Relation of heart rate recovery after exercise testing to coronary artery calcification

Background: We examined whether slow heart rate recovery (HRR) after exercise testing as an estimate of impaired autonomic function is related to coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis.

Methods: We evaluated 2088 men who participated in a health-screening program that included measures of CAC and peak or symptom-limited cardiopulmonary exercise testing. HRR was calculated as the difference between peak heart rate (HR) during exercise testing and the HR at 2?min of recovery after peak exercise. We measured CAC using multidetector computed tomography to calculate the Agatston coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th percentile for each age group.

Results: HRR was negatively correlated with CAC (r?=??.14, p?52 bpm). Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after adjusting for potential confounders.

Conclusions: An attenuated HRR after exercise testing is associated with advanced CAC, independent of coronary risk factors and other related hemodynamic response.

• KEY MESSAGES

• Slow heart rate recovery (HRR) after maximal exercise testing, indicating decreased autonomic function, is associated with an increased risk of cardiovascular event and mortality.

• Slow HRR has been linked with the occurrence of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is associated with an increased risk of coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis.

• An attenuated HRR after exercise testing was associated with advanced CAC, independent of coronary risk factors and other potential hemodynamic confounder, supporting the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery disease.

     

Identifying Reasons for Failed Same-Day Discharge Following Primary Total Hip Arthroplasty

Background

As total hip arthroplasty (THA) gains popularity in ambulatory surgery centers, it is important to understand the causes of failed same-day discharge (SDD). The purpose of this study is to (1) identify reasons for an overnight stay among patients selected as candidates for SDD following THA and (2) determine what pre-operative factors are more common among patients who fail SDD.

How does the application of surgical components in enhanced recovery programs for colorectal surgery change over time?

Background

Enhanced recovery programs (ERP) improve post-operative outcomes in proportion to how fully they are implemented. Maintaining an optimal level of application of all the ER components is thus essential. Our aim was to assess the sustainability of ER surgical components 2 years after their first implementation.

Resuscitation from cardiac arrest in cats: influence of epinephrine dosage on brain recovery

The quality of brain recovery after cardiac arrest depends crucially on the speed of cardiac resuscitation because the low cerebral perfusion pressure during the resuscitation procedure facilitates the development of no-reflow. To accelerate return of spontaneous circulation, high dose epinephrine has been recommended but the effect on the dynamics of early brain recovery is still unknown. We, therefore, studied the dynamics of brain resuscitation after cardiopulmonary resuscitation (CPR) with standard and high dose epinephrine using non-invasive NMR techniques. Fifteen min cardiac arrest was induced in normothermic cats by ventricular fibrillation. CPR was performed using an inflatable pneumatic vest for cyclic chest compression. With the beginning of CPR the standard dose group received 0.02 mg/kg epinephrine (n = 6) and the high dose group received 0.2 mg/kg (n = 8). Brain recovery was monitored by magnetic resonance imaging of the apparent diffusion coefficient (ADC) of water for 3 h. Although high dose epinephrine treatment led to a significantly higher blood pressure during early reperfusion, rapidly changing heterogeneities of early brain recovery were observed in both groups. High dose epinephrine thus does not improve the quality of post-cardiac arrest brain recovery during the first 3 h of reperfusion.     

纳洛酮治疗促进丘脑出血患者运动语言功能的恢复

目的:探讨纳洛酮对丘脑部高血压脑出血患者运动、语言功能的促进恢复作用。方法:44例丘脑部高血压脑出血并破入脑室内患者随机分成纳洛酮组和对照组,纳洛酮组22例,每天持续静脉注射纳络酮4.8mg,同时每天从脑室引流管中分10次共注入纳洛酮4mg,连续应用10d。对照组除未用纳洛酮外,其他治疗方法皆同纳洛酮组。同时观测两组患者第1,3,7,10天的哥拉斯格昏迷评分(GCS),代表患者的意识状况,大脑中动脉(MCA)的血流速度,血液流变学变化,血糖浓度,应激性溃疡发生率,语言和运动功能评分,哥拉斯格结局评分(GOS)评分。结果:纳洛酮组的GCS评分于第7天12.12±3.05,第10天12.66±3.25明显高于对照组10.23±4.01,10.89±4.21(P<0.05);纳洛酮组第3～7天内的MCA的平均血流速度、平均全血黏稠度和红细胞变形指数皆低于对照组(P<0.05);随访2个月时的运动、语言功能评分和GOS评分纳洛酮组皆高于对照组(P<0.05);纳洛酮组第7,10的血糖浓度低于对照组较接近正常值,应激性溃疡的发病率也较对照组低。结论:早期、多途径、大剂量应用纳洛酮能有效保护脑神经功能,降低机体损伤后应激反应的程度,促进脑神经功能的恢复。     

加速康复外科策略中使用帕瑞昔布钠对胃癌根治术患者术后恢复的影响

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)策略中围术期使用帕瑞昔布钠对胃癌根治患者术后恢复的影响。方法选择2016年6月至2017年5月胃癌根治术患者60例,男40例,女20例,年龄18～65岁,BMI 18～30kg/m2,ASAⅠ—Ⅲ级。采用随机数字表法随机分为帕瑞昔布钠组(P组)和对照组(S组),每组30例。P组术前30min帕瑞昔布钠40mg+生理盐水稀释至5ml缓慢静推,术后每间隔12h静推帕瑞昔布钠40mg,连续使用3d;S组术前30min生理盐水5ml缓慢静推,术后每间隔12h静推生理盐水5ml,连续使用3d。两组围术期均采用ERAS策略,术后均给予舒芬太尼PCIA。记录两组患者术前(T0)、术后12h(T1)、24h(T2)和48h(T3)静息和咳嗽时VAS评分,术后24h内PCIA有效按压次数和舒芬太尼用量;检测术后2、5d炎性因子和癌胚抗原(CEA)浓度;记录术后排气时间、术后住院时间、术后切口感染、炎性肠梗阻和肺部感染等并发症的发生情况。结果 T1和T2时P组静息和咳嗽时VAS评分明显低于S组(P0.05);术后24h内P组PCIA有效按压次数和舒芬太尼用量明显少于S组(P0.05)。术后2dP组白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)浓度明显低于S组(P 0.05);术后5dP组IL-1β浓度、TNF-α浓度、中性粒细胞绝对数、前列腺素E2(PGE2)和CEA浓度明显低于S组(P0.05)。P组术后排气时间和术后住院时间明显短于S组(P0.05)。两组术后并发症发生率差异均无统计学意义。结论 ERAS策略中使用帕瑞昔布钠能有效减轻胃癌根治术患者术后疼痛和炎症反应,促进术后恢复和缩短术后住院时间,且不增加术后并发症风险。     

Rapid Systematic Review: Intra-Arterial Thrombectomy (“Clot Retrieval”) for Selected Patients with Acute Ischemic Stroke

Background

Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality. However, precisely defining the optimal treatment for individual patients early after AIS onset remains elusive. There has recently been a surge in published studies documenting the effectiveness of mechanical intra-arterial thrombectomy for treatment of a subset of patients with AIS. This therapy has been proposed and studied for the small (<1.2%) subgroup of patients with ischemic strokes who have “large vessel” strokes or strokes that fail to improve after the administration of tissue plasminogen activator (t-PA). The current rapid systematic review provides practicing emergency physicians updated information regarding mechanical thrombectomy as a treatment option for carefully selected AIS patients.

Fast T2-weighted liver MR imaging: comparison among breath-hold turbo-spin-echo, HASTE, and inversion recovery (IR) HASTE sequences

Background: To evaluate the diagnostic efficacy of fast T2-weighted magnetic resonance (MR) imaging sequences on image quality, hepatic lesion detection, and lesion conspicuity. Methods: Three breath-hold, fast T2-weighted sequences with turbo-spin-echo (TSE), half-Fourier acquisition single-shot TSE (HASTE), and inversion recovery (IR) HASTE techniques were examined for 43 lesions in 20 consecutive patients. Evaluation was performed qualitatively on image quality and lesion detectability and quantitatively on lesion conspicuity by using lesion/liver signal-intensity and contrast-to-noise ratios. Results: Artifacts were significantly less present on the HASTE sequence (p < 0.01). Both TSE and HASTE sequences detected 39 lesions (91% each); the IR HASTE sequence detected 37 (86%). IR HASTE sequence showed a significantly higher signal-intensity ratio than did the others (p < 0.01). Conclusions: Breath-hold TSE versus breath-hold HASTE or IR HASTE is still the most robust sequence in lesion detection, image quality, and lesion conspicuity. However, the HASTE sequence offers good lesion detection and image quality, and the IR HASTE has a better signal-intensity ratio. Received: 15 January 1999/Accepted: 24 March 1999