Individual optimization of pacing sensors improves exercise capacity without influencing quality of life

INTRODUCTION: Programmable pacemaker sensor features are frequently used in default setting. Limited data are available about the effect of sensor optimization on exercise capacity and quality of life (QOL). Influence of individual optimization of sensors on QOL and exercise tolerance was investigated in a randomized, single blind study in patients with VVIR, DDDR, or AAIR pacemakers. METHODS: Patients with > or =75% pacing were randomized to optimized sensor settings (OSS) or default sensor setting (DSS). Standardized optimization was performed using three different exercise tests. QOL questionnaires (QOL-q: Hacettepe, Karolinska, and RAND-36) were used for evaluation of the sensor optimization. One month before and after optimization, exercise capacity using chronotropic assessment exercise protocol and the three QOL-q were assessed. RESULTS: Fifty-four patients (26 male, 28 female) with a mean age of 65 +/- 16 years were enrolled in the study. In each group (OSS and DSS) 27 patients were included. One month after sensor optimization, the achieved maximal heart rate (HR) and metabolic workload (METS) were significantly higher in OSS when compared with DSS (124 +/- 28 bpm vs 108 +/- 20 bpm, P = 0.036; 7.3 +/- 4 METS vs 4.9 +/- 4 METS, P = 0.045). Highest HR and METS were achieved in patients with pacemakers with accessible sensor algorithms. In patients with automatic slope settings (33%), exercise capacity did not improve after sensor optimization. QOL did not improve in OSS compared with DSS. CONCLUSION: After 1 month of individual optimization of rate response pacemakers, exercise capacity was improved and maximum HR increased, although QOL remained unchanged. Accessible pacemaker sensor algorithms are mandatory for individual optimization.     

Intra-operative oxygen delivery in infusion volume-optimized patients undergoing laparoscopic colorectal surgery within an enhanced recovery programme: the effect of different analgesic modalities

Aim Patients undergoing major open surgery who have an indexed oxygen delivery (DO₂I) > 600 ml/min/m² have been shown to have a lower incidence of morbidity and mortality compared with those whose DO₂I is below this level. Laparoscopy and Trendelenburg positioning cause a reduction in DO₂I. We aimed to quantify the effect of the type of analgesia on DO₂I and to correlate the DO₂I achieved with the incidence of anastomotic leakage in patients undergoing laparoscopic surgery. Method Following ethical approval, patients were randomized to receive spinal anaesthesia (Group S), epidural analgesia (Group E) or intravenous morphine (Group P) followed by postoperative patient‐controlled analgesia (PCA). In addition to standard monitoring, oesophageal Doppler monitoring of the stroke volume allowed directed intravenous fluid therapy. The mean DO₂I was compared with the anastomotic leakage rate. Results Seventy‐five patients were recruited (Group S, 27; Group E, 23; Group P, 25). The mean (range) DO₂I for all patients was 490 (230‐750) ml/min/m². The analgesic modality had no effect on DO₂I. Of the 18 patients with a DO₂I of < 400 ml/min/m², four (22%) developed anastomotic leakage compared with one (%) of the 57 patients with a DO₂I of > 400 ml/min/m² (P = 0.01). Conclusion The analgesic modality used had no effect on the DO₂I achieved. Anastomotic leakage was significantly higher in patients with a DO₂I of < 400 ml/min/m². A further study assessing the outcome after raising the DO₂I with inotropes is required.     

胶片-报告按需自助打印在放射科的应用

目的：分析胶片-报告按需自助打印技术对放射科取报告过程的流程优化价值。方法：针对放置在放射科入口处的四台自助打印机,观察患者使用及排队情况、胶片匹配识别情况和废弃胶片积压情况,记录机器故障情况。结果：经过一年的使用,每天约有80%患者愿意尝试通过自助打印机取检查结果,其中多数患者使用顺利,并表示愿意下次继续使用。少数情况下,由于患者行动不便、网络故障、耗材不足等因素,造成患者自助取结果失败。结论：胶片-报告自助打印技术在放射科存在许多应用价值,值得推广。同时需重视对设备的定期养护。     

樱花多糖提取工艺的优化及抗氧化性研究

目的:通过正交试验优化樱花多糖的提取工艺,对樱花多糖的抗氧化功能进行了相关的研究,为樱花多糖保健功能的研究提供试验依据。方法:通过正交设计优化樱花多糖的提取工艺,用蒽酮-硫酸法测定不同提取条件下多糖的含量,并对其进行抗氧化性试验和自由基的清除试验。结果与结论:通过对试验结果进行分析,最优工艺为3 g干燥的樱花花瓣置于烧杯中,加蒸馏水240 m L,在90℃的水浴锅中提取3 h,过滤,离心,得上清液。各种浓度的樱花多糖提取液均能够有效地清除超氧阴离子自由基(O2-·),且随着浓度的增大,其清除能力逐渐增强。浓度为70.5μg·L-1多糖提取液的清除率为58.82%。     

优化早交班内涵的实践与成效

目的：探讨早交班内涵的优化与实践成效。方法评估传统早交班内涵,对传统早交接内涵进行优化、培训,使责任护士掌握并应用于临床实践,对优化前、后的早交班内涵的相关护理指标进行评价。结果早交班内涵优化后的护理质量及患者对责任护士的满意度较优化前有显著提高,差异有统计学意义(P<0．05)。结论早交班内涵的优化提高了护理工作的质量及效率,体现了优质护理的人性化、连续性、整体性、专业化。     

Structure-Based Design of Type II Inhibitors Applied to Maternal Embryonic Leucine Zipper Kinase

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