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Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus, which imposes significant functional limitations and at times, sudden death. In an evolving healthcare landscape, physical therapists are assuming greater clinical responsibility and thus must be aware of this potential complication and tailor the plan of care appropriately. The purpose of this case report is to highlight the need for increased awareness of CAN among physical therapists in order to improve screening, diagnosis, and treatment. A 41-year-old Spanish-speaking male with uncontrolled type 2 diabetes arrived to the emergency department (ED) with dizziness and syncope leading to an inability to walk, work, or complete community service hours. After evaluation by the ED physical therapist, the patient was admitted for further work-up and diagnosed with CAN. After a short hospital course, the patient returned home symptomatic, fell, and was re-admitted the same day. Throughout the second hospital stay, the patient's symptoms improved with robust medical management allowing physical therapy treatment and functional independence for safe discharge home. Additionally, patient-specific goals were met with the help of social work and the medical team. Clinical knowledge of CAN for the non-cardiopulmonary specialist physical therapist is lacking. As physical therapists prepare to be advanced practice providers in a rapidly evolving healthcare landscape, increasing awareness has the potential to lead to improved screening, diagnosis, and treatment of persons with CAN, a severe complication of diabetes.  相似文献   
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目的分析急性心肌梗死患者在经皮冠状动脉介入治疗(PCI)术中应用全剂量替罗非班的临床效果。方法84例接受PCI术治疗的急性心肌梗死患者,依据随机数字表法分为试验组与对照组,各42例。对照组患者PCI术中配合半剂量替罗非班治疗;试验组患者PCI术中配合全剂量替罗非班治疗。对比两组心功能改善情况、心血管不良事件发生率、心肌梗死溶栓试验(TIMI)血流分级。结果治疗后,试验组的左室舒张末期内径(LVEDD)(50.98±4.23)mm短于对照组的(58.01±4.88)mm,左室射血分数(LVEF)(58.41±3.28)%高于对照组的(53.00±3.19)%,差异有统计学意义(P<0.05)。两组心血管不良事件发生率比较,差异无统计学意义(P>0.05)。试验组TIMI血流分级3级占比高于对照组,差异有统计学意义(P<0.05);两组血流分级2级、1级、0级占比比较,差异无统计学意义(P>0.05)。结论急性心肌梗死患者PCI术治疗时配合应用全剂量替罗非班能够更好的促进患者术后心功能恢复,且并不会增加治疗期间的不良事件发生率,值得在临床上推广使用。  相似文献   
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Catheter ablation is currently the only curative treatment for scar-related ventricular tachycardias (VTs). However, not only are ablation procedures long, with relatively high risk, but success rates are punitively low, with frequent VT recurrence. Personalized in-silico approaches have the opportunity to address these limitations. However, state-of-the-art reaction diffusion (R-D) simulations of VT induction and subsequent circuits used for in-silico ablation target identification require long execution times, along with vast computational resources, which are incompatible with the clinical workflow. Here, we present the Virtual Induction and Treatment of Arrhythmias (VITA), a novel, rapid and fully automated computational approach that uses reaction-Eikonal methodology to induce VT and identify subsequent ablation targets. The rationale for VITA is based on finding isosurfaces associated with an activation wavefront that splits in the ventricles due to the presence of an isolated isthmus of conduction within the scar; once identified, each isthmus may be assessed for their vulnerability to sustain a reentrant circuit, and the corresponding exit site automatically identified for potential ablation targeting. VITA was tested on a virtual cohort of 7 post-infarcted porcine hearts and the results compared to R-D simulations. Using only a standard desktop machine, VITA could detect all scar-related VTs, simulating activation time maps and ECGs (for clinical comparison) as well as computing ablation targets in 48 minutes. The comparable VTs probed by the R-D simulations took 68.5 hours on 256 cores of high-performance computing infrastructure. The set of lesions computed by VITA was shown to render the ventricular model VT-free. VITA could be used in near real-time as a complementary modality aiding in clinical decision-making in the treatment of post-infarction VTs.  相似文献   
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