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Zachary I. Whinnett BM BS B Med Sci Cathy Briscoe BSC MSC Justin E.R. Davies MBBS MRCP Keith Willson MSc MIPEM Charlotte H. Manisty MA MRCP D. Wyn Davies MD FRCP FHRS Nicholas S. Peters MD FRCP FHRS Prapa Kanagaratnam PhD MRCP Alun D. Hughes PhD MBMS Jamil Mayet MD MBA FESC FRCP Darrel P. Francis MD MRCP 《Heart rhythm》2008,5(3):378-386
BACKGROUND: Atrioventricular (AV) optimization of cardiac resynchronization therapy (CRT) is typically calculated at rest. However, patients often become symptomatic during exercise. OBJECTIVE: In this study, we use acute noninvasive hemodynamics to optimize the AV delay of CRT during exercise and investigate whether this exercise optimum can be predicted from a three-phase resting model. METHODS: In 20 patients with CRT, we adjusted the sensed AV delay while the patient exercised on a treadmill up to a heart rate of 100 bpm to identify the hemodynamically optimal value. Separately, at rest, by pacing with three different configurations and calculating the sensed-paced difference, we calculated an "expected" value for the exercise optimum. RESULTS: It was possible to perform AV delay optimization while a patient exercised. The resting three-phase model correlated well with the actual exercise optimal AV delay (r = 0.85, mean difference +/- standard deviation [SD] = 3.7 +/- 17 ms). Simply using measurements made at rest during atrial-sensed pacing showed a poorer correlation with exercise (r = 0.64, mean difference +/- SD = 2.2 +/- 24 ms). The three-phase resting model allows improved exercise hemodynamics to be achieved. Programming according to the three-phase resting model yields an exercise blood pressure of only 0.5 mmHg (+/-1.4 mmHg; P = NS) less than the true exercise optimum, whereas programming the resting sensed optimum yields an exercise blood pressure of 1.4 mmHg (+/-2.2 mmHg, P = .02) less than the true optimum. CONCLUSIONS: Using acute noninvasive hemodynamics and a protocol of alternations, it is possible to optimize the AV delay of cardiac resynchronization devices even while a patient exercises. In clinical practice, the exercise optimum AV delay could be determined from three phases of resting measurements, without performing exercise. 相似文献
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V.S.S.V. Prasad MBMS MCh D.Raja Reddy FRCS FRACS FICS C. Sundaram MD 《Clinical imaging》1994,18(4):275-276
Calcification is an unusual and atypical feature in medulloblastomas. Here we report a case of calcified medulloblastoma in a 5-year-old boy. The clinical correlation of this radiological finding is discussed. 相似文献
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Bernd Bittersohl MD Harish S. Hosalkar MD MBMS FCPS DNB Tanja Haamberg MD Young‐Jo Kim MD Stefan Werlen MD Klaus A. Siebenrock MD Tallal C. Mamisch MD 《Journal of magnetic resonance imaging : JMRI》2009,30(1):224-228
Purpose
To investigate the reproducibility of dGEMRIC in the assessment of cartilage health of the adult asymptomatic hip joint.Materials and Methods
Fifteen asymptomatic volunteers (mean age, 26.3 years ± 3.0) were preliminarily studied. Any volunteer that was incidentally diagnosed with damaged cartilage on MRI (n = 5) was excluded. Ten patients that had no evidence of prior cartilage damage (mean age, 26.2 years ± 3.4) were evaluated further in this study. The reproducibility of dGEMRIC was assessed with two T1Gd exams performed 4 weeks apart in these volunteers. The protocol involved an initial standard MRI to confirm healthy cartilage, which was then followed by dGEMRIC. The second scan included only the repeat dGEMRIC. Region of interest (ROI) analyses for T1Gd‐measurement was performed in seven radial reformats. Statistical analysis included the student's t‐test and intra‐class correlation (ICC) measurement to assess reproducibility.Results
Overall 70 ROIs were studied. Mean cartilage T1Gd values at various loci ranged from 560.9 ms to 684.4 ms at the first set of readings and 551.5 ms to 662.2 ms in the second one. The mean difference per region of interest between the two T1Gd‐measurements ranged from 21.4 ms (3.7%) to 45.0 ms (6.8%), which was not found to be statistically significant (P = 0.153). There was a high reproducibility detected (ICC range, 0.667–0.915). Intra‐ and Inter‐observer analyses proved a high agreement for T1Gd assessment (0.973 and 0.932).Conclusion
We found dGEMRIC to be a reliable tool in the assessment of cartilage health status in adult hip joints. J. Magn. Reson. Imaging 2009;30:224–228. © 2009 Wiley‐Liss, Inc. 相似文献4.
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Amy Sylivris MD Dhruvesh M. Ramson MBBS Jahan C. Penny-Dimri MBBS Zhengyang Liu MD Luke A. Perry MBBS Jessica Au MD Zoe Yang MD Brittany Park MBChB Renato Pitesa MBChB Surya Singh BSc Julian A Smith MBMS FRACS Ashish Taneja MBChB FRACS Tim Eglinton MBChB FRACS Fraser Welsh MBBS FRACS Jonathan Koea MD FRACS Andrew D. MacCormick MBChB FRACS Ahmed Barazanchi MBChB FRACS Andrew G. Hill MBChB FRACS 《ANZ journal of surgery》2023,93(7-8):1806-1810
Background
The ‘weekend effect’ is the term given to the observed discrepancy regarding patient care and outcomes on weekends compared to weekdays. This study aimed to determine whether the weekend effect exists within Aotearoa New Zealand (AoNZ) for patients undergoing emergency laparotomy (EL), given recent advances in management of EL patients.Methods
A cohort study was conducted across five hospitals, comparing the outcomes of weekend and weekday acute EL. A propensity-score matched analysis was used to remove potential confounding patient characteristics.Results
Of the 487 patients included, 132 received EL over the weekend. There was no statistically significant difference between patients undergoing EL over the weekend compared to weekdays. Mortality rates were comparable between the weekday and weekend cohorts (P = 0.464).Conclusions
These results suggest that modern perioperative care practice in New Zealand obviates the ‘weekend’ effect. 相似文献8.
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