Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

THIS IS THE FIRST OF 2 ARTICLES EVALUATING cardiac events in patients undergoing noncardiac surgery. In this article, we review the magnitude of the problem, the pathophysiology of these events, approaches to risk assessment and communication of risk. The number of patients undergoing noncardiac surgery worldwide is growing, and annually 500 000 to 900 000 of these patients experience perioperative cardiac death, nonfatal myocardial infarction (MI) or nonfatal cardiac arrest. Although the evidence is limited, a substantial proportion of fatal perioperative MIs may not share the same pathophysiology as nonoperative MIs. A clearer understanding of the pathophysiology is needed to direct future research evaluating prophylactic, acute and long-term interventions. Researchers have developed tools to facilitate the estimation of perioperative cardiac risk. Studies suggest that the Lee index is the most accurate generic perioperative cardiac risk index. The limitations of the studies evaluating the ability of noninvasive cardiac tests to predict perioperative cardiac risk reveals considerable uncertainty as to the role of these popular tests. Similarly, there is uncertainty as to the predictive accuracy of the American College of Cardiology / American Heart Association algorithm for cardiac risk assessment. Patients are likely to benefit from improved estimation and communication of cardiac risk because the majority of noncardiac surgeries are elective and accurate risk estimation is important to allow informed patient and physician decision-making.     

Measurement of maximum variability within event related potentials in schizophrenia.

One limitation of averaging individual late component event related potential (ERP) responses is that a single average ERP cannot reflect the variability of responses from epoch to epoch. In this article, we describe a method to quantify this variability and determine if any part of the overall ERP reflects a maximum variance through the use of response variance curves. We then apply this method to one disorder, schizophrenia, in which variability of information processing is hypothesized to underlie aspects of the symptomatology. Response variance curves in a group of unmedicated schizophrenic patients reveal systematic differences, maximal between 190 and 250 ms, compared with those in a group of medicated schizophrenic patients and normal control subjects.     

Resilience in Families with Children and Adult Members with Intellectual Disabilities: Tracing Elements of A Psycho‐Social Model

Aim This paper seeks to illumine how families with children and adult members with intellectual disabilities manage to manifest a buoyant and durable capacity over time. It is therefore concerned centrally with the idea of resilience. Method Drawing from diverse theoretical literatures from child development and protection and gerontology, the paper begins with a review of constructions of resilience. In an attempt to assess where there seems to be support for resilience in families, the core of the paper tests empirical evidence about positive experiences of families supporting children and adults with intellectual disabilities against the theoretical literature on resilience. Result and Conclusions The findings are used to suggest conditions under which resilience is produced and maintained, and to identify emergent elements of a psycho‐social model of resilience in families with children and adult members with intellectual disabilities.     

组织工程小血管摩擦力测量方法的研究与应用

目的设计一套用于组织工程小血管内壁摩擦力测量的装置并对组织工程血管的材料进行初步的测量,以验证装置的可靠性和相关结论。方法根据血液动力学的原理,对血管的力学模型进行分析,确定组织工程血管内皮细胞摩擦力的测量方法,从而设计完成整套装置并对弹性元件进行测量,并进行组织工程降解材料聚羟基乙酸PGA构成的管状支架进行摩擦力的测量。结果设计完成了测量组织工程血管内壁摩擦力的实验装置,弹性元件的牵拉力与位移的关系呈良好的线性关系。聚羟基乙酸PGA管状支架的摩擦力随流速的增加而增加。结论测量组织工程血管内壁摩擦力的实验装置是可行的,聚羟基乙酸PGA管状支架的摩擦力与流速基本呈现线性关系。