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Effect of Exercise-Based Cardiac Rehabilitation on Cardiorespiratory Fitness in Adults with Congenital Heart Disease

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Congenital Heart Disease 2021年第1期16卷 73-84页

作者： Prisca Eser thomas Gruber Thimo Marcin Claudia Boeni Kerstin Wustmann Christina DeLuigi Matthias Greutmann Daniel Tobler Markus Schwerzmann Matthias Wilhelm Department of Cardiology InselspitalBern University HospitalUniversity of BernBernSwitzerland Department for Neuroscience and Movement Science University of FribourgFribourgSwitzerland Center for Congenital Heart Disease Bern University HospitalUniversity of BernBernSwitzerland Department of Cardiology University Hospital ZurichUniversity of ZurichZurichSwitzerland Department of Cardiology University Hospital BaselUniversity of BaselBaselSwitzerland

Background:The purpose of this study was to investigate whether patients with adult congenital heart disease(ACHD)benefit from exercise-based cardiac rehabilitation(CR)short-and long-term with regard to improvement of cardiorespiratory ***:Cardiopulmonary exercise tests(CPET)completed by ACHD patients between January 2000 and October 2019 were analysed *** mixed models were performed for peak oxygen consumption(vo_(2))with patients as random effect and age,sex,disease classification,preceding surgery(≤3 months)and preceding CR(≤4 weeks for short term and>4 weeks for long term)as fixed ***:1056 CPETs of 311 ACHD patients with simple(7),moderate(188)or great(116)complexity heart defects were *** 59 patients who completed a CR(median age 27 yrs,38%females)increased peak vo_(2)from before to after CR by a median of 2.7(IQR–0.6 to 5.5)ml/kg/***,in the multivariate mixed model,peak vo_(2)was non-significantly increased short-term after CR(β0.8,95%CI–0.7 to 2.4),not maintained long-term after CR(β0.0,95%CI–1.7 to 1.6)but significantly reduced after surgery(β–5.1,95%CI–7.1 to–3.1).The 20 CR patients after surgery increased their peak vo_(2)by 6.2(IQR 3.6–9.5)ml/kg/min,while the 39 CR patients without preceding surgery increased it by 0.9(IQR–1.5 to 3.1)ml/kg/***:The increase in peak vo_(2)with CR was mainly due to recovery from surgical *** small independent benefit from CR was not maintained long-term,highlighting the potential to improve current CR concepts in ACHD populations.

关键词： Grown-ups with congenital heart disease exercise training cardiac rehabilitation surgical intervention peak oxygen consumption cardiorespiratory fitness

Cystic lesions of peripheral nerves:Are we missing the diagnosis of the intraneural ganglion cyst?

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World Journal of Radiology 2017年第5期9卷 230-244页

作者： Jyoti Panwar Anil Mathew Binu P thomas Department of Radiology Christian Medical College Joint Department of Medical Imaging University Health NetworkUniversity of Toronto Department of Hand Surgery and Leprosy Reconstructive Surgery Christian Medical College

AIM To highlight the salient magnetic resonance imaging(MRI) features of the intraneural ganglion cyst(INGC) of various peripheral nerves for their precise diagnosis and to differentiate them from other intra and extraneural cystic *** A retrospective analysis of the magnetic resonance(MR) images of a cohort of 245 patients presenting with nerve palsy involving different peripheral nerves was *** images were analyzed for the presence of a nerve lesion,and if found,it was further characterized as solid or *** serial axial,coronal and sagittal MR images of the lesions diagnosed as INGC were studied for their pattern and the anatomical extent along the course of the affected nerve and its *** relation to identifiable anatomical landmarks,intraarticular communication and presence of denervation changes in the muscles supplied by involved nerve was also *** A total of 45 cystic lesions in the intra or extraneurallocations of the nerves were identified from the 245 MR scans done for patients presenting with nerve *** of these 45 cystic lesions,13 were diagnosed to have INGC of a peripheral nerve on *** other cystic lesions included extraneural ganglion cyst,paralabral cyst impinging upon the suprascapular nerve,cystic schwannoma and nerve abscesses related to hansen's disease involving various peripheral *** lesions of INGC were identified in 12 *** of these affected the common peroneal nerve with one patient having a bilateral *** lesions each were noted in the tibial and suprascapular nerves,and one each in the obturator and proximal sciatic *** intra-articular connection along the articular branch was demonstrated in 12 out of 13 *** stages of denervation atrophy of the supplied muscles of the affected nerves were seen in 7 *** of these 13 lesions in 12 patients,6 underwent *** INGC is an important cause of reversible mono-neuropathy if diagnos

关键词： Intra-neural Magnetic resonance imaging Peripheral nerves Extra-neural Ganglion cyst

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经济世界的不确定性

作者： (美)拉尔斯·彼得·汉森(Lars Peter hansen) (美)托马斯·萨金特(thomas J. Sargent)

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稳健性

作者： (美)拉尔斯·彼得·汉森(Lars Peter hansen) (美)托马斯· J. 萨金特(thomas J. Sargent)

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动态线性经济的递归模型

Ankle Arthroscopy: A Complimentary Adjunct in the Diagnosis and Management of Ankle Fractures

作者： (美)拉尔斯·彼得·汉森(Lars Peter hansen) (美)托马斯 J. 萨金特(thomas J. Sargent)

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Open Journal of Orthopedics 2020年第12期10卷 403-411页

作者： Ciaran McDonald Conor O’Dwyer Peter McLoughlin Rebecca Jeanne Bermingham thomas Bayer Department of Orthopaedics and Trauma Midlands Regional Hospital Tullamore Tullamore Ireland

Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.

关键词： Ankle Fracture Arthroscopy Osteochondral Injury Syndesmosis Lauge-hansen ORIF Ligamentous Injury Syndesmosis Disruption Persistent Ankle Pain Post-Traumatic Arthritis

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针灸改善危重患者胃排空延迟的随机对照研究

麻醉与镇痛 2012年第1期8卷 78-84页

作者： Florian Pfab, MD, PhD Martina Winhard, MD Martina Nowak-Machen, MD Vitaly Napadow, PhD Dominik Irnich, MD, PhD Michael Pawlik, MD, PhD thomas Bein, MD, PhD Ernil hansen, MD, PhD 姚凤珍（译） Department of Anesthesiology University Hospital Regensburg Regensburg Germany Marti-nos Center for Biomedical Imaging Department of Radiology Massachusetts General Hospital Harvard Medical School Boston Massachusetts Department of Anesthesiology Brigham andWomen＇s Hospital Harvard Medical School Boston Massachusetts Department of Anesthe-siology University of Munich Campus Innenstadt Munich Germany

背景营养不良仍然是重症患者恢复过程中的一个严重问题，不仅增加住院死亡率，同时也延长住院时间。早期肠内营养已被证明可以全面改善重症监护室（intensivecareunit，ICU）患者的预后，然而，鼻饲可造成胃排空延迟和胃食管反流。针灸... 详细信息

背景营养不良仍然是重症患者恢复过程中的一个严重问题，不仅增加住院死亡率，同时也延长住院时间。早期肠内营养已被证明可以全面改善重症监护室（intensivecareunit，ICU）患者的预后，然而，鼻饲可造成胃排空延迟和胃食管反流。针灸已经成功用于治疗和预防围术期的恶心和呕吐。本研究中，我们评估在接受肠内营养的重症患者中，与常规胃动力剂相比针灸是否能改善胃排空状态。方法30例在ICU行机械通气并伴有胃排空延迟[定义为胃剩余容积（gastricresidualvolume，GRV）≥500ml，持续时间〉12天]的神经外科患者，前瞻性地随机分至穴位刺激组（acupointstimulationgroup，ASG，经皮电穴位刺激双侧内关穴，PC-6）或常规胃动力剂治疗组（drugtreatmentgroup，DTG），治疗时间超过6天（胃复安、西沙必利、红霉素）。ASG组患者不使用任何传统动力剂。治疗成功（鼻饲患者）的定义为GRV〈200ml／24h。结果两组人口统计学和血流动力学数据相似。治疗5天后，ASG组80％患者治疗成功，DTG组为60％。治疗第一天，ASG组GRV从970±87ml下降至346±71ml，而DTG组GRV从903±60ml显著增加至1040±211ml（P=0．015）。此外，ASG组（15例患者中有14例）比DTG组（15例患者中有7例）有更多患者出现GRV的下降和鼻饲平衡（定义为鼻饲容积减去GRV）的改善（P=0．014）。治疗第一天ASG组（121±128m1）鼻饲平衡显著高于DTG组（-727±259m1）（P=0．005）。总体来说，治疗的每一天，ASG组鼻饲平衡的改善显著超过DTG组。DTG组直至治疗第6天鼻饲平衡也没有得到改善。结论我们为重症监护提供了一项新的方案，即针灸治疗。本研究表明在重症患者胃排空延迟的治疗中，针灸比常规动力剂更加有效。针刺内关穴可能是预防和治疗重症患者营养不良的一个物美价廉的选择（几乎无副作用）。

关键词：胃排空延迟随机对照研究危重患者针灸治疗早期肠内营养鼻饲患者重症监护室重症患者

Noninvasive Surrogates for Left Ventricular Filling Pressure in Patients with Valvular Heart Disease

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International Journal of Clinical Medicine 2015年第3期6卷 193-203页

作者： Debora Brala thomas G. Allison Wilhelm Haverkamp Ingolf Schimke Olaf Schulz Department of Cardiology Universitatsmedizin Berlin Berlin Germany Department of Cardiology Sana Klinikum Lichtenberg Berlin Germany Deparment of Cardiovascular Diseases Mayo Clinic and Medical School Rochester MN USA Kardio-West Praxis für Interventionelle und Konventionelle Kardiologie Spandau Berlin Germany

Background: Invasive measurement of left ventricular filling pressure is the gold standard for determining diastolic dysfunction and predicting subsequent outcomes. For repetitive assessment of diastolic function during long-term management, noninvasive surrogates are used. Their reliability and reproducibility should be validated separately for different cardiovascular diseases and conditions. The aim of this study was to identify noninvasive surrogates of invasively derived left ventricular filling pressure and to relate these surrogates to outcomes (death or valve replacement) in patients with stable, asymptomatic valvular heart disease and preserved ejection fraction. Materials and Methods: In a first cohort, we investigated 54 patients who had spiroergometry, echocardiography, and left heart catheterization within a range of 100 days. In a second cohort (n = 64), noninvasive measures were related to outcomes after follow-up of 694 ± 576 days. Transmitral doppler E/tissue doppler E’ (E/E’), E/flow propagation velocity (E/Vp), isovolumetric relaxation time/time to E’-time to E (IVRT/TE’-TE), ventilatory efficiency (VE/VCO2slope), O2 consumption at anaerobic threshold and at peak exercise (vo2AT, vo2peak) as well as NT-pro brain natriuretic peptide (NTpro-BNP) were assessed in relation to left ventricular filling pressure and outcome. Results: NT-proBNP, vo2AT, VE/VCO2slope as well as echocardiographic surrogates E/E’ and E/flow propagation velocity were indicators of elevated end diastolic filling pressure. In multivariable analysis, vo2AT was the only independent predictor. NT-proBNP was the only surrogate of left ventricular filling pressure which predicted outcome. Conclusion: In patients with asymptomatic valvular heart disease and preserved systolic function, spiroergometric parameters and NT-proBNP performed best to assess filling pressure. Only NT-proBNP showed prognostic value in this cohort.

关键词： Filling Pressure NT-proBNP E/E’ vo2 VE/VCO2slope Valvular Heart Disease

Synthetic,Zwitterionic Sp1 Oligosaccharides Adopt a Helical Structure Crucial for Antibody Interaction

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Synthetic,Zwitterionic Sp1 Oligosaccharides Adopt a Helical ...