BACKGROUND & AIMS: By rigorous statistical standards, the expression false negative rate is a misnomer because the concept of "rate" is associated with the rapidity of change of phenomena per unit of time or other variable (e.g., temperature). Uncertainty about the term false negative rate resulted in the introduction of similar but equally dubious expressions, including false negative fraction and miss rate. The statistically correct term in the practice of cytopathology is false negative proportion because we have here a fraction in which the numerator (number of false negative cases) is a part of the denominator (number of true positive cases plus number of false negative cases). This is the classic definition of the term proportion.

背景与目标： 按照严格的统计标准，由于“速率”的概念与每单位时间或其他变量（例如温度）的现象变化的速度有关，因此错误否定率的表达是不正确的。术语“假阴性率”的不确定性导致引入了类似但同样令人怀疑的表达式，包括假阴性率和遗漏率。在细胞病理学实践中，统计上正确的术语是假阴性比例，因为在这里我们有一个分数，其中分子（假阴性病例数）是分母的一部分（真阳性病例数加假阴性病例数）。这是术语比例的经典定义。

BACKGROUND & AIMS: :Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.

背景与目标： 亚临床甲状腺功能减退症通常无症状，但可能与各种不良心脏预后相关。为了深入了解甲状腺刺激激素（TSH）在先天性心脏病中的作用，本研究测量了不同类型的成年先天性心脏病（GUCHD）患者的血清TSH浓度。测量血清TSH（参考范围0.34-5.6 mIU / L），肌酐，胆固醇，C反应蛋白（CRP），N端proB型利钠肽（NT-pro-BNP）和24小时蛋白尿。 249位GUCHD患者。 TSH水平高于5.6 mUI / L的24名GUCHD患者（9.6％）中，有9名发（37.5％）和7名（29.1％）患有唐氏综合症。血清TSH超过5.6 mIU / L的GUCHD患者的血清NT-pro-BNP显着更高（195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001）和CRP（0.30 [0.06; 1.87） [] vs. 0.16 [0.00; 1.40]； p = 0.011]，TSH水平为5.6 mIU / L或更低；两组之间的血清肌酐，脂质或24小时蛋白尿无显着差异。 TSH超过5.6 mIU / L的GUCHD患者的血药浓度在正常范围内（0.89±0.23 ng / dL）。在多变量分析中，紫（（比值[OR]为6,399； 95％置信区间[CI]为2,296- 17,830; p <0.001），唐氏综合症（OR，6,208; 95％CI，1,963-19,636; p = 0.002）和NT-pro-BNP浓度（OR，1,001; 95％CI，1,000-1,002; p <0.026） ）被证明是TSH水平高于5.6 mIU / L的危险因素。由于亚临床甲状腺功能减退症会引起心血管疾病风险，因此作者推测TSH筛查应包括在GUCHD的常规随访评估中紫osis或唐氏综合症患者。

BACKGROUND & AIMS: INTRODUCTION:Cornelia de Lange syndrome (CdLS) is produced by mutations in genes that encode regulatory or structural proteins of the cohesin complex. Congenital heart disease (CHD) is not a major criterion of the disease, but it affects many individuals. The objective of this study was to study the incidence and type of CHD in patients with CdLS. MATERIAL AND METHOD:Cardiological findings were evaluated in 149 patients with CdLS and their possible relationship with clinical and genetic variables. RESULTS:A percentage of 34.9 had CHD (septal defects 50%, pulmonary stenosis 27%, aortic coarctation 9.6%). The presence of CHD was related with neonatal hospitalisation (P=.04), hearing loss (P=.002), mortality (P=.09) and lower hyperactivity (P=.02), it being more frequent in HDAC8+ patients (60%), followed by NIPBL+ (33%) and SMC1A+ (28.5%). While septal defects predominate in NIPBL+, pulmonary stenosis is more common in HDAC8+. CONCLUSIONS:Patients with CdLS have a high incidence of CHD, which varies according to the affected gene, the most frequent findings being septal defects and pulmonary stenosis. Perform a cardiologic study in all these patients is suggested.

背景与目标： 简介：Cornelia de Lange综合征（CdLS）是由编码粘着蛋白复合物的调节蛋白或结构蛋白的基​​因突变产生的。先天性心脏病（CHD）不是该疾病的主要标准，但会影响许多人。这项研究的目的是研究CdLS患者冠心病的发生率和类型。
材料与方法：对149例CdLS患者的心脏病学发现及其与临床和遗传变量的可能关系进行了评估。
结果：34.9％的人患有冠心病（房间隔缺损50％，肺动脉狭窄27％，主动脉缩窄9.6％）。冠心病的存在与新生儿住院（P = .04），听力损失（P = .002），死亡率（P = .09）和多动症（P = .02）有关，在HDAC8患者中更常见（ 60％），其次是NIPBL（33％）和SMC1A（28.5％）。尽管间隔缺损在NIPBL中占优势，但肺动脉狭窄在HDAC8中更常见。
结论：CdLS患者的CHD发病率很高，根据患病基因的不同而不同，最常见的发现是房间隔缺损和肺动脉狭窄。建议对所有这些患者进行心脏检查。

BACKGROUND & AIMS: :The cardioprotective drugs used for treatment against ischemia/reperfusion (MI/R) injury have been well evaluated and are considered inadequate. The Chinese herbal medicine formula, Xinji pill (XJP) has been used traditionally for the prevention and treatment of ischemic heart diseases for decades. In the present study, the cardioprotective effects of XJP against MI/R injury were assessed in vivo and its possible mechanism was examined. Male Sprague‑Dawley rats were selected for establishing an MI/R model, which was induced by ischemia for 30 min followed by 24 h reperfusion. Drugs and saline were administered intragastrically from day 14 prior to MI/R. Blood samples were collected for biochemical detection. The rats were then sacrificed and cardiac muscle tissues were harvested. The mRNA expression levels of antioxidant genes were measured by reverse transcription‑quantitative polymerase chain reaction and the protein levels were measured by western blotting. Pretreatment with XJP for 14 days protected the heart against I/R‑induced myocardial function disorder, protected against heart injury, as demonstrated by normalized serum levels of lactate dehydrogenase and creatine kinase, and suppressed oxidative stress. XJP markedly upregulated the expression of antioxidant genes, including superoxide dismutase, catalase, glutathione reductase and glutathione peroxidase, and promoted the protein expression of heme oxygenase‑1 and NFE2‑related factor 2 (Nrf2) in the heart tissues. Furthermore, Akt kinase was confirmed to be upstream of Nrf2 in the XJP treatment. LY294002, a specific inhibitor of Akt, significantly eliminated the cardioprotective effects of XJP. In conclusion, these results demonstrated that XJP exhibited notable cardioprotective properties, in which the Akt/Nrf2 signaling pathway may be involved.

背景与目标： ：用于抵抗缺血/再灌注（MI / R）损伤的心脏保护药物已得到很好的评估，被认为是不足的。几十年来，传统的中草药配方辛集丸（XJP）被用于预防和治疗缺血性心脏病。在本研究中，体内评估了XJP对MI / R损伤的心脏保护作用，并研究了其可能的机制。选择雄性Sprague-Dawley大鼠建立MI / R模型，该模型由局部缺血30分钟然后再灌注24 h诱导。从MI / R之前第14天开始，在胃内施用药物和盐水。收集血样用于生化检测。然后处死大鼠并收获心肌组织。通过逆转录定量聚合酶链反应测量抗氧化剂基因的mRNA表达水平，并通过蛋白质印迹法测量蛋白质水平。 XJP预处理14天可以保护心脏免受I / R诱导的心肌功能障碍的侵害，防止心脏受伤，如血清乳酸脱氢酶和肌酸激酶水平的正常化以及抑制氧化应激所证明的。 XJP明显上调了抗氧化基因的表达，包括超氧化物歧化酶，过氧化氢酶，谷胱甘肽还原酶和谷胱甘肽过氧化物酶，并促进了心脏组织中血红素加氧酶-1和NFE2相关因子2（Nrf2）的蛋白表达。此外，在XJP处理中，证实Akt激酶位于Nrf2的上游。 LY294002是Akt的特异性抑制剂，可显着消除XJP的心脏保护作用。总之，这些结果表明，XJP具有明显的心脏保护特性，其中可能涉及Akt / Nrf2信号传导途径。

BACKGROUND & AIMS: BACKGROUND:Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. OBJECTIVE:To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. DESIGN:This research project employed a classic grounded theory analysis of qualitative data. PARTICIPANTS:Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from individual interviews and open-ended responses from an online questionnaire. METHODS:Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. RESULTS:The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include; Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome; Minimalizing, when nurses believe that the patient's outcome would be no different if they recorded an accurate respiratory rate or not and; Trivialising, a strategy that sanctions negligent behaviour and occurs when nurses 'cut corners' to get the job done. Nurses' use these strategies to titrate the level ofemotional discomfort associated with erroneous behaviour, thereby rationalising transgression CONCLUSION: This research reveals that despite continuing education regarding gold standard guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses' understanding of acceptable practice methods. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.

背景与目标： 背景：呼吸频率异常是急诊科（ED）患者临床恶化的首批指标之一。尽管进行呼吸频率观察很重要，但这种生命体征常常不准确地记录在ED观察图上，从而损害了患者的安全性。同时，很少有研究报告这种现象发生的原因。
目的：建立一个实质性的理论来解释急诊室注册护士错过或误报呼吸频率观察值时的推理。
设计：该研究项目对定性数据进行了经典的扎根理论分析。
参与者：目前在澳大利亚的急诊室工作的九十九名注册护士。收集的数据包括个人访谈的详细答复和在线调查表的开放式答复。
方法：由于采用了经典的扎根理论（CGT）研究方法，因此编码对于数据的抽象及其作为理论的重新整合至关重要。与CGT方法同义的常量比较用于编码数据。这种方法有助于确定参与者的主要关注点，并有助于产生解释参与者如何处理此问题的理论。
结果：确定的主要问题是，急诊科注册护士并不认为需要在每一轮观察中为所有患者收集准确的呼吸频率，但是组织要求经常要求每次重要时都应包括呼吸频率值收集迹象。 “合理化违法行为”理论解释了参与者如何持续解决这一问题。研究发现，尽管感到职业上有矛盾，但护士经常会错误地记录呼吸频率的观察结果，然后通过采用可调整组织要求重要性的策略来合理化这种行为。这些策略包括：补偿：当护士认为他们通过提高患者的治疗效果来补偿错误的行为时；当护士认为患者记录正确的呼吸频率与否时，结局没有什么不同，并且最小化；琐事化是一种惩罚过失行为的策略，当护士“偷工减料”完成工作时就会发生。护士使用这些策略来减轻与错误行为有关的情绪不适水平，从而使过犯合理化。结论：本研究表明，尽管继续接受有关呼吸频率收集的金标准指南的教育，但最佳实践仍在继续。理想情况下，为了应对这种违法行为，必须在护士对可接受的练习方法的理解上发生文化转变。护士必须接受一定程度的教育，以使他们了解定期收集的准确呼吸频率观察值与患者最佳结局之间的关系。

BACKGROUND & AIMS: :Evidence for the stress-buffering effects of social support in intimate relationships raises important questions about whether partner support promotes recovery in physiological systems implicated in physical health. The present study examined (a) whether observed dyadic coping enhances cortisol stress recovery and (b) whether a stressed partner's self-reported attachment anxiety and avoidance moderate these effects. Stress was experimentally induced by asking either the man or woman in 123 heterosexual couples to participate in a standardized public speaking task. Stressed individuals recovered faster from stress the more positive dyadic coping they received from the partner, with women high in attachment anxiety benefiting less from these behaviors. Attachment avoidance did not moderate these associations. This study highlights the value of examining the interplay between partners' behaviors and attachment orientations in order to understand the impact of stress on close relationships and partners' health.

背景与目标： ：在亲密关系中社会支持对压力的缓冲作用的证据提出了一个重要问题，即伴侣支持是否会促进与身体健康有关的生理系统的恢复。本研究调查了（a）观察到的二元应对是否增强了皮质醇应激恢复，以及（b）应激伴侣的自我报告的焦虑和避免焦虑是否减轻了这些影响。通过让123对异性恋夫妇中的男人或女人参加标准化的公开演讲任务，实验性地诱发了压力。压力大的人从伴侣那里得到的积极积极的应对使他们从压力中恢复得更快，而依恋焦虑高的女性则从这些行为中受益较少。避免依恋并没有减轻这些联系。这项研究强调了检查伴侣行为与依恋取向之间相互作用的价值，以了解压力对亲密关系和伴侣健康的影响。

BACKGROUND & AIMS: :An environmental survey was conducted regarding substance abuse recovery supports and services (RSS) delivered across California, where these services are offered, and by whom. Inquiries were made regarding RSS measurement efforts, funding mechanisms, and technical assistance needs. A survey was disseminated to all 57 administrators of county alcohol and other drug or behavioral departments. Results indicate that 62% (23 of 37) of responding counties offer RSS. Overall, certified addiction counselors (CACs) were the staff most utilized to provide RSS, followed by peers, clinicians, and volunteers. Among recovery-community organizations (RCOs), peers, volunteers, and CACs were the most utilized staff. Sober living homes were the most prevalent type of RCO, followed by recovery centers, faith-based/recovery ministries, and recovery schools. Forty-five percent of counties reported funding RSS; 37.8% collect data. RSS may provide valuable support services for individuals recovering from alcohol/drug use; however, the field must further define RSS and develop measurement strategies to justify RSS funding.

背景与目标： ：进行了一次环境调查，涉及在加利福尼亚州，提供这些服务的地点以及由谁提供的滥用药物回收支持和服务（RSS）。询问了有关RSS测量工作，资金机制和技术援助需求的信息。一项调查已分发给县酒精及其他毒品或行为部门的所有57位管理员。结果表明，有62％的县（占23个县）提供RSS。总体而言，认证成瘾咨询师（CAC）是最常用于提供RSS的人员，其次是同伴，临床医生和志愿者。在恢复社区组织（RCO）中，同龄人，志愿者和CAC是使用最多的人员。清醒的居住房屋是RCO的最普遍类型，其次是恢复中心，基于信仰/恢复的部门和恢复学校。百分之四十五的县报告资助了RSS； 37.8％的收集数据。 RSS可以为从戒酒/吸毒中康复的个人提供有价值的支持服务；但是，该领域必须进一步定义RSS，并制定衡量策略以证明RSS资金的合理性。

BACKGROUND & AIMS: OBJECTIVE:To investigate: (1) the course of coronary heart disease risk factors (lipid profiles and body mass index (BMI)) in the first five years after discharge from inpatient spinal cord injury (SCI) rehabilitation and (2) the association between lifestyle (physical activity, self-care related to fitness, smoking, alcohol, body mass and low-fat diet) and coronary heart disease risk factors during that period. DESIGN:Prospective cohort study. PARTICIPANTS/METHODS:Individuals with SCI (N=130). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG) and BMI were determined at discharge from inpatient rehabilitation and 1 and 5 years after discharge. Using multilevel regression models, the effects of lifestyle (drinking alcohol, smoking, active lifestyle and self-care) on the lipid profiles and BMI were determined. RESULTS:After correction for lesion and personal characteristics, no changes in lipid profiles in the five years after discharge were seen, whereas the BMI increased significantly with 1.8 kg m(-2). A high percentage was at risk of cardiovascular disease due to high BMI (63-75%) or HDL (66-95%). The individuals who indicated to maintain their fitness level as good as possible and the individuals with a low BMI showed better lipid profiles. Individuals with a more active lifestyle showed higher HDL levels. Individuals who avoid smoking showed a 1.5 kg m(-2) higher BMI. CONCLUSION:Lipid profiles seem to stabilize in the years after discharge from inpatient SCI rehabilitation, whereas the BMI increased. Lifestyle factors associated with a favorable lipid profile and BMI could be identified.

背景与目标： 目的：调查：（1）住院脊髓损伤（SCI）康复出院后的最初五年中，冠心病危险因素（血脂和体重指数（BMI））的病程，以及（2）在此期间的生活方式（体育锻炼，与健身，吸烟，饮酒，体重和低脂饮食有关的自我保健）和冠心病的危险因素。
设计：前瞻性队列研究。
参与者/方法：具有SCI的个人（N = 130）。在住院康复出院时以及出院后1和5年测定总胆固醇（TC），高密度脂蛋白（HDL），低密度脂蛋白（LDL），甘油三酸酯（TG）和BMI。使用多级回归模型，确定了生活方式（饮酒，吸烟，积极的生活方式和自我保健）对血脂和BMI的影响。
结果：校正病灶和个人特征后，出院后五年内血脂没有变化，而BMI显着增加，为1.8 kg m（-2）。高百分比的BMI（63-75％）或HDL（66-95％）导致罹患心血管疾病的风险较高。表示要尽可能保持健康水平的个体和BMI较低的个体表现出更好的血脂状况。生活方式更加活跃的人表现出较高的HDL水平。避免吸烟的人的BMI升高1.5 kg m（-2）。
结论：住院SCI康复出院后的几年中，脂质分布似乎稳定，而BMI升高。可以确定与良好的脂质状况和BMI相关的生活方式因素。

BACKGROUND & AIMS: :Myocardial extracellular volume fraction (ECV) reflecting diffuse myocardial fibrosis can be measured with T1 mapping cardiovascular magnetic resonance (CMR) before and after the application of a gadolinium-based extracellular contrast agent. The equilibrium between blood and myocardium contrast concentration required for ECV measurements can be obtained with a primed contrast infusion (equilibrium contrast-CMR). We hypothesized that equilibrium can also be achieved with a single contrast bolus to accurately measure diffuse myocardial fibrosis in patients with congenital heart disease (CHD). Healthy controls (n = 17; median age 24.0 years) and patients with CHD (n = 19; 25.0 years) were prospectively enrolled. Using modified Look-Locker inversion recovery T1 mapping before, 15 min after bolus injection, and during constant infusion of gadolinium-DOTA, T1 values were obtained for blood pool and myocardium of the left ventricle (LV), the interventricular septum (IVS), and the right ventricle (RV) in a single midventricular plane in short axis or in transverse orientation. ECV of LV, IVS and RV by bolus-only and bolus-infusion correlated significantly in CHD patients (r = 0.94, 0.95, and 0.74; p < 0.01, respectively) and healthy controls (r = 0.96, 0.89, and 0.64; p < 0.05, respectively). Bland-Altman plots revealed no significant bias between the techniques for any of the analyzed regions. ECV of LV and RV myocardium measured by bolus-only T1 mapping agrees well with bolus-infusion measurements in patients with CHD. The use of a bolus-only approach facilitates the integration of ECV measurements into existing CMR imaging protocols, allowing for assessment of diffuse myocardial fibrosis in CHD in clinical routine.

背景与目标： ：应用基于g的细胞外造影剂前后，可通过T1映射心血管磁共振（CMR）来测量反映弥漫性心肌纤维化的心肌细胞外体积分数（ECV）。 ECV测量所需的血液和心肌造影剂浓度之间的平衡可通过灌注造影剂（平衡造影剂CMR）获得。我们假设通过单次对比推注也可以达到平衡，以准确测量先天性心脏病（CHD）患者的弥漫性心肌纤维化。前瞻性纳入健康对照组（n = 17）；中位年龄24.0岁； CHD患者（n = 19； 25.0岁）。使用改良的Look-Locker反转恢复T1映射，在推注大剂量，之后15分钟以及在持续输注--DOTA期间，获得了左心室（LV），心室间隔（IVS）的血池和心肌的T1值，右心室（RV）在短心轴或横向方向的单个心室中平面内。仅推注和推注输注的LV，IVS和RV的ECV在CHD患者（分别为r = 0.94、0.95和0.74； p <0.01）和健康对照者（r = 0.96、0.89和0.64； p中显着相关）分别<0.05）。布兰德-奥特曼（Bland-Altman）图显示，任何被分析区域的技术之间均无明显偏差。通过仅推注T1测绘测得的LV和RV心肌的ECV与CHD患者的推注量测量非常吻合。仅推注方法的使用有助于将ECV测量值集成到现有的CMR成像协议中，从而可以在临床常规中评估CHD中弥漫性心肌纤维化。

BACKGROUND & AIMS: :Anxiety and depression for 399 survivors of a 1,102-member heart disease cohort were assessed 8 to 9 years post-hospitalization. Approximately one-third reported symptoms of emotional distress and one-fourth were on anti-anxiety drugs. Predictors of anxiety and depression were analyzed through logistic regression. Subjects age 65 and over were less likely than younger patients to report anxiety or depression and also reported less heart-associated disability, the strongest predictor of distress for both age groups. Other significant predictors included a previous history of distress, low income, female sex, and beta blocker use.

背景与目标： ：在住院后8到9年评估了1,102名心脏病患者队列中399名幸存者的焦虑和抑郁情绪。大约三分之一的人报告说有情绪困扰症状，而四分之一则是在服用抗焦虑药。焦虑和抑郁的预测因素通过逻辑回归分析。 65岁及65岁以上的受试者比年轻患者报告焦虑或抑郁的可能性更低，而且与心脏相关的残疾报告的可能性也较小，这是两个年龄组的最强烈的痛苦预测指标。其他重要的预测指标包括以前的困扰，低收入，女性和使用β-受体阻滞剂的病史。

BACKGROUND & AIMS: :We performed a retrospective cohort analysis of pregnancies among women with moderate to complex congenital heart disease or pulmonary hypertension over a 12-year period, resulting in a cohort of 107 cases in 65 women. Neuraxial analgesia or anaesthesia was provided in 84%, 89% and 95% of spontaneous vaginal, operative vaginal and caesarean deliveries, respectively. The caesarean delivery rate was 43% compared to our institution average of 27% over the same period (p = 0.02), and 38% had operative vaginal deliveries compared to a 10.5% institution rate (p < 0.01). Invasive monitoring was used in 28% of all deliveries. There were one maternal and two neonatal deaths. This study provides detailed anaesthetic and peripartum management of women with congenital heart disease, a patient population in whom evidence-based practice and data are largely lacking. We observed a predominance of neuraxial anaesthetic techniques, increased caesarean and operative delivery rates, and favourable maternal and neonatal outcomes. Multicentre studies and registries to compare anaesthetic and obstetric management strategies further and delineate risk factors for adverse outcomes are required.

背景与目标： ：我们对12年来中度至复杂性先天性心脏病或肺动脉高压妇女的妊娠进行了回顾性队列研究，得出65例妇女的107例队列。自发性阴道，手术阴道和剖腹产分别有84％，89％和95％提供神经镇痛或麻醉作用。剖腹产率为43％，而同期我们机构的平均水平为27％（p = 0.02），而手术阴道分娩的比例为38％，而机构率为10.5％（p <0.01）。在所有分娩中有28％使用了侵入式监测。有1例孕产妇死亡和2例新生儿死亡。这项研究为患有先天性心脏病的妇女提供了详细的麻醉和围产期治疗方法，该病患者中大量缺乏循证医学实践和数据。我们观察到神经麻醉技术占优势，剖腹产和手术分娩率增加，孕产妇和新生儿预后良好。需要进行多中心研究和登记，以进一步比较麻醉和产科管理策略，并描述不良后果的危险因素。

BACKGROUND & AIMS: :Normal adult zebrafish can completely regenerate lost myocardium following partial amputation of the ventricle apex. We report that 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) significantly impairs this regeneration. Adult male zebrafish were injected with vehicle (control) or TCDD (70ng/g, ip) 1 day prior to partial amputation of the ventricle apex. Gross observation and histological analysis of the amputated heart at 21 days postamputation revealed that TCDD-exposed fish had not progressed beyond the initial clot formation stage, whereas the vehicle control fish showed substantial recovery and almost complete resolution of the formed clot. In contrast, hearts that were not surgically wounded showed no signs of TCDD toxicity. Striking features in the TCDD-exposed hearts were the absence of the normal sheath of new tissue enveloping the wound and the absence of intense cell proliferation at the site of the wound. In addition, the patterns of collagen deposition at the wound site were different between the TCDD and vehicle groups. Because the receptor for TCDD is the aryl hydrocarbon receptor ligand-activated transcriptional regulator, we examined the effects of TCDD exposure on gene expression in the ventricle using DNA microarrays. Samples were collected just prior to amputation and at 6h and 7 days postamputation. TCDD-pretreated hearts had dysregulated expression of genes involved in heart function, tissue regeneration, cell growth, and extracellular matrix. Because embryonic, but not adult, hearts are major targets for TCDD-induced cardiotoxicity, we speculate that the need for embryonic-like cells in regeneration is connected with the effects of TCDD in inhibiting the response to wounding.

背景与目标： ：正常的成年斑马鱼在部分切除了心尖后可以完全再生丢失的心肌。我们报告说，2,3,7,8-四氯二苯并-p-二恶英（TCDD）大大损害了这种再生。成年雄性斑马鱼在部分截肢心室前1天注射媒介物（对照）或TCDD（70ng / g，腹膜内）。截肢后21天对断肢心脏的大体观察和组织学分析表明，暴露于TCDD的鱼没有超过最初的血块形成阶段，而溶媒对照鱼显示出了充分的恢复，几乎完全消解了形成的血块。相比之下，未经手术创伤的心脏则无TCDD毒性迹象。暴露于TCDD的心脏的显着特征是没有包裹伤口的新组织的正常鞘，并且在伤口部位没有强烈的细胞增殖。此外，TCDD组和赋形剂组之间伤口部位胶原蛋白沉积的方式也不同。因为TCDD的受体是芳烃受体配体激活的转录调节因子，所以我们使用DNA微阵列检查了TCDD暴露对心室中基因表达的影响。截肢前以及截肢后6h和7天收集样品。 TCDD预处理的心脏的基因表达失调，涉及心脏功能，组织再生，细胞生长和细胞外基质。因为心脏（而非成年心脏）是TCDD诱导的心脏毒性的主要靶标，所以我们推测再生过程中对类胚胎细胞的需求与TCDD抑制伤口反应的作用有关。

BACKGROUND & AIMS: BACKGROUND:Hormone replacement therapy increases the number and quality of grafts recovered from brain-dead organ donors. Arginine vasopressin (AVP) has also been shown to have beneficial effects. The aim of this study was to determine the effect of AVP on recovery rates. METHODS:The Organ Procurement and Transplantation Network database was used. Donors treated with hormone replacement therapy and vasopressor agents who were successfully procured between January 1, 2009, and June 30, 2011, were studied. AVP-positive and AVP-negative donors were compared. The primary study end point was the rate of high-yield procurement (≥4 organs). RESULTS:A total of 10,431 donors were included. AVP was infused in 7,873 (75.5%) and was associated with an increased rate of high-yield procurement (50.5% vs 35.6%, P < .001). There was less overall graft refusal due to poor function (38.9% vs 45.6%, P < .001). AVP independently predicted high yield procurement. CONCLUSIONS:The use of AVP with hormone replacement therapy is independently associated with an increased rate of organ recovery. This strategy should be universally adopted in the management of donors progressing to neurologic death.

背景与目标： 背景：激素替代疗法增加了从脑死亡器官供体中回收的移植物的数量和质量。精氨酸加压素（AVP）也已被证明具有有益作用。这项研究的目的是确定AVP对恢复率的影响。
方法：使用器官采购和移植网络数据库。研究了在2009年1月1日至2011年6月30日期间成功采购的经过激素替代疗法和血管升压药治疗的捐赠者。比较了AVP阳性和AVP阴性的供体。主要研究终点是高产采购率（≥4个器官）。
结果：总共包括10,431个捐助者。 AVP注入了7,873（75.5％），并且与高收益采购率增加有关（50.5％对35.6％，P <.001）。由于功能不佳，总体拒绝移植的几率较低（38.9％比45.6％，P <.001）。 AVP独立预测高收益采购。
结论：激素替代疗法与AVP的使用独立地与器官恢复率增加相关。此策略应在处理进展为神经系统死亡的捐献者中普遍采用。

BACKGROUND & AIMS: BACKGROUND:Clinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance. METHODS:We included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool. RESULTS:Fifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as "guidelines", however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with 'applicability' the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and 'rigour of development' rated lowest for other guidance types (mean score 33%). CONCLUSIONS:While a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians.

背景与目标： 背景：鼓励临床医生使用指南来协助为冠心病患者提供循证二级预防。但是，提供有关运动训练指南的出版物数量不断增加，可能会使心脏康复临床医生感到困惑。因此，我们试图探讨已发表的基于运动的心脏康复指南的数量，范围，出版特征，方法学质量和临床实用性。
方法：我们纳入了建议对冠心病患者进行体育锻炼，运动或心脏康复的出版物。这些包括系统开发的临床实践指南，以及旨在支持临床医生决策的其他出版物，例如立场书或共识声明。出版物通过预防性心脏病学会，指南数据库和PubMed的电子搜索获得，截止日期为2016年11月。提取了出版物的特征，两名独立评估者使用23项指南研究和评估II（AGREE）评估工具对质量进行了评估。
结果：确定了1994年至2016年的54种国际出版物。大多数在预防心脏病学协会网站上发现（n = 35; 65％），并且可以免费访问（n = 50; 93％）。 30种（56％）出版物仅包含有关体育锻炼和心脏康复参考的广泛建议，而24种（44％）包含必要的详细运动训练建议。许多被标记为``指南''，但是带有其他标题（例如科学陈述）的出版物很常见（n = 24; 44％）。后一组出版物包含的详细运动训练建议所占比例比临床指南要大得多（p = 0.017）。质量也存在很大差异，其中“适用性”在临床指南中得分最差的AGREE II域（平均得分53％），在“发展的严谨性”中其他指南类型的得分最低（平均得分33％）。
结论：尽管大量指导文件为基于运动的心脏康复提供了建议，但大多数在方法学质量或临床实用性方面均存在局限性。缺乏严格制定的指南，其中也包含有关运动训练的必要细节，这仍然是临床医生面临的重大问题。

BACKGROUND & AIMS: :A 31-year-old woman complained of dyspnea and orthopnea at 38 weeks of gestation. A grade 3/6 pansystolic murmur was heard, and echocardiography revealed severe mitral regurgitation with a hyperechoic obstacle on the posterior mitral valve leaflet, consistent with a diagnosis of acute heart failure due to a ruptured chordae tendineae or an infectious endocarditis. An emergency cesarean section was performed under general anesthesia. A male infant was born weighing 2928 g with Apgar scores of 7 and 8 at 1 and 5 min, respectively. The patient was managed in the intensive care unit and underwent open-heart surgery for mitral valve repair on postpartum day 3. The two chordal tendineae appeared torn and frail, and a mitral annuloplasty was performed. No finding of infectious endocarditis was observed. Because it is a dramatic and life-threatening clinical situation, proper diagnosis and treatment in the intensive care unit assure a good outcome for both mother and fetus.

背景与目标： ：一名31岁妇女在妊娠38周时主诉呼吸困难和正气呼吸。听到了3/6级的收缩期杂音，超声心动图显示二尖瓣反流严重，二尖瓣后叶上有高回声障碍，与诊断为腱索破裂或感染性心内膜炎导致的急性心力衰竭相一致。全身麻醉下进行紧急剖宫产。一名男婴出生时体重为2928微克，在1分钟和5分钟时Apgar得分分别为7和8。患者在重症监护病房接受治疗，并在产后第3天接受心脏直视手术以修复二尖瓣。两个腱腱均出现撕裂和脆弱，并进行了二尖瓣瓣环成形术。没有发现感染性心内膜炎。由于这是一种戏剧性且危及生命的临床情况，因此在重症监护室进行正确的诊断和治疗可确保母亲和胎儿均获得良好的治疗效果。