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121.
122.
Oral squamous cell carcinoma of the tongue: Prospective and objective speech evaluation of patients undergoing surgical therapy 下载免费PDF全文
123.
Lower body mass index and atrial fibrillation as independent predictors for mortality in patients with implantable cardioverter defibrillator 总被引:1,自引:0,他引:1 下载免费PDF全文
Aim
To evaluate risk factors related to total mortality in an unselected population of patients implanted with a cardioverter defibrillator.Methods
Survival analysis was performed retrospectively investigating the records of 77 consecutive patients implanted with defibrillators (median 67 years, range 38-83 years; 63 men). All patients were followed regularly in 3-month intervals. The cause of mortality was assessed clinically, including post-mortem examination of device to assess possible arrhythmogenic death. Predictors were evaluated by Kaplan-Meier analysis with log-rank tests and by Cox regression analysis (proportional hazards).Results
Defibrillator recipients had a mean (±SD) ejection fraction of 34 ± 13%, left ventricular end-diastolic dimension (LVEDD) of 6.24 ± 0.8 cm, QRS duration of 129 ± 34 ms, and body mass index (BMI) of 26.4 ± 4.3 kg/m2. Atrial fibrillation was present in 32 patients, paroxysmal fibrillation in 23, and permanent fibrillation in 9 patients. The estimate of mean survival time for all patients was 51.5 (95% confidence interval 46.6-56.5) months. During the study period 11/77 (14%) patients died. Mean follow-up time was 24.5 months (range 0.2-60.7) for survivors and 7.6 months (range 1.5-42) for non-survivors. Independent predictors of mortality were the NYHA class (P = 0.004), BMI≤26 kg/m2 (P = 0.024), presence of paroxysmal or permanent atrial fibrillation (P = 0.014), and absence of arterial hypertension (P = 0.010). LVEDD showed a weak significant effect on survival (P = 0.049).Conclusion
Patients with implantable cardioverter defibrillator and a normal to lower BMI or atrial fibrillation had a significantly higher overall mortality. These factors may be indicative of end stage heart failure or diseases associated with high sympathetic activation.Patients with implantable cardioverter defibrillator, in addition to an intrinsic residual risk of sudden cardiac death due to a reduced effectiveness of defibrillators, have a high incidence of co-morbidities, which increase mortality in this population. Several studies have demonstrated that the implantation of a cardioverter defibrillator for both secondary and primary prevention significantly reduces total mortality by preventing sudden cardiac death (1-3). However, the death rate from non-arrhythmic causes among patients with implantable cardioverter defibrillator is substantial (4) and deserves further investigation. The purpose of this study was to investigate various risk factors with respect to total mortality in an unselected population of patients with implanted cardioverter defibrillator devices. 相似文献124.
Adipose tissue macrophages 总被引:3,自引:0,他引:3
It is now broadly accepted that low-grade chronic inflammation associated with obesity leads to the onset of insulin resistance and type 2 diabetes mellitus. Obesity-associated inflammation is characterized by an increased abundance of macrophages in adipose tissue along with production of inflammatory cytokines. Adipose tissue macrophages (ATMs) are suspected to be the major source of inflammatory mediators such as TNF-alpha and IL-6 that interfere with adipocyte function by inhibiting insulin action. However, ATMs phenotypically resemble alternatively activated (M2) macrophages and are capable of anti-inflammatory mediator production challenging the concept that ATMs are simply the "bad guys" in obese adipose tissue. Triggers promoting ATM recruitment, ATM functions and dysfunctions, and stimuli and molecular mechanisms that drive them into becoming detrimental to their environment are subject to current research. Strategies to interfere with ATM recruitment and adverse activation could give rise to novel options for treatment and prevention of insulin resistance and type 2 diabetes mellitus. 相似文献
125.
Dan Bieler Thomas Paffrath Annelie Schmidt Maximilian Vollmecke Rolf Lefering Martin Kull Erwin Kollig Axel Franke Sektion NIS of the German Trauma Society 《中华创伤杂志(英文版)》2020,23(4):224-232
Purpose: The mortality rate for severely injured patients with the injury severity score (ISS) 16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients.
Methods: In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS 16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism,
conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room.
Results: We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention.
Conclusion: Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely
injured patients. 相似文献
126.
Maximilian
Krämer Christoph Rösmann Frank Hoffmann Torsten Bertram 《Optimal control applications & methods.》2020,41(4):1211-1232
Collaborative robots have to adapt its motion plan to a dynamic environment and variation of task constraints. Currently, they detect collisions and interrupt or postpone their motion plan to prevent harm to humans or objects. The more advanced strategy proposed in this article uses online trajectory optimization to anticipate potential collisions, task variations, and to adapt the motion plan accordingly. The online trajectory planner pursues a model predictive control approach to account for dynamic motion objectives and constraints during task execution. The prediction model relates reference joint velocities to actual joint positions as an approximation of built-in robot tracking controllers. The optimal control problem is solved with direct collocation based on a hypergraph structure, which represents the nonlinear program and allows to efficiently adapt to structural changes in the optimization problem caused by moving obstacles. To demonstrate the effectiveness of the approach, the robot imitates pick-and-place tasks while avoiding self-collisions, semistatic, and dynamic obstacles, including a person. The analysis of the approach concerns computation time, constraint violations, and smoothness. It shows that after model identification, order reduction, and validation on the real robot, parallel integrators with compensation for input delays exhibit the best compromise between accuracy and computational complexity. The model predictive controller can successfully approach a moving target configuration without prior knowledge of the reference motion. The results show that pure hard constraints are not sufficient and lead to nonsmooth controls. In combination with soft constraints, which evaluate the proximity of obstacles, smooth and safe trajectories are planned. 相似文献
127.
To complement the 2005 Annual Clinical Focus on medical genomics, AFP is publishing a series of short reviews on genetic syndromes. This series was designed to increase awareness of these diseases so that family physicians can recognize and diagnose children with these disorders and understand the type of care they might require in the future. This review discusses Prader-Willi syndrome. 相似文献
128.
Mark Christopher Snoddy Maximilian Frank Lang Thomas J. An Phillip Michael Mitchell William Jeffrey Grantham Benjamin Scoot Hooe Harrison Ford Kay Ritwik Bhatia Rachel V. Thakore Jason Michael Evans William Todd Obremskey Manish Kumar Sethi 《International orthopaedics》2014,38(8):1711-1716
Purpose
We evaluated factors influencing re-operation in tension band and plating of isolated olecranon fractures.Methods
Four hundred eighty-nine patients with isolated olecranon fractures who underwent tension band (TB) or open reduction internal fixation (ORIF) from 2003 to 2013 were identified at an urban level 1 trauma centre. Medical records were reviewed for patient information and complications, including infection, nonunion, malunion, loss of function or hardware complication requiring an unplanned surgical intervention. Electronic radiographs of these patients were reviewed to identify Orthopaedic Trauma Association (OTA) fracture classification and patients who underwent TB or ORIF.Results
One hundred seventy-seven patients met inclusion criteria of isolated olecranon fractures. TB was used for fixation in 43 patients and ORIF in 134. No statistical significance was found when comparing complication rates in open versus closed olecranon fractures. In a multivariate analysis, the key factor in outcome was method of fixation. Overall, there were higher rates of infection and hardware removal in the TB compared with the ORIF group.Conclusions
Our results demonstrate that the dominant factor driving re-operation in isolated olecranon fractures is type of fixation. When controlling for all variables, there is an increased chance of re-operation in patients with TB fixation. 相似文献129.
Boris Michael Holzapfel Hakan Pilge Peter Michael Prodinger Andreas Toepfer Susanne Mayer-Wagner Dietmar Werner Hutmacher Ruediger von Eisenhart-Rothe Maximilian Rudert Reiner Gradinger Hans Rechl 《International orthopaedics》2014,38(7):1435-1442
Purpose
We sought to analyse clinical and oncological outcomes of patients after guided resection of periacetabular tumours and endoprosthetic reconstruction of the remaining defect.Methods
From 1988 to 2008, we treated 56 consecutive patients (mean age 52.5 years, 41.1 % women). Patients were followed up either until death or February 2011 (mean follow up 5.5 years, range 0.1–22.5, standard deviation ± 5.3). Kaplan–Meier analysis was used to estimate survival rates.Results
Disease-specific survival was 59.9 % at five years and 49.7 % at ten and 20 years, respectively. Wide resection margins were achieved in 38 patients, whereas 11 patients underwent marginal and seven intralesional resection. Survival was significantly better in patients with wide or marginal resection than in patients with intralesional resection (p = 0.022). Survival for patients with secondary tumours was significantly worse than for patients with primary tumours (p = 0.003). In 29 patients (51.8 %), at least one reoperation was necessary, resulting in a revision-free survival of 50.5 % at five years, 41.1 % at ten years and 30.6 % at 20 years. Implant survival was 77.0 % at five years, 68.6 % at ten years and 51.8 % at 20 years. A total of 35 patients (62.5 %) experienced one or more complications after surgery. Ten of 56 patients (17.9 %) experienced local recurrence after a mean of 8.9 months. The mean postoperative Musculoskeletal Tumor Society (MSTS) score was 18.1 (60.1 %).Conclusion
The surgical approach assessed in this study simplifies the process of tumour resection and prosthesis implantation and leads to acceptable clinical and oncological outcomes. 相似文献130.
Oleg Rud Marcus Horstmann Atiqullah Aziz Hans-Martin Fritsche Sabine Brookman-May Christian Gilfrich Maximilian Burger Matthias May 《World journal of urology》2014,32(3):691-695