood pooling, leading to postprandial hypotension. In older ambulatory persons, postprandial hypotension is an important pathophysiological condition associated with an increased propensity for syncope, falls, coronary vascular events, stroke and death. In older critically ill patients, the administration of enteral nutrition acutely increases mesenteric blood flow, but whether this pathophysiological response is protective, or precipitates mesenteric ischaemia, is unknown. There are an increasing number of older patients surviving admission to intensive care units, who are likely to be at increased risk of postprandial hypotension, both during, and after, their stay in hospital. In this review, we describe the prevalence, impact and mechanisms of postprandial hypotension in older people and provide an overview of the impact of postprandial hypotension on feeding prescriptions in older critically ill patients. Finally, we provide evidence that postprandial hypotension is likely to be an unrecognised problem in older survivors of critical illness and discuss potential options for management.

关键词： Postprandial hypotension Enteral nutrition Critical care Aged Mesenteric ischaemia

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Tissue engineering in urethral reconstruction--an update

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Asian Journal of Andrology 2013年第1期15卷 89-92页

作者： Altaf Mangera Christopher R chapple Department of Urology Research Sheffield Teaching Hospitals N HS Trust Royal Hallamshire Hospital Sheffield S10 2JF U K and sheffield Hallam University and Consultant Urological surgeon at the Royal Hallamshire Hospital Sheffield S10 2JF UK

The field of tissue engineering is rapidly progressing. Much work has gone into developing a tissue engineered urethral graft. Current grafts, when long, can create initial donor site morbidity. In this article, we evaluate the progress made in finding a tissue engineered substitute for the human urethra. Researchers have investigated cell-free and cell-seeded grafts. We discuss different approaches to developing these grafts and review their reported successes in human studies. With further work, tissue engineered grafts may facilitate the management of lengthy urethral strictures requiring oral mucosa substitution urethroplasty.

关键词： reconstructive urology tissue engineering urethra urethroplasty

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Non-invasive transcutaneous electrical stimulation in the treatment of overactive bladder

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Asian Journal of Urology 2015年第2期2卷 92-101页

作者： Martin slovak Christopher R.chapple Anthony T.Barker Department of Medical Physics&Clinical Engineering Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK Department of Urology Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK

We reviewed the literature on transcutaneous electrical nerve stimulation(TENs)used as a therapy for overactive bladder(OAB)symptoms,with a particular focus on:stimulation site,stimuli parameters,neural structures thought to be targeted,and the clinical and urodynamic outcomes *** majority of studies used sacral or tibial nerve *** literature suggests that,whilst TENs therapy may have neuromodulation effects,patient are unlikely to benefit to a significant extent from a single application of TENs and indeed clear benefits from acute studies have not been *** long-term studies there were differences in the descriptions of stimulation intensity,strategy of the therapy,and positioning of the electrodes,as well as in the various symptoms and pathology of the ***,most studies were uncontrolled and hence did not evaluate the placebo *** is known about the underlying mechanism by which these therapies work and therefore exactly which structures need to be stimulated,and with what *** is promising evidence for the efficacy of a transcutaneous stimulation approach,but adequate standardisation of stimulation criteria and outcome measures will be necessary to define the best way to administer this therapy and document its efficacy.

关键词： Overactive bladder Posterior tibial nerve stimulation sites of stimulation sacral stimulation sham stimulation methodology surface electrodes Transcutaneous electrical nerve stimulation

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Ventricular Arrhythmia in the Fontan Circulation:Prevalence,Risk Factors and Clinical Implications

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Congenital Heart Disease 2023年第5期18卷 507-523页

作者： Charis Tan Diana Zannino Carley Clendenning sophie Offen Thomas LGentles Julian Ayer David Tanous Vishva Wijesekera leeanne Grigg David Celermajer Mark McGuire Yves d’Udekem Rachael Cordina Department of Cardiothoracic surgery Royal Prince Alfred HospitalCamperdownAustralia sydney Medical school University of SydneyCamperdownAustralia Clinical Epidemiology and Biostatistics Unit Murdoch Children’s Research InstituteParkvilleAustralia Department of Cardiology Royal Prince Alfred HospitalCamperdownAustralia Department of Paediatric Cardiology Starship HospitalAucklandNew Zealand Department of Paediatric Cardiology The Children’s Hospital at WestmeadWestmeadAustralia Department of Cardiology Westmead HospitalWestmeadAustralia Adult Congenital Heart Disease Unit The Prince Charles HospitalBrisbaneAustralia Department of Cardiology The Royal Melbourne HospitalMelbourneAustralia Heart Research Institute CamperdownAustralia Department of Cardiac surgery The Royal Children’s Hospital MelbourneParkvilleAustralia Department of Paediatrics The University of MelbourneParkvilleAustralia

Objective:sudden cardiac death(sCD)and malignant ventricular arrhythmia(VA)are increasingly recognized as important issues for people living with a Fontan circulation,but data are *** sought to characterize the cohort who had sudden cardiac death,most likely related to VA and/or documented VA in the Australia and New Zealand Fontan Registry including risk factors and clinical ***:A retrospective cohort study was *** criteria were documented non-sustained ventricular tachycardia,sustained ventricular tachycardia,ventricular fibrillation,resuscitated cardiac arrest or sCD>30 days post-Fontan ***:Of 1611 patients,20(1.2%)had VA;14(1.0%)had VA without sCD and 6(sCD(6%of all deaths recorded in Registry;5 of those had documented VA at the time of arrest and 1 was presumed to be VA-associated).The median age at first VA was 20.5(14–32)years,10(50%)were females,and the median age at Fontan operation was 8(4–17)*** univariable analysis,hypoplastic left heart syndrome(p=0.03)and older age Fontan operation(pssociated with *** Fontan era(pst-Fontan atrial arrhythmia(p=0.010)were associated with *** with VA had a 3 times higher risk of death or heart transplant(HR 3.27(1.19,8.98),p=0.02).Conclusions:A proportion of people living with a Fontan circulation have malignant *** VA screening in this cohort is *** data are needed to aid risk stratification.

关键词： Fontan congenital cardiac arrhythmia sudden cardiac death ventricular tachyarrhythmia

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Functional and reconstructive urology (part one)

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Asian Journal of Urology 2018年第3期5卷 55-56页

作者： Christopher R chapple Qiang Fu Chuanliang Xu sheffield Teaching Hospitals NHs Foundation Trust Sheffield UK. Department of Urology Shanghai Jiao Tong University Affiliated 6th People's Hospital Shanghai PR China. Department of Urology Changhai Hospital Second Military Medical University Shanghai PR China.

Dear Colleagues,It is a great honour that the Asian Journal of Urology has agreed to host two special issues on the subject of functional and reconstructive urology and to introduce the first of these *** an era when technology has come to the fore in urological practice with new developments(not only in terms of the equipment used to facilitate minimally invasive surgery but also developments such as the robot which have revolutionised access to laparoscopic surgery),it is very important to realise that functional and reconstructive urology still remains an important cornerstone of urological practice.

关键词： surgery corners constructive

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Are neonatal morbidities associated with no prenatal care different from those associated with inadequate prenatal care?

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Open Journal of Obstetrics and Gynecology 2012年第2期2卷 89-97页

作者： Ekwutosi M. Okoroh Dean V. Coonrod Kristina chapple David Drachman Consultant 9239 E. Desert View Scottsdale USA Department of Obstetrics Gynecology & Women’s Health Maricopa Integrated Health System and University of Arizona College of Medicine Phoenix USA Department of Research Maricopa Integrated Health System Phoenix USA Division of Blood Disorders National Center for Birth Defects and Developmental Disorders Atlanta USA

Objective: Compare neonatal morbidities in women with no prenatal care, and women with inadequate prenatal care, to those with adequate prenatal care. Methods: Retrospective cohort study of neonatal morbidities of 3 exposure groups. Group 1: No prenatal care;Group 2: Inadequate prenatal care;Group 3: Intermediate/adequate prenatal care. Results: 2.5%, 23.3% and 74.1% of subjects (N = 264,138) were in Groups 1, 2 and 3 respectively. severe neonatal morbidity was more common in Group 1, followed by Group 2, and least common in Group 3. After controlling for gestational age and birth weight, most of these differences were attenuated and not significant except for the following Group 1 vs Group 3 comparisons: meconium aspiration, odds ratio (OR) 2.15 and 95% confidence interval (CI) 1.39 - 3.33;suspected sepsis, OR 1.30 and CI 1.13 - 1.49;proven viral sepsis, OR 2.23 and CI 1.24 - 4.00. Conclusions: severe neonatal morbidity was most common in those with no prenatal care followed by those with inadequate prenatal care. For most neonatal morbidities, this could largely be explained by gestational age and birth weight differences, but for some neonatal morbidities (meconium aspirations, viral sepsis and dysmorphic features) the impact of no prenatal care persisted after adjustment for these factors.

关键词： Prenatal Care Neonatal Outcomes Retrospective Cohort study

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膀胱过度活动症：发病机制及治疗现状

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中华泌尿外科杂志 2012年第9期33卷 699-704页

作者： Nadir I. Osman Altaf Mangera Christopher R. chapple 廖利民美国谢菲尔德教学医院泌尿外科Glossop Road shef-fieldS102JFUnited Kingdom 不详

内容摘要OAB为一类发病率较高的慢性疾病，严重影响患者的生活质量，给个人及社会带来了巨大的经济负担。OAB为基于症候群进行诊断的综合征，定义为“尿急，伴或不伴急迫性尿失禁，常伴有尿频和夜尿症状”。OAB无明确的病因，不包括由... 详细信息

内容摘要OAB为一类发病率较高的慢性疾病，严重影响患者的生活质量，给个人及社会带来了巨大的经济负担。OAB为基于症候群进行诊断的综合征，定义为“尿急，伴或不伴急迫性尿失禁，常伴有尿频和夜尿症状”。OAB无明确的病因，不包括由急性尿路感染或其他形式的膀胱尿道局部病变所致的症状。OAB的核心症状为尿急，尿急是指一种突发、强烈的排尿欲望，且很难被主观抑制而延迟排尿。

关键词：膀胱过度活动症发病机制治疗急迫性尿失禁急性尿路感染慢性疾病生活质量经济负担

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Predictors of future stroke in adults 60-64 years living in the community

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World Journal of Neurology 2016年第1期6卷 14-22页

作者： Nicolas Cherbuin leeanne Carey Moyra Mortby Kaarin J Anstey Centre for Research on Ageing Health and Wellbeing Australian National University Neurorehabilitation and Recovery Stroke Division the Florey Institute of Neuroscience and Mental Health Department of Occupational Therapy La Trobe University

AIM:To investigate predictors of incident stroke in a large epidemiological sample of cognitively healthy individuals in their early 60'***:Cardiovascular(systolic and diastolic blood pressure, hypertension status and medication, body mass index, lung forced vital capacity), lifestyle(alcohol intake, smoking, physical activity), mental health(anxiety and depression status, medication and symptomatology), cognition(executive function, processing speed, working memory, sensorimotor skills), and personality measures(behavioural inhibition and activation, positive and negative affect, neuroticism, psychoticism, extraversion) were investigated as predictors of incident stroke in 1774 participants from the Personality and Total Health Through Life Project over an 8-year *** regression analyses controlled for age, gender, and education were conducted in the whole cohort as well as in case-control subanalyses including precisely matched controls to identify factors associated with stroke ***:The cohort selected had a mean age of 62.5 years(sD = 1.5) and was 48.6% female with an average of 14.1 years of education(sD = 2.6).When 28 individuals with incident stroke were compared to 1746 cognitively healthy individuals in multivariate logistic regression analyses the only significant predictors of stroke across the five domains considered(cardiovascular, lifestyle, mental health, cognition, personality) and after controlling for gender, age, and education were systolic blood pressure(per unit above 140 mm Hg:OR = 1.04, 95%CI:1.01-1.07, P = 0.002), smoking(trend OR = 2.28, 95%CI:0.99-5.24, P = 0.052), and sensorimotor skills(purdue pegboard:OR = 0.80, 95%CI:0.62-0.96, P = 0.037).similarly, in matched-control analyses significant group differences were found for systolic blood pressure(P = 0.001), smoking(P = 0.036), and sensorimotor skills(P = 0.028).CONCLUsION:Identified predictors of incident stroke in community-living individuals included hi

关键词： smoking Fine motor skills Longitudinal Epidemiology Hypertension Cognition Personality stroke

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台湾板岩带的运动学分析

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海洋地质译丛 1995年第6期 1-12页

作者： K.s.Tillman 陶铮

1引言在最近几年,我们对造山机制的认识有了很大进展。在一篇里程碑文章中,chapple(1978)把前陆褶皱和冲断带模拟为下伏有弱底层的到处处于临界破裂点边缘的完全塑性楔形体。chapple(1978)用这个模型证明了水平挤压作为驱动力的重要性... 详细信息

1引言在最近几年,我们对造山机制的认识有了很大进展。在一篇里程碑文章中,chapple(1978)把前陆褶皱和冲断带模拟为下伏有弱底层的到处处于临界破裂点边缘的完全塑性楔形体。chapple(1978)用这个模型证明了水平挤压作为驱动力的重要性,并得出楔形体的形状和地形取决于楔形体物质和底层的相对强度。Davis等(1983)修正Tchapple的模型.选定库伦破裂流变为上地壳的较现实流变。他们认为,如果有物质加到楔形体或离出楔形体,那么整个楔形体必定发生变形,以保持临界斜度。自这些早期论文以来,许多作者应用、推广并修改过这个临界楔形体模型,以更好地理解区域规模的造山过程。然而,临界楔形体型模型并不意味能详细预测造山楔形体内变形的运动情况(chapple,1978),相反,他们推测,造山楔形体的整个形状接近于由连续模型预测的形状。因此这些模型对详细理解变形运动过程是有限的。近来,在试图设计一般造山过程的较现实运动学模式方面,特别在台湾,Hwang等 (1993)提出一个顺序冲断模式,把造山带当作为一系列前陆倒转,前陆推进的冲断片。此模式是以前陆褶皱冲断带发展的两个基本原则为根据的:(1)

关键词：台湾板岩带运动学造山运动

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