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581.
Tim Kinnaird Richard Anderson Sean Gallagher Alex Sirker Peter Ludman Mark de Belder Samuel Copt Keith Oldroyd Nick Curzen Adrian Banning Mamas Mamas 《JACC: Cardiovascular Interventions》2018,11(24):2480-2491
Objectives
Using the British Cardiovascular Intervention Society percutaneous coronary intervention (PCI) database, temporal trends, predictors, and outcomes of radial access (RA) versus femoral access (FA) for unprotected left main stem percutaneous coronary intervention (LMS-PCI) were studied.Background
Data on arterial access site for LMS-PCI are poorly defined.Methods
Data were analyzed from 19,482 LMS-PCI procedures performed in England and Wales between 2007 and 2014. Multivariate logistic regression was used to identify predictors of access site choice and its association with outcomes.Results
The frequency of FA use fell from 77.7% in 2007 to 31.7% in 2014 (p < 0.001 for trend). In the most contemporary study years (2012 to 2014), the strongest associates of FA use for unprotected LMS-PCI were renal disease, PCI for restenosis, chronic total occlusion intervention, and female sex. Use of intravascular imaging and chronic anticoagulation were associated with a higher likelihood of RA use. Complexity of the PCI procedure in the RA cohort increased significantly during the study period. Length of stay was shorter (2.6 ± 9.2 vs. 3.6 ± 9.0; p < 0.001) and same day discharge greater (43.0% vs. 26.6%; p < 0.001) with RA use. After propensity matching, RA use was associated with significant reductions in in-hospital events including access site arterial complications, major bleeding, and major adverse cardiovascular events. Conversion to RA for LMS-PCI was associated with similar reductions in the whole patient cohort. RA use was not associated with lower 12-month mortality.Conclusions
In contemporary practice, the radial artery is the predominant access site for unprotected LMS-PCI, and its use is associated with shorter length of stay, less vascular complications, and less major bleeding than femoral access. 相似文献582.
目的:研究使用ω-9单不饱和脂肪酸对精准肝切除术后病人恢复的影响。方法:选择接受精准肝切除的病人70例,随机、双盲分为两组,术后使用等氮、等热量PN支持。研究组病人使用ω-9单不饱和脂肪酸脂肪乳,对照组病人单纯使用中长链脂肪乳。分别于术后第l、3、7天清晨抽取静脉血,检测肝功能、前清蛋白、C反应蛋白、降钙素原、细胞因子(IL-6)和丙二醛等;同时记录病人术后感染性并发症的发生率、术后住院时间和住院费用等指标。结果:研究组病人术后肝功能恢复优于对照组;两组病人手术后前清蛋白和C反应蛋白无显著性差异;研究组病人术后C反应蛋白、降钙素原、细胞因子(IL-6、IL-10)和丙二醛等均优于对照组(P0.05);两组病人感染性并发症的发生率、术后住院时间和费用均无显著性差异。结论:ω-9单不饱和脂肪酸有助于改善精准肝切除病人术后肝功能的恢复和减轻氧化应激损伤。 相似文献
583.
Bas R. Aerts P. Paul Kuijer Annechien Beumer Denise Eygendaal Monique H. Frings-Dresen 《Archives of physical medicine and rehabilitation》2018,99(9):1818-1826
Objective
To test a 17-item questionnaire, the WOrk-Related Questionnaire for UPper extremity disorders (WORQ-UP), for dimensionality of the items (factor analysis) and internal consistency.Design
Cross-sectional study.Setting
Outpatient clinic.Participants
A consecutive sample of patients (N=150) consisting of all new referral patients (either from a general physician or other hospital) who visited the orthopedic outpatient clinic because of an upper extremity musculoskeletal disorder.Interventions
Not applicable.Main Outcome Measures
Number and dimensionality of the factors in the WORQ-UP.Results: Four factors with eigenvalues (EVs) >1.0 were found. The factors were named exertion, dexterity, tools & equipment, and mobility. The EVs of the factors were, respectively, 5.78, 2.38, 1.81, and 1.24. The factors together explained 65.9% of the variance. The Cronbach alpha values for these factors were, respectively, .88, .74, .87, and .66.Conclusions
The 17 items of the WORQ-UP resemble 4 factors—exertion, dexterity, tools & equipment, and mobility—with a good internal consistency. 相似文献584.
585.
目的：探讨不同单肺通气模式对于呼吸功能及七氟醚FA／FI的影响。方法：选取本院2012年1月-2014年1月45例行开胸肺叶切除并行单肺通气（OLV）的患者,按照随机数字表法分为A、B和C组各15例。A组行定容通气,B组行定压通气,C组行小潮气量联合PEEP通气。比较三组双肺通气（TLV）后10min以及OLV后20、45、70min时的生命体征以及气道压变化;OLV20min时,三组均予以吸入1．5％七氟醚20min,记录并比较三组肺泡七氟醚浓度以及吸入浓度比（FA／FI）。结果：OLV后,T2～T4时,三组的气道峰压均有所升高,但A、B两组均明显升高（P〈0．05）,三组肺顺应性均有所降低,其中A、c组均明显降低（P〈0．05）;三组肺内分流率均明显升高,但C组明显低于A、B组（P〈0．05）;三组动脉血氧分压均明显降低（P〈O．05）,但组间比较差异无统计学意义（P〉0．05）。在初期8min内,B组的FA／FI明显高于c组,随着时间的延长,三组的FA／FI趋于一致。结论：在单肺通气状态下实施定压通气有利于提高患者的肺部顺应性,但对于麻醉药物的FA／FI无明显影响。 相似文献
586.
587.
588.
Inmaculada Pérez-Sánchez Antonio José Romero-Puche Esperanza García-Molina Sáez María Sabater-Molina José María López-Ayala Carmen Muñoz-Esparza David López-Cuenca Gonzalo de la Morena Francisco José Castro-García Juan Ramón Gimeno-Blanes 《Revista espa?ola de cardiología》2018,71(3):146-154
Introduction and objectives
Hypertrophic cardiomyopathy (HCM) is a disorder with variable expression. It is mainly caused by mutations in sarcomeric genes but the phenotype could be modulated by other factors. The aim of this study was to determine whether factors such as sex, systemic hypertension, or physical activity are modifiers of disease severity and to establish their role in age-related penetrance of HCM.Methods
We evaluated 272 individuals (mean age 49 ± 17 years, 57% males) from 72 families with causative mutations. The relationship between sex, hypertension, physical activity, and left ventricular hypertrophy was studied.Results
The proportion of affected individuals increased with age. Men developed the disease 12.5 years earlier than women (adjusted median, 95%CI, –17.52 to –6.48; P < .001). Hypertensive patients were diagnosed with HCM later (10.8 years of delay) than normotensive patients (adjusted median, 95%CI, 6.28-17.09; P < .001). Individuals who performed physical activity were diagnosed with HCM significantly earlier (7.3 years, adjusted median, 95%CI, –14.49 to –1.51; P = .016). Sex, hypertension, and the degree of physical activity were not significantly associated with the severity of left ventricular hypertrophy. Adjusted survival both free from sudden death and from the combined event were not influenced by any of the exploratory variables.Conclusions
Men and athletes who are carriers of sarcomeric mutations are diagnosed earlier than women and sedentary individuals. Hypertensive carriers of sarcomeric mutations have a delayed diagnosis. Sex, hypertension, and physical activity are not associated with disease severity in carriers of HCM causative mutations.Full English text available from: www.revespcardiol.org/en 相似文献589.
Peter H. Stone Akiko Maehara Ahmet Umit Coskun Charles C. Maynard Marina Zaromytidou Gerasimos Siasos Ioannis Andreou Dimitris Fotiadis Kostas Stefanou Michail Papafaklis Lampros Michalis Alexandra J. Lansky Gary S. Mintz Patrick W. Serruys Charles L. Feldman Gregg W. Stone 《JACC: Cardiovascular Imaging》2018,11(3):462-471
Objectives
This study sought to determine whether low endothelial shear stress (ESS) adds independent prognostication for future major adverse cardiac events (MACE) in coronary lesions in patients with high-risk acute coronary syndrome (ACS) from the United States and Europe.Background
Low ESS is a proinflammatory, proatherogenic stimulus associated with coronary plaque development, progression, and destabilization in human-like animal models and in humans. Previous natural history studies including baseline ESS characterization investigated low-risk patients.Methods
In the PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) study, 697 patients with ACS underwent 3-vessel intracoronary imaging. Independent predictors of MACE attributable to untreated nonculprit (nc) coronary lesions during 3.4-year follow-up were large plaque burden (PB), small minimum lumen area (MLA), and thin-cap fibroatheroma (TCFA) morphology. In this analysis, baseline ESS of nc lesions leading to new MACE (nc-MACE lesions) and randomly selected control nc lesions without MACE (nc-non-MACE lesions) were calculated. A propensity score for ESS was constructed for each lesion, and the relationship between ESS and subsequent nc-MACE was examined.Results
A total of 145 lesions were analyzed in 97 patients: 23 nc-MACE lesions (13 TCFAs, 10 thick-cap fibroatheromas [ThCFAs]), and 122 nc-non-MACE lesions (63 TCFAs, 59 ThCFAs). Low local ESS (<1.3 Pa) was strongly associated with subsequent nc-MACE compared with physiological/high ESS (≥1.3 Pa) (23 of 101 [22.8%]) versus (0 of 44 [0%]). In propensity-adjusted Cox regression, low ESS was strongly associated with MACE (hazard ratio: 4.34; 95% confidence interval: 1.89 to 10.00; p < 0.001). Categorizing plaques by anatomic risk (high risk: ≥2 high-risk characteristics PB ≥70%, MLA ≤4 mm2, or TCFA), high anatomic risk, and low ESS were prognostically synergistic: 3-year nc-MACE rates were 52.1% versus 14.4% versus 0.0% in high-anatomic risk/low-ESS, low-anatomic risk/low-ESS, and physiological/high-ESS lesions, respectively (p < 0.0001). No lesion without low ESS led to nc-MACE during follow-up, regardless of PB, MLA, or lesion phenotype at baseline.Conclusions
Local low ESS provides incremental risk stratification of untreated coronary lesions in high-risk patients, beyond measures of PB, MLA, and morphology. 相似文献590.
Rita Marinheiro Leonor Parreira Pedro Amador Catarina Sá Tatiana Duarte Marta Fonseca José Farinha Cláudia Lopes Rui Caria 《Revista portuguesa de cardiologia》2018,37(10):835-841