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1.
Yoshio Yamanouchi Kei Miyoshi Sunao Kodama Yuhei Shiga Shunichiro Sumi Hideya Niimura Hideaki Toujou Hidenori Urata 《Experimental & Clinical Cardiology》2009,14(1):3-5
BACKGROUND:
Increased ventricular pacing thresholds have been observed following monophasic implantable cardioverter defibrillator (ICD) shocks.AIM:
To examine changes following high-energy biphasic shocks delivered by integrated bipolar ICD systems.METHOD:
Ten episodes of ventricular fibrillation (VF) were induced at 10 min intervals in nine pigs with integrated ICD systems. After 10 s of each episode of VF, a 40 J biphasic shock was delivered, which successfully terminated VF (a total of 10 shocks). The bipolar pacing threshold at the right ventricular apex was measured before each shock and at 1 min intervals after each shock.RESULTS:
The mean pacing threshold was 0.029±0.059 μJ before the first shock and gradually increased to 0.14±0.10 μJ after the 10th shock.CONCLUSION:
It may be necessary to pace at a high-voltage output following biphasic shocks delivered by integrated bipolar ICD systems. 相似文献2.
Vehreschild MJ Meissner AM Cornely OA Maschmeyer G Neumann S von Lilienfeld-Toal M Karthaus M Wattad M Staib P Hellmich M Christ H Vehreschild JJ 《Haematologica》2011,96(12):1855-1860
Background
Neutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients’ morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia.Design and Methods
This observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for “transfer to intensive care” and “death” were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients.Results
The incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (P<0.001; OR 4.753; 95% CI 2.297–9.833, and P=0.003; OR 1.061/d; 95% CI 1.021–1.103). Chemotherapy-associated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573–13.515 and P=0.026; OR 3.628; 95% CI 1.169–11.256).Conclusions
The occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients’ outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications. 相似文献3.
Lee JH Jang JH Park J Park S Joo YD Kim YK Kim HG Choi CW Kim SH Park SK Park E Min YH 《Haematologica》2011,96(10):1441-1447
Background
Decitabine was evaluated for its efficacy and safety in Korean patients with myelodysplastic syndrome with IPSS score of 0.5 or over.Design and Methods
Decitabine 20 mg/m2/day was given intravenously over one hour for five consecutive days every four weeks. The primary end point was overall response rate.Results
A total of 101 patients were analyzed. The International Prognostic Scoring System risk category was Intermediate-2/High in 47.5%. A median of 5 courses (range 1–18) were delivered. The overall response rate was 55.4% (13 complete responses, one partial response, 23 marrow complete responses, and 19 hematologic improvements). Forty-eight patients (47.5%) showed some hematologic improvement. With a median follow-up duration of 478 days (range 69–595), median overall survival was 17.7 months. Patients who showed hematologic improvement had significantly longer overall survival than those who did not (19.2 vs. 15.9 months, P=0.006 by landmark analysis at six months). The difference in overall survival was evident in the Intermediate-2/High risk group but not in the Intermediate-1 risk group. The progression-free survival and acute myeloid leukemia-free survival were 61.9% and 77.9% at one year, respectively. Among 489 assessable treatment courses, there were 97 fever episodes requiring intravenous antimicrobials.Conclusions
Decitabine treatment was feasible and effective in Korean patients with myelodysplastic syndrome, and the overall survival was significantly longer in patients showing hematologic improvement. 相似文献4.
Castle JR Engle JM El Youssef J Massoud RG Ward WK 《Journal of diabetes science and technology》2010,4(6):1305-1310
Background
Administration of small, intermittent doses of glucagon during closed-loop insulin delivery markedly reduces the frequency of hypoglycemia. However, in some cases, hypoglycemia occurs despite administration of glucagon in this setting.Methods
Fourteen adult subjects with type 1 diabetes participated in 22 closed-loop studies, duration 21.5 ± 2.0 h. The majority of subjects completed two studies, one with insulin + glucagon, given subcutaneously by algorithm during impending hypoglycemia, and one with insulin + placebo. The more accurate of two subcutaneous glucose sensors was used as the controller input. To better understand reasons for success or failure of glucagon to prevent hypoglycemia, each response to a glucagon dose over 0.5 µg/kg was analyzed (n = 19 episodes).Results
Hypoglycemia occurred in the hour after glucagon delivery in 37% of these episodes. In the failures, estimated insulin on board was significantly higher versus successes (5.8 ± 0.5 versus 2.9 ± 0.5 U, p < .001). Glucose at the time of glucagon delivery was significantly lower in failures versus successes (86 ± 3 versus 95 ± 3 mg/dl, p = .04). Sensor bias (glucose overestimation) was highly correlated with starting glucose (r = 0.65, p = .002). Prior cumulative glucagon dose was not associated with success or failure.Conclusion
Glucagon may fail to prevent hypoglycemia when insulin on board is high or when glucagon delivery is delayed due to overestimation of glucose by the sensor. Improvements in sensor accuracy and delivery of larger or earlier glucagon doses when insulin on board is high may further reduce the frequency of hypoglycemia. 相似文献5.
Agrawal P Welsh JB Kannard B Askari S Yang Q Kaufman FR 《Journal of diabetes science and technology》2011,5(5):1137-1141
Background
Sensor-augmented insulin pumps may be programmed to suspend insulin delivery in response to hypoglycemia. The Medtronic Paradigm® Veo™ pump with automatic low glucose suspend (LGS) was released in 2009. Data from 7 months of real-world use of the system were analyzed to assess usage patterns and effectiveness of LGS.Method
Data from 935 patients totaling 49,867 patient days were collected; the LGS feature was on for 82% of these days. A subset of 278 subjects who used the pump for ≥3 months was analyzed separately; these subjects provided 28,401 patient days of data, with LGS used for 92% of the time.Results
The LGS threshold was most commonly set between 50 and 60 mg/dl. A total of 27,216 LGS events occurred, and 60% began in the afternoon or evening. The median duration of LGS events was 9.87 min, 45% lasted for <5 min, and 11% lasted for >115 min (equivalent to the full extent of the LGS event between 115 and 120 min). Among the episodes lasting for >115 min, the mean sensor glucose (SG) was 58.8 ± 12.4 mg/dl at LGS activation (time 0), rose to 102.2 ± 52.8 mg/dl by the end of the LGS episode (when insulin delivery was automatically resumed), and was 150.1 ± 68.6 mg/dl at 240 min. In the 278-subject subgroup, LGS usage significantly reduced the number of SG readings <50 mg/dl (p = 0.001) and >300 mg/dl (p = 0.001).Conclusions
The LGS feature was on for most of the patient days in the study. Most LGS episodes lasted for <10 min. Use of the LGS feature significantly reduced exposure to hypoglycemia. Profound hyperglycemia resulting from LGS episodes lasting >115 min was not observed. 相似文献6.
Svein Skeie Gunn B. B. Kristensen Siri Carlsen Sverre Sandberg 《Journal of diabetes science and technology》2009,3(1):83-88
Objective
Little attention has been given and few studies have been published focusing on how to optimize self-monitoring of blood glucose (SMBG) use to monitor daily therapy for persons with type 1 diabetes mellitus. This study was designed to evaluate the effect on glycated hemoglobin (A1C) of a structured intervention focused on SMBG in type 1 diabetes patients with insufficient metabolic control (A1C ≥ 8%) using a randomized clinical trial design.Method
One hundred fifty-nine outpatients with type 1 diabetes on multiple injection therapy with insulin and A1C ≥8% were recruited and randomized to one group receiving a focused, structured 9-month SMBG intervention (n = 59) and another group receiving regular care based on guidelines (n = 64).Results
Glycated hemoglobin values (mean % ± standard deviation) at study start was similar: 8.65 ± 0.10 in the intervention group and 8.61 ± 0.09 in the control group. The two groups were comparable (age, gender, body mass index, complication rate, and treatment modality) at study start and had mean diabetes duration and SMBG experience of 19 and 20 years, respectively. At study end, there was decrease in A1C in the intervention group (p < .05), and the A1C was 0.6% lower compared with the control group (p < .05). No increase in the number of minor or major hypoglycemia episodes was observed in the intervention group during the study period.Conclusions
A simple, structured, focused SMBG intervention improved metabolic control in patients with longstanding diabetes type 1 and A1C ≥ 8%. The intervention was based on general recommendations, realistic in format, and can be applied in a regular outpatient setting. 相似文献7.
Pagano L Caira M Nosari A Cattaneo C Fanci R Bonini A Vianelli N Garzia MG Mancinelli M Tosti ME Tumbarello M Viale P Aversa F Rossi G;HEMA e-Chart Group 《Haematologica》2011,96(9):1366-1370
Background
Neutropenic patients with persistent fever despite antibiotic therapy are managed with empirical or pre-emptive antifungal therapy. The aim of the present study was to evaluate the current clinical use and efficacy of these two approaches in patients with high risk hematologic conditions.Design and Methods
An electronic medical record system, the “Hema e-Chart”, was designed and implemented to collect information prospectively on infectious complications, particularly on invasive fungal diseases, in patients with hematologic malignancies treated with chemotherapy and/or autologous or allogenic hemopoietic stem cell transplantation. The patients were enrolled from Hematology units distributed widely across Italy.Results
Three hundred and ninety-seven adults with hematologic malignancies treated with chemotherapy with persistent fever and suspected invasive fungal disease were evaluable for the study (190 treated had been treated with empirical antifungal therapy and 207 with preemptive antifungal therapy). There was a significantly lower incidence of proven/probable invasive fungal diseases in patients treated with empirical antifungal therapy (n=14, 7.4%) than in patients treated with pre-emptive therapy (n=49, 23.7%) (P<0.001). The rate of deaths attributable to invasive fungal diseases was significantly lower in subjects treated with empirical antifungal therapy (1 case; 7.1%) than in subjects treated with pre-emptive therapy (11 cases; 22.5%) (P=0.002).Conclusions
These data indicate that empirical antifungal treatment decreased the incidence of invasive fungal disease and of attributable mortality with respect to a pre-emptive antifungal approach in neutropenic febrile patients with hematologic malignancies. (ClinicalTrials.gov Identifier: ) NCT01069887相似文献8.
Peter Adolfsson Hans ?rnhagen Johan Jendle 《Journal of diabetes science and technology》2008,2(5):778-784
Background
Our objective is to evaluate the Medtronic CGMS® continuous glucose monitoring system and plasma glucose (PG) measurement performed in a monitoring schedule as tools to identify individuals with type 1 diabetes at risk when diving.Methods
We studied 24 adults, 12 type 1 diabetes subjects and 12 controls, during 5 recreational scuba dives performed on 3 consecutive days. The CGMS was used by all participants on all the days and all the dives. Comparisons were made between PG performed in a monitoring schedule during the days of diving, self-monitored blood glucose (SMBG) performed 2 weeks prior to diving, and the CGMS during the study.Results
One hundred seventeen dives were performed. Hypoglycemia (<70 mg/dl) was found in six individuals and on nine occasions. However, no symptoms of hypoglycemia were present during or immediately postdiving. In one case, repetitive hypoglycemia prediving gave rise to a decision not to dive. None of the dives were aborted. The number of hypoglycemic episodes, 10 min prediving or immediately postdiving, were related to the duration of diabetes, r = 0.83 and p =0.01, and the percentage of SMBG values below target (<72 mg/dl), r = 0.65 and p =0.02. Moreover, the number of hypoglycemic episodes was also related to the total duration below low limit (<70 mg/dl), measured by the CGMS, r =0.74 and p =0.006.Conclusion
Safe dives are possible to achieve by well-informed, well-controlled individuals with type 1 diabetes. Using downloaded SMBG, CGMS, and repetitive PG in a monitoring schedule, it is possible to identify those subjects who are suitable for diving. 相似文献9.
10.
Ikonomidis I Lekakis J Vamvakou G Loizou S Revela I Andreotti F Kremastinos DT Nihoyannopoulos P 《Heart (British Cardiac Society)》2007,93(11):1412-1413
Background:
Circulating anticardiolipin antibodies (aCL) may cause endothelial dysfunction. We investigated whether aCL are related to platelet activation, thrombin generation and daily‐life ischaemia in patients with chronic coronary artery disease (CAD).Methods
We measured (medians 25th–75th percentile) IgG, IgM, IgA aCL serum levels (Arbitrary Elisa Units, AEU), prothrombin fragments (F1+2, nmol/l), 24 h urine excretion of 11‐dehydrothromboxane B2 (11‐DHTXB2, ng/mg creatinine) creatine kinase (CK) and its cardiac isoenzyme CK‐MB (IU/l) in 60 patients with angiographically documented CAD and in 40 age and sex matched controls. Patients underwent a 48 h Holter monitoring for assessment of the number and duration of ischaemic episodes.Results
Patients had higher IgA‐aCL levels than controls (3.2 vs 2.4 AEU, p = 0.002). Increased IgA‐ACA levels were related to increased number and duration of ischaemic episodes (p<0.01). By ANOVA, patients with ⩾10 ischaemic episodes (3rd tertile) or duration of ischaemia ⩾32min (3rd tertile) had higher IgA‐aCL than those with lower ischaemic burden (4.95 vs 3 vs 2.5 AEU, p = 0.002 and 4.9 vs 3 vs 2.5 AEU, p = 0.001 respectively). Patients with ⩾2 ischaemic episodes (2nd and 3rd tertile) had higher 11‐DHTXB2, than those with minimal ischaemia (2< episodes, 1st tertile) (p = 0.001). CK and CK‐MB were within normal range after Holter monitoring. Receiver operating curve analysis showed a greater area under the curve for IgA‐aCL than for 11‐DHTXB2 in predicting severe ischaemia (⩾10 ischemic episodes or ⩾32 min duration of ischaemia).Conclusion
Increasing IgA‐aCL levels are associated with increasing ischemic burden in patients with CAD.While cardiac enzymes are sensitive markers of myocardial necrosis, there are no reliable biomarkers for myocardial ischaemia. Increased production of anticardiolipin antibodies (aCL) has been linked to lipid peroxidation and may cause endothelial dysfunction favouring vasoconstriction.1 In this study we examined the relationship between aCL, platelet activation and ischaemia during daily‐life activities as assessed by 48 h Holter monitoring in chronic coronary artery disease (CAD). 相似文献11.
Objective To investigate the clinical applications of coronary CT angiography in patients with suspected coronary artery disease and identify factors that affect CT findings. Methods Medical records of patients suspected of coronary artery disease over a period of 12 months from a tertiary teaching hospital were retrospectively reviewed. Patient age, sex (male/female), duration of symptoms and abnormal rates of coronary CT angiography scans were analysed to investigate the relationship among these parameters. The patients by age were characterized into five groups: under 36 years, 36–45 years, 46–55 years, 56–65 years and more than 66 years, respectively; while the duration of symptoms was also classified into five groups: less than one week, one week to one month, one to three months, three to six months and more than six months. Results Of the 880 patient records reviewed, 800 met the above study criteria. Five hundred and forty nine patients demonstrated abnormal CT findings (68.6%). There was no significant difference in the percentage of abnormal CT findings based on patient sex and the duration of symptoms (P = 0.14). The abnormal rates of coronary CT angiography, however, increased significantly with increasing age (P < 0.001); with patients over 65 years of age 2.5 times more likely to have an abnormal CT scan relative to a patient under 45 years. A significant difference was found between abnormal coronary CT angiography and the duration of symptoms (P = 0.012). Conclusions Our results indicate coronary CT angiography findings are significantly related to the patient age group and duration of symptoms. Clinical referral for coronary CT angiography of patients with suspected coronary artery disease needs to be justified with regard to the judicious use of this imaging modality. 相似文献
12.
Frank van der Kley Philippe J van Rosendael Spyridon Katsanos Vasileios Kamperidis Nina A Marsan Ioannis Karalis Arend de Weger Meindert Palmen Jeroen J Bax Martin J Schalij Victoria Delgado 《老年心脏病学杂志》2016,13(1):31-36
Objective To investigate the procedural outcomes and the long-term survival of patients undergoing transcatheter aortic valve implantation (TAVI) and compare study results of patients ≤ 80 years and patients > 80 years old. Methods A total of 240 patients treated with TAVI were divided into two groups according to age ≤ 80 years (n = 105; 43.8%) and > 80 years (n = 135; 56.2%). The baseline characteristics and the procedural outcomes were compared between these two groups of patients. Results With the exception of peripheral artery disease and hypercholesterolemia, which were more frequently observed in the older age group, baseline characteristics were comparable between groups. Complication rates did not differ significantly between patients ≤ 80 years and patients > 80 years. There were no differences in 30-day mortality rates between patients aged ≤ 80 years and patients > 80 years old (9.5% vs. 7.4%, respectively; P = 0.557). After a median follow-up of 28 months (interquartile range: 16–42 months), 50 (47.6%) patients aged ≤ 80 years died compared to 57 (42%) deaths in the group of patients > 80 years old (P = 0.404). Conclusion The results of the present single center study showed that age didn't significantly impact the outcomes of TAVI. 相似文献
13.
Yang JF Kao YH Dai CY Huang JF Hsieh MY Lin ZY Chen SC Hsieh MY Wang LY Chuang WL Yu ML 《Hepatology International》2010,4(4):732-740
Purpose
Pegylated interferon (Peg-IFN)-based therapy is effective in treating chronic hepatitis B (CHB) and C (CHC) but frequently induces adverse events (AEs). This study was conducted to compare the incidence of Peg-IFN-based therapy-associated AEs in Taiwanese patients with CHB and CHC.Methods
Fifty-six patients with CHB and 103 age-, sex- and treatment duration-matched patients with CHC were enrolled. Patients with CHB were treated with Peg-IFN-α-2a 180 μg/week for 24 weeks (HBeAg+, n = 31) or 48 weeks (HBeAg−, n = 25); patients with CHC were treated with Peg-IFN-α-2a 180 μg/week plus ribavirin 1,000–1,200 mg/day for 24 weeks (genotype 2/3, n = 57) or 48 weeks (genotype 1, n = 46).Results
Significantly higher incidences of Peg-IFN-related AEs, especially neuropsychiatric symptoms, and ribavirin-associated skin manifestations were observed in patients with CHC compared with those with CHB, with either the 24- or 48-week regimen. Frequencies of laboratory abnormalities, except for anemia, were comparable in both groups. Neither group showed overt hepatic decompensation. Frequency of dose reduction was similar between the groups. Substantially higher rates of early termination and severe AEs were observed in patients with CHC.Conclusions
Patients with CHB treated with Peg-IFN had fewer AEs than patients with CHC treated with Peg-IFN/ribavirin. All patients were treated safely. 相似文献14.
Saima I. Chaudhry MD MSHS Sandy Balwan MD Karen A. Friedman MD FACP Suzanne Sunday PhD Basit Chaudhry MD PhD Deborah DiMisa Alice Fornari EdD 《Journal of general internal medicine》2013,28(8):1100-1104
BACKGROUND
Traditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed.AIM
To compare the impact of a traditional ambulatory training model with a templated 4 + 1 model.SETTING
A large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices.PARTICIPANTS
Residents, faculty, and administrative staff.PROGRAM DESCRIPTION
Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously.PROGRAM EVALUATION
A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents’ learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p < 0.0001). Satisfaction with ambulatory training improved (p < 0.0001). Self-reported empanelment also increased (p < 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p < 0.0001).DISCUSSION
A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-013-2387-3) contains supplementary material, which is available to authorized users.KEY WORDS: ambulatory training, 4 + 1 model 相似文献15.
Thakar CV Christianson A Himmelfarb J Leonard AC 《Clinical journal of the American Society of Nephrology》2011,6(11):2567-2572
Summary
Background and objectives
Prior studies have examined long-term outcomes of a single acute kidney injury (AKI) event in hospitalized patients. We examined the effects of AKI episodes during multiple hospitalizations on the risk of chronic kidney disease (CKD) in a cohort with diabetes mellitus (DM).Design, setting, participants, & measurements
A total of 4082 diabetics were followed from January 1999 until December 2008. The primary outcome was reaching stage 4 CKD (GFR of <30 ml/min per 1.73 m2). AKI during hospitalization was defined as >0.3 mg/dl or a 1.5-fold increase in creatinine relative to admission. Cox survival models examined the effect of first AKI episode and up to three episodes as time-dependent covariates, on the risk of stage 4 CKD. Covariates included demographic variables, baseline creatinine, and diagnoses of comorbidities including proteinuria.Results
Of the 3679 patients who met eligibility criteria (mean age = 61.7 years [SD, 11.2]; mean baseline creatinine = 1.10 mg/dl [SD, 0.3]), 1822 required at least one hospitalization during the time under observation (mean = 61.2 months [SD, 25]). Five hundred thirty of 1822 patients experienced one AKI episode; 157 of 530 experienced ≥2 AKI episodes. In multivariable Cox proportional hazards models, any AKI versus no AKI was a risk factor for stage 4 CKD (hazard ratio [HR], 3.56; 95% confidence interval [CI], 2.76, 4.61); each AKI episode doubled that risk (HR, 2.02; 95% CI, 1.78, 2.30).Conclusions
AKI episodes are associated with a cumulative risk for developing advanced CKD in diabetes mellitus, independent of other major risk factors of progression. 相似文献16.
Are late-night eating habits and sleep duration associated with glycemic control in adult type 1 diabetes patients treated with insulin pumps?
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Bartlomiej Matejko Beata Kiec‐Wilk Magdalena Szopa Iwona Trznadel Morawska Maciej T. Malecki Tomasz Klupa 《Journal of diabetes investigation.》2015,6(4):460-464
Aims/Introduction
Little is known about the impact of sleep duration and late-night snacking on glycemic control in patients with type 1 diabetes using insulin pumps. The aim of the present study was to examine whether late-night eating habits and short sleep duration are associated with glycemic control in continuous subcutaneous insulin infusion-treated type 1 diabetic patients.Materials and Methods
We included 148 consecutive adult type 1 diabetic subjects using an insulin pump (100 women and 48 men). Participants completed a questionnaire regarding sleep duration (classified as short if ≤6 h) and late-night snacking. Other sources of information included medical records and data from blood glucose meters. Glycemic control was assessed by glycated hemoglobin (HbA1c) levels and mean self-monitoring of blood glucose (SMBG) readings.Results
The mean age of patients was 26 years, mean type 1 diabetes duration was 13.4 years and mean HbA1c level was 7.2%. In a univariate regression analysis, sleep duration was a predictor of both HbA1c (β = 0.51, P = 0.01) and SMBG levels (β = 11.4, P = 0.02). Additionally, an association was found between frequent late-night snacking and higher SMBG readings (often snacking β = 18.1, P = 0.05), but not with increased HbA1c levels. In the multivariate linear regression, independent predictors for HbA1c and SMBG were sleep duration and patient age. In a univariate logistic regression, sleep duration and frequency of late-night snacking were not predictors of whether HbA1c target levels were achieved.Conclusions
Short sleep duration, but not late-night snacking, seems to be associated with poorer glycemic control in type 1 diabetic patients treated with continuous subcutaneous insulin infusion. 相似文献17.
Devon A. Dobrosielski PhD Bethany Barone Gibbs PhD Pamela Ouyang MBBS Susanne Bonekamp DVM Jeanne M. Clark MD Nae-Yuh Wang PhD Harry A. Silber MD PhD Edward P. Shapiro MD Kerry J. Stewart EdD 《Journal of general internal medicine》2012,27(11):1453-1459
BACKGROUND
Increased blood pressure (BP) in type 2 diabetes (T2DM) markedly increases cardiovascular disease morbidity and mortality risk compared to having increased BP alone.OBJECTIVE
To investigate whether exercise reduces suboptimal levels of untreated suboptimal BP or treated hypertension.DESIGN
Prospective, randomized controlled trial for 6 months.SETTING
Single center in Baltimore, MD, USA.PATIENTS
140 participants with T2DM not requiring insulin and untreated SBP of 120–159 or DBP of 85–99 mmHg, or, if being treated for hypertension, any SBP <159 mmHg or DBP < 99 mmHg; 114 completed the study.INTERVENTION
Supervised exercise, 3 times per week for 6 months compared with general advice about physical activity.MEASUREMENTS
Resting SBP and DBP (primary outcome); diabetes status, arterial stiffness assessed as carotid-femoral pulse-wave velocity (PWV), body composition and fitness (secondary outcomes).RESULTS
Overall baseline BP was 126.8 ± 13.5 / 71.7 ± 9.0 mmHg, with no group differences. At 6 months, BP was unchanged from baseline in either group, BP 125.8 ± 13.2 / 70.7 ± 8.8 mmHg in controls; and 126.0 ± 14.2 / 70.3 ± 9.0 mmHg in exercisers, despite attaining a training effects as evidenced by increased aerobic and strength fitness and lean mass and reduced fat mass (all p < 0.05), Overall baseline PWV was 959.9 ± 333.1 cm/s, with no group difference. At 6-months, PWV did not change and was not different between group; exercisers, 923.7 ± 319.8 cm/s, 905.5 ± 344.7, controls.LIMITATIONS
A completion rate of 81 %.CONCLUSIONS
Though exercisers improve fitness and body composition, there were no reductions in BP. The lack of change in arterial stiffness suggests a resistance to exercise-induced BP reduction in persons with T2DM.KEY WORDS: exercise training, diabetes, high blood pressure, randomized trial 相似文献18.
Vashitz G Pliskin JS Parmet Y Kosashvili Y Ifergane G Wientroub S Davidovitch N 《Journal of general internal medicine》2012,27(10):1265-1271
Background
Second medical opinions have become commonplace and even mandatory in some health-care systems, as variations in diagnosis, treatment or prognosis may emerge among physicians.Objective
To evaluate whether physicians’ judgment is affected by another medical opinion given to a patient.Design
Orthopedic surgeons and neurologists filled out questionnaires presenting eight hypothetical clinical scenarios with suggested treatments. One group of physicians (in each specialty) was told what the other physician’s opinion was (study group), and the other group was not told what it was (control group).Participants
A convenience sample of 332 physicians in Israel: 172 orthopedic surgeons (45.9% of their population) and 160 neurologists (64.0% of their population).Measurements
Scoring was by choice of less or more interventional treatment in the scenarios. We used χ2 tests and repeated measures ANOVA to compare these scores between the two groups. We also fitted a cumulative ordinal regression to account for the dependence within each physician’s responses.Results
Orthopedic surgeons in the study group chose a more interventionist treatment when the other physician suggested an intervention than those in the control group [F (1, 170) = 4.6, p = 0.03; OR = 1.437, 95% CI 1.115-1.852]. Evaluating this effect separately in each scenario showed that in four out of the eight scenarios, they chose a more interventional treatment when the other physician suggested an intervention (scenario 1, p = 0.039; scenario 2, p < 0.001; scenario 3, p = 0.033; scenario 6, p < 0.001). These effects were insignificant among the neurologists [F (1,158) = 0.44, p = 0.51; OR = 1.087, 95% CI 0.811-1.458]. In both specialties there were no differences in responses by level of clinical experience [orthopedic surgeons: F (2, 166) = 0.752, p = 0.473; neurologists: F (2,154) = 1.951, p = 0.146].Conclusions
The exploratory survey showed that in some cases physicians’ judgments may be affected by other physicians’ opinions, but unaffected in other cases. Weighing previous opinions may yield a more informed clinical decision, yet physicians may be unintentionally influenced by previous opinions. Second opinion has the potential to improve the clinical decision-making processes, and mechanisms are needed to reconcile discrepant opinions.Electronic supplementary material
The online version of this article (doi:10.1007/s11606-012-2056-y) contains supplementary material, which is available to authorized users.KEY WORDS: second-opinion, differential diagnosis, diagnostic reasoning, medical decision-making, health policy, surgery, orthopedics, neurology, surveys, consultation 相似文献19.
Glyburide prevents isoflurane’s reducing effects on hydroxyl radical formation in the postischemic reperfused rat heart
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Toshiaki Yamaguchi Satoshi Kashimoto Takeshi Oguchi Teruo Kumazawa 《Experimental & Clinical Cardiology》2002,7(1):25-29
BACKGROUND:
The role of KATP channels in isoflurane’s reducing effects on oxygen free radical formation are not well known.OBJECTIVES:
To investigate whether glyburide, an ATP-regulated potassium (KATP) channel blocker, abolishes isoflurane-induced cardioprotective effects and whether it affects hydroxyl radical formation in the postischemic reperfused heart.ANIMALS AND METHODS:
Thirty-nine male Wistar rats were divided into four groups: group C (control, n=10), group I (isoflurane, n=9), group G (glyburide, n=10) and group GI (glyburide and isoflurane, n=10). The hearts were perfused as a Neely’s working heart model. Afterwards, global heart ischemia was induced for 15 min followed by reperfusion for 20 min. The formation of hydroxyl radicals in the coronary effluent and heart was measured with high performance liquid chromatography.RESULTS:
Isoflurane alone and glyburide alone produced significant decreases in the duration of ventricular fibrillation during reperfusion (group C 452±345, group I 247±60, group G 261±135 s; P<0.05). In the presence of glyburide, isoflurane did not further decrease the duration of arrhythmia (group GI 230±48 s). Isoflurane reduced hydroxyl radical formation significantly in the coronary effluent during ischemia and reperfusion, but this was prevented by glyburide.CONCLUSION:
The results suggest that isoflurane reduces hydroxyl radical formation, at least in part, through activation of KATP channels. 相似文献20.
Erica S. Spatz MD MHS Sameer D. Sheth MD Kensey L. Gosch MS Mayur M. Desai PhD MPH John A. Spertus MD MPH Harlan M. Krumholz MD SM Joseph S. Ross MD MHS 《Journal of general internal medicine》2014,29(6):862-869