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Does right Coronary Artery Stenosis Increase Morbi-Mortality in Patients Undergoing Coronary Artery Bypass Graft for Left Main Coronary Artery Disease?

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World Journal of Cardiovascular Diseases 2015年第12期5卷 397-404页

作者： M. Aithoussa A. Abdou N. Atmani M. Bamous Y. Moutakiallah F. Nya A. Seghrouchni A. Hatim Y. Elbekkali A. Boulahya Cardiac Surgery Department Mohammed V Military Hospital Mohammed V University Hay Riad Rabat Morocco

Background: The association of right coronary artery (RCA) stenosis in patients undergoing myocardial revascularization for left main coronary artery (LMCA) stenosis affects the prognosis. This study aimed to compare immediate results of patients with isolated LMCA stenosis and those with combined RCA stenosis. Patients and methods: We retrospectively evaluated 107 consecutive patients with LMCA disease who underwent coronary artery bypass grafts. The patients were divided into two groups: isolated LMCA stenosis (n = 36) and LMCA stenosis + RCA stenosis (n = 71). Different variables (preoperative, intra operative and post operative) were compared. Results: Patients with LMCA stenosis + RCA stenosis experienced higher prevalence of diabetes mellitus (p = 0.024) and smoker (p = 0.032). Also left ventricular EF was reduced (p = 0.004). Myocardial revascularization was more complete in patients with LMCA stenosis + RCA stenosis (p = 0.033), but in-hospital mortality rate was higher (12.6% vs 5.5%) in isolated LLMCA stenosis, but it did not reach statistical significance (p = 0.32). Except low output syndrome (LOS) that was frequent in presence of RCA stenosis (p = 0.026), no significant difference was found between groups for other complications. Conclusion: The presence of RCA stenosis in patients undergoing CABG for LMCA disease increases 30 day mortality but without significant impact on overall morbidities.

关键词： Left Main Coronary Artery (LMCA) Stenosis Left Main Coronary Artery and right Coronary Artery Stenosis Coronary Artery Bypass Graft (CABG) Immediate Results

The Duty of States to Give Sufficient Recognition to the right to Health

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Psychology Research 2021年第10期11卷 429-440页

作者： Alfred P.Minei Sam O.Kaipu University of Papua New Guinea(UPNG) Port MoresbyPapua New Guinea National&Supreme Courts of Papua New Guinea Port MoresbyPapua New Guinea

Modern human rights,as they have developed since World War II,have several characteristics that are imperative to how they are viewed.They are universal,indivisible,interdependent and interrelated.That is,they are held by all people by virtue of the fact that they are human,and apply to all people everywhere.Not all human rights are absolute.That is,some are considered“qualified rights”which may be subject to lawful interference.In the Papua New Guinea(PNG)context,interference will be lawful if it is prescribed by law consistent with the national Constitution and necessary to protect either the rights of others or for other considerations,such as national security,public order or public health.In the ending of life context,the weight that should be given to the consent to,and refusal of,treatment in circumstances where the decision will lead to the death of a patient is debated.This leads to another concern which is the way in which the prerequisites for a refusal of treatment(or valid consent)have been construed.The requirements of competence,voluntariness and information-giving arguably come under more intense scrutiny where the ramifications of the decision have such grave consequences.This paper considers consent as a reflection of the ethical principle of respect for personal autonomy that is often expressed in the law as the principle of self-determination.It also reviews the experiences of healthcare professionals who guide an informed consent process made by individuals,spouses,family members and advisors for the loved ones whose sickness,injury or geriatric age prevent them from having decision-making capacity.The last part summarizes the understanding of the nature of the procedure,benefits and risks which are important to informed consent and offers suggestions as to how the situation can be remedied.

关键词： constitution human rights qualified rights right to die PNG

The Pacing Effects on Myocardial Mechanics of the right Ventricle Using Two-Dimensional Strain Imaging

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World Journal of Cardiovascular Diseases 2020年第5期10卷 247-256页

作者： A. Soliman W. Fareed A. Katta R. Yaseen Cardiology Department Faculty of Medicine Menoufia University Al Minufya Egypt National Heart Institute Giza Egypt

Objective: Our study aimed to assess the 6 months effect of right ventricular apical (RVA) pacing on RV longitudinal systolic strain (LSS) using two-dimensional speckle tracking echocardiography (2D STE). Background: RVA pacing differs from the natural conduction through His-Purkinje fibers in having slower conduction velocity as well as altering the normal myocardial sequences of activation. Despite the fact that numerous studies have investigated the effects of RVA pacing on the LV, data on the effects on the RV function remain scarce. 2-D STE permits an objective and quantitative assessment of segmental and global myocardial function and has been validated against tagged MRI. We used 2-D STE to evaluate the RV LSS in response to RVA pacing. Methods: This case-control study was carried out on 60 subjects (30 patients implanted with DDD devices for 3rd degree AV block + 30 age and sex matched controls) in the period between February 2018 and February 2020 in the Cardiology Department, Faculty of Medicine, Menoufia University. The patients were evaluated 6 months after their implantation using conventional echo, M Mode, Doppler and 2D STE. 2D STE was used to identify the LSS of RV myocardial segments at the time of aortic valve closure. Statistical analysis was conducted using SPSS software v 20. Results: Results revealed that RVA pacing resulted in a statistically significant reduction of the global RV LSS in patients with DDD pacemakers vs controls (P Conclusion: RVA pacing reduces the RV free wall and the global RV LSS. Apical segments were the most affected.

关键词： right Ventricle Strain Pacing

Consideration of the Necessity of Prophylactic Bypass Grafting for Anomalous Origin of the right Coronary Artery—Based on a Case with Concomitant Left Main Trunk Disease Resuscitated from Cardiopulmonary Arrest

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World Journal of Cardiovascular Surgery 2017年第6期7卷 79-85页

作者： Hirotaro Sugiyama Keisuke Miyajima Kazuyoshi Hatada Toshihiro Ishikawa Sawa Matsumoto Shigeo Umezawa Masao Takahashi Department of Cardiovascular Surgery Hiratsuka Kyosai Heart Center Hiratsuka Kyosai Hospital Hiratsuka Kanagawa Japan Department of Cardiovascular Surgery Odawara Municipal Hospital Odawara Kanagawa Japan Department of Cardiology Hiratsuka Kyosai Heart Center Hiratsuka Kyosai Hospital Hiratsuka Kanagawa Japan

Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.

关键词： Anomalous Origin of the right Coronary Artery Prophylactic Bypass Grafting Saphenous Vein Graft Left Main Trunk Disease Sudden Death

Characteristics of Non-Small Cell Lung Cancer Located in the right Middle Lobe According to a Retrospective Study of Recurrence and Prognosis

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Open Journal of Thoracic Surgery 2012年第3期2卷 52-57页

作者： Katsuhiko Shimizu Yuji Hirami Riki Okita Shinsuke Saisho Takuro Yukawa Ai Maeda Koichiro Yasuda Masao Nakata Department of General Thoracic Surgery Kawasaki Medical School Kurashiki Japan

Background: Some studies have suggested that among all cases of lung cancer, the outcome of lung cancer located in the right middle lobe (RML) is the worst. However, with the advances in the diagnosis and treatment methods of lung cancer over the last couple of decades, we investigated whether the prognosis of primary lung cancer located in the RML still remains inferior to that of lung cancer arising from other lobes. Methods: Between July 2003 and December 2011, 505 consecutive patients with non-small cell lung cancer (NSCLC) underwent surgical resection at our institution. Of these, 32 patients (6.3%) had tumors arising from the RML. Results: The rate of incomplete resection was higher for cancer located in the RML than that for cancer arising from other lobes. Significant associations were noted between cancer located in the RML and the rate of lymph node metastasis and initial locoregional recurrence. Multivariate analysis identified lymph node metastasis and location in the RML as independent risk factors influencing the recurrence-free survival (p = 0.006), although location in the RML was not extracted as an independent risk factor influenceing the overall survival (p = 0.060). Conclusion: Despite the recent advances in the treatment of lung cancer, evaluation of complete resection revealed that the outcome of cancer located in the RML is still the worst among cancer of all the lobes. Further early diagnosis and adjuvant therapy are needed for improving the prognosis of cancer located in the RML.

关键词： right Middle Lobe Non-Small Cell Lung Cancer Prognosis

Comparison Study between Extracorporeal and Intracorporeal Anastomosis for Laparoscopic right Hemicolectomy

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Journal of Cancer Therapy 2019年第10期10卷 796-805页

作者： Badawy M. Ahmed Ebrahim Aboeleuon Ahmed Soliman Surgical Oncology Department South Egypt Cancer Institute Assiut University Assiut Egypt General Surgery Department Assiut University Hospital Assiut University Assiut Egypt.

Background: Nowadays, laparoscopic colectomy is considered a safe and effective surgical technique regarding short- and long-term outcomes, as well as specific oncologic outcomes. The anastomosis can be created intra- or extracorporeally. The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Aim of the Study: The goal of our study was to evaluate and compare short term outcomes of extra- and intra-corporeal anastomosis after laparoscopic right hemi colectomies. Methods: In the period from December 2014 to January 2019, all patients underwent laparoscopic right hemicolectomy for cancer colon who presented to surgical oncology department—south Egypt cancer institute and general surgery department—Assiut University was analyzed. Data like age, sex, body mass index (BMI), operative technique, operative times, blood loss, intra- and post-operative complications, pathology and hospital stay were reported and analyzed. Results: Twenty three (69.7%) patients underwent extracorporeal anastomosis while intracorporeal anastomosis was performed in ten (30.3%) patients. There was no significant difference in patient characteristics and demographic data in both groups (P > 0.05). There was no statistically significant difference in operative (operative time, blood loss or length of hospital stay) and postoperative (ileus, anastomotic leak, wound infection, incisional hernia, readmission, reoperation or deaths) details in the 2 groups except in length of the incision which was significantly shorter in the IA group (5.500 ± 1.269) vs. (6.565 ± 1.308) for EA (P = 0.015). Conclusion: No significant difference in short term outcomes of laparoscopic-assisted and total laparoscopic right colectomy. Intracorporeal anastomosis had shorter incision which may decrease wound-related complications.

关键词： Extracorporeal Anastomosis Intracorporeal Anastomosis Laparoscopic right Hemicolectomy

Effect of Altitude, right Ascension of Ascending Node and Inclination on Lifetime of Circular Lunar Orbits

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International Journal of Astronomy and Astrophysics 2011年第3期1卷 155-163页

作者： Shraddha Gupta Ram Krishan Sharma 不详

The lifetime of a lunar satellite orbit is constrained by the non-spherical nature of the Moon’s gravity field. The orbital lifetime of lunar orbits depends significantly on the initial conditions of the orbit. right ascension of ascending node (Ω) is one of the important orbital parameter affecting the orbital lifetime. In the present work we have analyzed the effect of Ω on the variation of lifetime with altitude for circular lunar orbits. It is found that at a particular initial altitude, a small increase in the altitude results in substantial increase in the orbital lifetime due to effect of the long periodic terms of Earth’s gravity on eccentricity and this transition altitude is different for different Ω. Further, it is observed that the variation of transition altitude with Ω follows a definite, but different trend for orbits with different inclinations. The transition altitude for polar orbits is found to be higher without the effect of Sun and Earth gravity. Variation of transition altitude with orbital inclination is also analyzed. Lifetimes of high altitude circular lunar orbits are analyzed and it is observed that at high altitudes lifetime decreases with altitude.

关键词： Lifetime of Lunar Orbits Transition Altitude right Ascension of Ascending Node Polar Orbits Long-Periodic Effects of Earth’s Gravity

Effect of exercise on left and right ventricular ejection fraction and wallmotion in patients with coronary artery disease: an ultrafast computed tomography study

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Journal of Medical Colleges of PLA(China) 1998年第1期13卷 73-78页

作者：毛松寿王绍军

To measure the response of left and right ventricular ejection fraction and wall motion to exercise in eighteen patients with angiogl’aphically documented coronary artery disease (CAD) and in twenty-two patients with angiographicallynormal coronary arteries using ultrafast computed tomography(UFCT). Methods: Angiography and UFCT exercise cine studieswere performed for the evaluation of chest pain in all 40 cases, including 18 CAD patients and 22 patients with normal coronary arteries. Results: Of the 18 patients with CAD, 14(78% ) had a≥5% decrease in left ventricular ejection fraction (LVEF) duringexercise by UFCT (P 5%; none had an abnormal response in LV wall motion during peak exercise or a RVWMA at restor during stress. Using a decrease of ≥5 % in LVEF or a LVWMA or RVWMA during stress as a criterion for identifying patientswith CAD, the accuracy was 88% (35/40) with LVEF, 90% (36/40) with LVWMA, and 92% (37/40) with a combination ofLVEF, LVWMA and RVWMA. The sensitivity of RVWMA alone in detecting right coronary artery disease (RCAD) was 60%(6/10) and the specificity was 78% (7/9). Conclusion: Our study suggests that exercise-UFCT appears to be a useful tool for thedetection of CAD in patients with chest pain. The abnormal response of LVEF and exercise-induced LVWMA and RVWMA as determined by UFCT were important predictors CAD. Both LVWMA and RVWMA of important value in identifying patientswith CAN from those with normal coronary arteries, as is RVWMA in defining the existence of RCAD in patients with CAD.

关键词： ultrafast computed tomograph left ventricular ejection fraction right ventricular ejection fraction exercise test

Study on Farmers' Cognition and Willingness to Plant Trees during Collective Forest right Reform Based on Data from Plain Areas of Henan Province

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Asian Agricultural Research 2013年第6期5卷 14-18,23页

作者： Min LIU Shaozhou ZHOU China National Forestry Economics and Development Research Center

On the basis of the survey data from plain areas of Henan Province,farmers' cognition and willingness to plant trees in collective forest right reform are studied. According to statistical analysis and regression equation of binary logistic regress analysis,it is generally believed that different participants have various attitudes to the reform,with regard to if planting trees or more,reform variables have a distinct effect,as well as income variable and loaning or lending variable. At last,some advices are put forward,that is,the government should strengthen collective forest right reform,accelerate matching reform and increase policy and financial support to forestry farmers.

关键词： Collective forest right system Plain areas Perform