An association between anxiety and neurocardiogenic syncope during head-up tilt table testing

To study the association between anxiety and neurocardiogenic syncope as determined by head-up tilt table testing (HUT) in men and women with presyncope or syncope, patients with unexplained syncope or presyncope undergoing HUT were asked to complete the Burns Anxiety Inventory (BAI), a validated inventory of 33 questions with responses graded from 0 to 3. HUT consisted of a 30-minute tilt to 60 degrees, which if negative, was repeated with an isoproterenol infusion. A positive HUT was defined as symptomatic hypotension and/or bradycardia. Of the 66 patients who completed the BAI and underwent HUT, 33 were men and 33 were women. The mean age was 57 +/- 18 years (17-91 years). Patients with a positive HUT had a higher BAI score than those with a negative HUT (22 +/- 12 vs 14 +/- 13, P = 0.017). This association was stronger in women with a BAI score of 24 +/- 11 in those with a positive HUT versus 13 +/- 8 in those with a negative HUT (P = 0.005). In contrast, the mean BAI score for men with a positive HUT was 19 +/- 13, as compared to 15 +/- 16 for a negative HUT (P = 0.5). In conclusion, the present study demonstrates a statistical association between anxiety (as determined by BAI) and HUT result. Gender-based analysis revealed a more statistically significant relationship between anxiety and HUT outcome for women as compared to men.     

Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations

BackgroundLumbar spinal stenosis (LSS) leads patients to adapt their posture and walking parameters. Pelvic retroversion might be a compensation mechanism of pain. Pelvic and lower limbs compensations during gait are still not precisely understood, as well as the effect of a surgical decompression on them. These dynamic parameters can be studied through three-dimensional gait analysis.Research questionIs the dynamic pelvic tilt modified after decompression surgery in LSS patients compared to asymptomatic subjects?Material and methods50 asymptomatic subjects (C-group) and 37 patients operated on for lumbar decompression underwent a three-dimensional gait analysis one month before (M0) and six months after (M6) the surgery. 3D gait analysis was performed and hip and knee flexion, trunk kinematics, walking speed, stride length and pelvic tilt during gait or dynamic pelvic tilt (dPT) were recorded. Health-related quality of life (HRQL) scores (Oswestry Disability Index (ODI) and Visual Analogic Scales (VAS)) and radiological assessment were performed preoperatively and postoperatively.ResultsMean values of maximum and minimum dPT in the LSS-group preoperatively were significantly higher compared to the C-group (respectively 10.9 (6.2)° versus 7.3 (5.6)°, p = 0.003; 7.7 (6.1)° versus 4.8 (5.8)°, p = 0.011), and were significantly lowered at M6 (respectively 10.9 (6.2)° versus 8.1 (4.8)°, p = 0.0087; and 7.7 (6.1)° versus 5.1 (4.7)°, p = 0.012), and became similar to the C-group. The dPT range of motion at M0 and M6 were similar, and were both significantly higher than control values. Mean values of maximum and minimum hip flexion were significantly higher at M0 compared to the C-group, and were significantly lowered at M6. No difference was found between the pre- and postoperative radiographic pelvic tilt. The VAS for lumbar pain, the VAS for radicular pain and the ODI were significantly decreased at M6.SignificanceCompared to asymptomatic people, LSS patients walked with a pelvic anteversion, a hip flessum and a knee flessum before surgery, which tended to disappear after the surgical decompression. These differences were not noticed on static radiographs.     

Usefulness and safety of shortened head-up tilt testing potentiated with sublingual glyceryl trinitrate in older patients with recurrent unexplained syncope

OBJECTIVES: To evaluate the sensitivity and tolerability of shortened, glyceryl trinitrate (GTN)-potentiated, head-up tilt test (HUT) in patients older and younger than 65 with unexplained syncope and to compare the specificity of GTN-potentiated HUT (GTN-HUT) in older and younger controls. DESIGN: Methodological study. SETTING: Syncope units in secondary and tertiary hospitals. PARTICIPANTS: Three hundred twenty-four consecutive patients with unexplained syncope (100 aged > or =65 (mean age +/- standard deviation 73 +/- 6; 35 men) and 224 aged <65 (41 +/- 15; 111 men)) and 64 controls (29 aged > or =65 (73 +/- 6; 13 men) and 35 aged <65 (42 +/- 13; 16 men)). INTERVENTION: Patients and controls were tilted upright to 60 degrees for 20 minutes. If syncope did not occur, sublingual GTN (400 microg) was administered and 60 degrees HUT was continued for 15 minutes. Responses were classified as positive, negative, or exaggerated (slow decrease in blood pressure with a slight decrease in heart rate after GTN). MEASUREMENTS: Electrocardiogram and arterial pressure were monitored continuously. RESULTS: GTN-HUT was positive in 60% and 66% (NS), negative in 29% and 33% (NS), and exaggerated in 11% and 1% (P <.001) of older and younger patients, respectively. In older and younger controls, the GTN-HUT was negative in 70% and 86% and exaggerated in 28% and 9% of cases, respectively, (P <.05). The overall specificity (considering as negative also the exaggerated responses) was 97% in older and 94% in younger subjects. No patient or control experienced serious side effects. CONCLUSION: The shortened GTN-HUT provides satisfactory positivity rate and specificity in older patients. This test may be considered as a diagnostic tool in assessing recurrent unexplained syncope in older patients.     

30 d头低位卧床期间体育锻炼对立位耐力、运动耐力和心率变异性的影响

目的:观察和比较30 d -6°头低位卧床期间下肢肌力训练和自行车功量计训练对立位耐力、最大运动时间、体质量以及心率变异性（HRV）的影响,旨在进一步明确体育锻炼方法对失重所致心血管失调的对抗效果,为制定我国载人航天飞行时航天员失重对抗方案提供实验依据。方法:15名男性健康被试者,随机分为对照组、下肢肌力训练组和自行车功量计训练组3组,每组5人。对照组仅-6°头低位卧床30 d,不进行任何处理,下肢肌力训练组和自行车功量计训练组在30 d卧床期间分别进行下肢肌力训练和自行车功量计训练。实验前后测量立位耐力、最大运动时间,实验期间测量体质量及HRV。结果:卧床30 d,对照组的立位耐力较卧床前显著降低（P<0.01）,而下肢肌力训练组和自行车功量计训练组的立位耐力较卧床前有所降低,但未达到显著水平。卧床第30 d,对照组和下肢肌力训练组的最大运动时间较卧床前显著降低（P<0.05）,而自行车功量计训练组较卧床前无明显变化,且较对照组和下肢肌力训练组显著升高（P<0.05）。卧床期间,对照组体质量较卧床前有降低趋势,下肢肌力训练组有升高趋势,自行车功量计训练组无明显变化;卧床第10 d,下肢肌力训练组体质量较对照组显著增加（P<0.05）。HRV分析发现,卧床期间对照组归一化低频（LFn）、低频功率与高频功率的比值（LF/HF）较卧床前有升高趋势,归一化高频（HFn）有降低趋势,两锻炼组上述指标变化与对照组相似。结论:30 d头低位卧床可引起立位耐力和运动耐力显著降低,心血管自主神经调节均衡性发生改变。下肢肌力训练在一定程度上能够提高模拟失重后的立位耐力,而自行车功量计训练可提高模拟失重后的立位耐力和运动耐力。     

Reasons for using power tilt: perspectives from clients and therapists

Purpose: A power tilt wheelchair allows independence in changing body position to address a variety of needs throughout the day; however, literature and clinical practice suggest that actual use varies greatly. This grounded theory study examined how power tilt was used in daily life from the perspectives of adults who used power tilt and therapists who prescribed this technology.

Methods: A constant comparative approach was used to collect and analyze interview data from five people who use power tilt and six therapists who prescribe this technology.

Results: This paper presents the findings specific to understanding the reasons why power tilt was used, focusing on the relationships between tilt use and (1) the reasons for use, (2) the reasons for prescribing power tilt and (3) the associated amplitudes of tilt.

Conclusions: This study advances knowledge related to how power tilt is used in daily life by elucidating that how the reasons for use are conceptualized is complex. The three relationships related to the reason for power tilt use identified in this paper have the potential to influence the quality of communication about power tilt use in clinical practice between therapist and client and in research between researcher and participant.

• Implications for Rehabilitation:

• Understanding the inconsistencies and variations in how power tilt is used in daily life is dependent on exploring the reasons beyond the words or terms expressed to describe use.

• Reasons for tilt use are context dependent, particularly the activity occurring at the time of tilt use, the associated amplitude of tilt and the influence of other reasons occurring at the same time.

     

年龄和性别对直立倾斜试验诊断血管迷走性晕厥结果的影响

目的：探讨年龄和性别对疑似血管迷走性晕厥（VVS）患者进行直立倾斜试验(HUTT)诊断结果的影响。
　　方法：收集2008-08至2012-12在阜外心血管病医院进行HUTT检查的患者共1223例,其中男性549例。患者年龄7~79岁,按年龄依次分为≤20岁组、21~40岁组、41~60岁组和＞60岁组。HUTT包括30 min的基础试验阶段和（或）20 min的药物（硝酸甘油）试验阶段。根据阳性患者血压和心电学的变化,VVS分为血管抑制型、心脏抑制型和混合型。
　　结果：HUTT阳性率为51%（624/1223例）,女性阳性率高于男性（60.1%vs 39.9%,P=0.001）。四组阳性率依次为68.3%、49.1%、48.6%和47.9%。阳性患者中混合型占51.4%(321例),血管抑制型占28.7%(179例),心脏抑制型占19.9%(124例)。HUTT阳性类型的分布受年龄因素的影响(男性：χ2=15.65, P=0.016;女性：χ2=18.84,P=0.004),性别间差异无统计学意义（P>0.05）。基础试验阶段74.8%的阳性反应出现在试验开始后22.5（17.5~27.5）min,但无年龄性别差异（P>0.05）;药物试验阶段81.9%的阳性反应出现在试验开始后7.5（5~10）min,女性发生阳性反应的时间比男性提前（7.5 min vs 10 min,P=0.004）,无年龄差异。
　　结论：HUTT诊断VVS的阳性率、阳性分型和发生阳性反应的时间存在年龄和性别差异。     

自主神经介导性晕厥儿童在直立倾斜试验中阳性反应与并发症的早期发现和处理

目的探讨如何早期发现并及时处理自主神经介导性晕厥(NMS)患儿在直立倾斜试验(HUTT)中的阳性反应与并发症。方法回顾分析行HUTT检查阳性确诊NMS患儿的临床资料。结果 201例NMS患儿中,男性95例、女性106例,年龄7岁4月～16岁9月,血管迷走性晕厥(VVS)103例、体位性心动过速综合征(POTS)98例。患儿在HUTT中,晕厥再现5例(2.5%),均为VVS;出现并发症200例(99.5%),其中窦性心动过速182例(90.5%)、窦性心动过缓38例(18.9%),包括心率骤升骤降20例(10.0%),心脏停搏2例(1.0%),交界性逸搏心律2例(1.0%),II度房室传导阻滞1例(0.5%),房性早搏1例(0.5%),抽搐2例(1.0%),暂时性失语2例(1.0%)。达到阳性反应后迅速将倾斜床恢复至水平位,晕厥者予以吸氧并抬高及按摩双下肢,心脏停搏者予以胸外心脏按压,部分清醒后予口服牛奶等处理,全部患儿短时间内临床表现消失,意识、心率、血压、心电图恢复正常,无遗留后遗症及死亡病例。181例(90.0%)患儿在HUTT中有晕厥先兆,108例(53. 7%)先有晕厥先兆其后达到阳性反应标准,其中103例在晕厥先兆出现后的8分钟内达到阳性反应标准;47例(23.4%)晕厥先兆与到阳性反应几乎同时出现。结论 NMS儿童在HUTT时存在一定风险,早期发现并及时处理阳性反应和并发症,是降低试验风险的关键。     

扫频OCTCASIA2测量白内障患者术前晶状体与术后人工晶状体偏心和倾斜的相关性

目的：应用眼前节扫频OCT CASIA2研究白内障患者术前晶状体和术后人工晶状体（IOL）偏心和 倾斜的相关性。方法：自身对照研究。纳入2020年3月至7月于川北医学院附属医院接受白内障手 术的患者109例（157眼）,其中右眼80眼,左眼77眼,年龄为48~88（69.8±9.1）岁。应用CASIA2 于白内障手术前、术后1周测量散瞳前、后晶状体和IOL的偏心和倾斜,3次测量并取其矢量平均 值。采用Pearson相关分析术后IOL与术前晶状体相同指标间的相关性。结果：在散瞳前,白内障 患者右眼术后IOL偏心量与术前晶状体无相关性,术后IOL偏心轴向、倾斜度及倾斜轴向与术前 晶状体的相同指标均分别呈正相关（r=0.48, P<0.001; r=0.53, P<0.001; r=0.36, P=0.002）;左眼术后 IOL偏心量与术前晶状体同样无相关性,术后IOL倾斜度与术前晶状体的倾斜度呈中等强度相关 性（r=0.44, P＜0.001）,术后IOL偏心轴向、倾斜轴向与术前晶状体的相同指标分别呈较强相关性 （r=0.62, P<0.001; r=0.91, P<0.001）。散瞳后测量,右眼术后IOL偏心量与术前晶状体呈弱相关性 （r=0.26, P=0.024）,右眼术后IOL偏心轴向、倾斜度和倾斜轴向与术前晶状体的相同指标均分别成正 相关性（r=0.34, P=0.004; r=0.56, P<0.001; r=0.36, P=0.002）;左眼术后IOL偏心量与术前晶状体无相 关性,左眼术后IOL与术前晶状体的偏心轴向、倾斜度及倾斜轴向均分别呈较强的正相关性（r=0.64, P=0.010; r=0.55, P<0.001; r=0.93, P<0.001）。结论：除偏心量外,CASIA2测量白内障患者术后IOL 和术前晶状体的偏心轴向、倾斜度和倾斜轴向均分别呈正相关,且倾斜轴向的相关性最高。临床可 参考白内障术前晶状体的偏心和倾斜,为患者选择更合适的IOL。     

高度近视眼不同程度视盘倾斜患者临床特征分析

目的 分析高度近视(HM)眼不同程度视盘倾斜患者的临床特征。方法 横断面研究。纳入2021年4月至12月在成都中医药大学附属医院就诊的HM患者60例120眼,依据用视盘椭圆指数(OI)衡量的视盘倾斜程度分为4组,无视盘倾斜(OI>0.80)组31眼,轻度视盘倾斜(OI为>0.75～0.80)组27眼,中度视盘倾斜(OI为>0.70～0.75)组24眼,重度视盘倾斜(OI≤0.70)组38眼。分析视盘倾斜程度与眼部生物学参数及眼底改变的关系。结果 无视盘倾斜组、轻度视盘倾斜组、中度视盘倾斜组和重度视盘倾斜组患眼的眼压、角膜厚度、前房深度比较差异均无统计学意义(均为P>0.05),4组患眼间最佳矫正视力、等效球镜度、眼轴长度、黄斑中心凹下脉络膜厚度及眼底黄斑病变的发生率比较差异均有统计学意义(均为P=0.000)。随着视盘倾斜程度加重,HM眼呈现出最佳矫正视力更差、等效球镜度更大、眼轴长度更长、黄斑中心凹下脉络膜厚度更薄、更易合并眼底黄斑病变的趋势。有视盘旋转的HM眼底黄斑病变的发生率为24.39%,低于无视盘旋转的HM眼底黄斑病变的发生率43.04%,差异有统计学...