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61.
62.
Hans-Joachim Kabitz Hinrich-Cordt Bremer Anja Schwoerer Florian Sonntag Stephan Walterspacher David Johannes Walker Nicola Ehlken Gerd Staehler Wolfram Windisch Ekkehard Grünig 《Lung》2014,192(2):321-328
Purpose
Increased dyspnea and reduced exercise capacity in pulmonary arterial hypertension (PAH) can be partly attributed to impaired respiratory muscle function. This prospective study was designed to assess the impact of exercise and respiratory training on respiratory muscle strength and 6-min walking distance (6MWD) in PAH patients.Methods
Patients with invasively confirmed PAH underwent 3 weeks of in-hospital exercise and respiratory training, which was continued at home for another 12 weeks. Medication remained constant during the study period. Blinded observers assessed efficacy parameters at baseline (I) and after 3 (II) and 15 weeks (III). Respiratory muscle function was assessed by twitch mouth pressure (TwPmo) during nonvolitional supramaximal magnetic phrenic nerve stimulation.Results
Seven PAH patients (4 women; mean pulmonary artery pressure 45 ± 11 mmHg, median WHO functional class 3.1 ± 0.4, idiopathic/associated PAH n = 5/2) were included. The training program was feasible and well tolerated by all patients with excellent compliance. TwPmo was I: 0.86 ± 0.37 kPa, II: 1.04 ± 0.29 kPa, and III: 1.27 ± 0.44 kPa, respectively. 6MWD was I: 417 ± 51 m, II: 509 ± 39 m, and III: 498 ± 39 m, respectively. Both TwPmo (+0.41 ± 0.34 kPa, +56 ± 39 %) and 6MWD (+81 ± 30 m, +20 ± 9 %) increased significantly in the period between baseline and the final assessment (pairwise comparison: p = 0.012/<0.001; RM-ANOVA considering I, II, III: p = 0.037/<0.001).Conclusions
Exercise and respiratory training as an adjunct to medical therapy may be effective in patients with PAH to improve respiratory muscle strength and exercise capacity. Future, randomized, controlled trials should be carried out to further investigate these findings. 相似文献63.
Hans-Joachim Nickenig Ali-Farid Safi Ragai-Edward Matta Joachim E. Zöller Matthias Kreppel 《Journal of cranio-maxillo-facial surgery》2019,47(11):1787-1792
For horizontal bone deficiency alveolar ridge osteotomy is considered an option for augmentation. Major advantages are the option for a one-stage approach and the absence of donor site morbidity. However, the conventional technique is associated with complications such as perforations and fractures of the cortical bone.A case using a 3D based modified, full-guided alveolar ridge expansion is described to explain the technique step by step. Main features of modified technique: successive application of surgical guides for ridge osteotomy and expansion – implementation of virtually determined splitting vector, which allows guided bone splitting along a guide surface of template in an ideal direction - osteotomy as deep as implant length. The example shows that the 3D based modified alveolar ridge osteotomy is a suitable alternative to the conventional technique as it has several advantages such as fewer fractures and perforations of the cortical vestibular bone.The individualized preoperative planning helps to minimize complications. However, long-term outcomes and a study, conducted on a study group, is needed to evaluate the benefits of our presented treatment protocol. 相似文献
64.
Objective
Health economic evaluation of a health insurance based case management intervention for persons with mood to severe depressive disorders from payers’ perspective. Intervention intended to raise utilization rates of outpatient health services.Methods
Comparison of patients of one German health insurance company in two different regions/states. Cohort study consists of a control region offering treatment as usual. Patients in the experimental region were exposed to a case management programme guided by health insurance account manager who received trainings, quality circles and supervisions prior to intervention. Utilization rates of ambulatory psychiatrist and/or psychotherapist should be increased. Estimation of incremental cost effectiveness ratio (ICER) was intended.Results
Intervention yielded benefits for patients at comparable costs. A conservative estimation of the ICER was 44,16 €. Maximum willingness to pay was 378,82 € per year. Sensitivity analyses showed that this amount of maximum willingness to pay can be reduced to 34,34 € per year or 2,86 € per month due to cost degression effects.Conclusions
The intervention gains increasing cost effectiveness by the number of included patients and case managers. Cooperation between health insurances is suggested in order to minimize intervention cost and to maximize patient benefits. Results should be confirmed by individual longitudinal data (bottom-up approach) first. 相似文献65.
Schmitt Friedhelm C. Büntjen Lars Schütze Hartmut Kaufmann Jörn Heinze Hans-Joachim Hinrichs Hermann Tempelmann Claus Düzel Emrah Voges Jürgen 《Zeitschrift für Epileptologie》2020,33(1):42-49
Clinical Epileptology - Wir berichten über einen 30-jährigen Patienten, der mit 21 Jahren an einer fokalen Epilepsie mit epigastrischen Auren und nicht bewusst erlebten... 相似文献
66.
Matthias Zirk Ali-Farid Safi Johannes Buller Hans-Joachim Nickenig Timo Dreiseidler Max Zinser Uta Drebber Joachim E. Zöller Matthias Kreppel 《Journal of cranio-maxillo-facial surgery》2018,46(2):195-200
Background
Recently, lymph node ratio (LNR) has been recognized as an important prognosticator for oral squamous cell carcinoma (OSCC). However, its relevance for the specific subsite floor of mouth (FOM) has not been investigated. This study was conducted to elucidate the prognostic significance of LNR for the subsite FOM among other prognostic factors.Methods
A retrospective study of 155 patients with FOM SCC who received primary curative resection and neck dissection was conducted. We analyzed the impact of LNR among other clinicopathologic variables on overall survival (OS) in univariate and multivariate analysis.Results
In univariate analysis, patients detected with LNR ≤ 0.07 (cutoff-point: 0.07) showed an 85% 5-year OS rate, whereas for patients with LNR > 0.07 the OS rate reached 25% after 5-years (p < 0.001). The 5-year DFS rate was 72% for patients with LNR ≤ 0.07; on the contrary, patients with LNR > 0.07 the 5-year DFS rate was 17% (p < 0.001). LNR was detected as an independent predictor of OS in multivariate analysis (p = 0.032) for the subsite FOM.Conclusion
We concluded that LNR is an important predictor of prognosis in patients with FOM SCC, LNR should be considered in the choice of adjuvant treatment for these patients. 相似文献67.
It is occasionally necessary to repeat diffusion weighted imaging (DWI) after giving intravenous contrast medium (CM). However, the effects of CM on DWI and apparent diffusion coefficients (ADC) have not been fully examined. The aim of this prospective study was to investigate whether there are any diagnostically significant differences between echo-planar imaging (EPI)-DWI before and after intravenous CM. EPI-DWI was acquired twice in 203 consecutive patients before and after i.v. CM. Three blinded readers rated the diagnostic image quality. Quantitative ADC calculations were performed before and after CM in all 72 patients with lesions sufficiently large for quantification, and in 72 normal brain regions. Of the 203 patients, 127 had abnormalities on MRI, including ischaemic stroke (52), bleeding (nine), brain tumour with disturbed blood-brain barrier (BBB) (18) and other lesions (48). There were no significant signal differences on isotropic DWI before and after CM, even in lesions with definite disturbance of the BBB. No statistically significant difference between ADC of lesions and contralateral normal brain was observed. 相似文献
68.
Heme oxygenase does not contribute to control of basal vascular tone in isolated blood-perfused rat lung. 总被引:2,自引:0,他引:2
Takayuki Nakamura Brigitte Vollmar Michael D Menger Kenji Inui Hiromi Wada Hans-Joachim Sch?fers 《The Journal of heart and lung transplantation》2004,23(5):599-605
BACKGROUND: Vasoconstriction in pulmonary ischemia-reperfusion injury may involve dysfunction of the physiologic vasodilation of pulmonary arteries. Little is known of the relative importance of heme oxygenase (HO)/carbon monoxide (CO)-dependent vs nitric oxide synthase (NOS)/nitric oxide (NO)-dependent vasodilation of the pulmonary vasculature. We evaluated the significance of HO function on basal pulmonary vascular resistance (PVR) and compared it with the function of NOS. METHODS: Using an isolated blood-perfusion model, lungs of Lewis rats were assigned to 3 groups (n = 6/group). After stabilization, either an inhibitor of HO (tin-protoporphyrin-9 [SnPP-9]) or an inhibitor of NOS (NG-nitro-L-arginine methylester [L-NAME]) was added to the perfusate (50 micromol/liter and 1 mmol/liter as the final concentration, respectively). Lungs receiving saline served as controls. Gas exchange, hemodynamic and respiratory functions and the levels of cyclic 3',5'-guanosine monophosphate (cGMP) in the perfusate were measured. RESULTS: Inhibition of NOS by L-NAME resulted in a significant (p < 0.01) increase in PVR (DeltaPVR: 0.110 +/- 0.012 cm H(2)O/ml. min) within 5 minutes. In contrast, PVR was minimally affected by SnPP-9 (DeltaPVR: 0.005 +/- 0.005 cm H(2)O/ml. min), which was comparable to control lungs (DeltaPVR: 0.012 +/- 0.005 cm H(2)O/ml. min). The level of cGMP in the perfusate 5 minutes after drug application was markedly, but not significantly, lower in the L-NAME group (1.67 +/- 0.74 nmol/liter) when compared with controls (2.69 +/- 0.89 nmol/liter) and SnPP-9-treated lungs (2.65 +/- 0.66 nmol/liter). CONCLUSIONS: NOS but not HO contributes to the control of basal vascular tone in the rat lung. 相似文献
69.
70.