• 【the门手术后儿童次最大运动的增强生理功能。】 复制标题 收藏 收藏
    DOI:10.1249/MSS.0b013e31827b0b20 复制DOI
    作者列表:Banks L,McCrindle BW,Russell JL,Longmuir PE
    BACKGROUND & AIMS: PURPOSE:After the Fontan procedure, children exhibit reduced peak exercise capacity, yet their submaximal exercise response remains unclear. This study sought to determine the relationship between submaximal and peak exercise capacity and physical activity in Fontan patients. METHODS:This cross-sectional study recruited 50 Fontan patients (59% males) with a median age of 9 yr (range = 6-12 yr). The median age at Fontan procedure was 2.9 yr (range = 1.6-9.1 yr). Study assessments included medical history, exercise testing, and accelerometry. RESULTS:Significantly lower submaximal oxygen consumption (V˙O2) and HR in response to a standardized workload than published values for healthy children (mean ± SD) of -1.72 ± 5.24 (P < 0.001) and -1.45 ± 1.98 (P < 0.001), respectively, suggest enhanced submaximal work efficiency in this group of patients after Fontan. Higher submaximal V˙O2 z-score was associated with higher submaximal HR z-score (P = 0.02) and lower body mass index z-score (P = 0.01). Higher V˙O2peak was associated with higher submaximal V˙O2 z-score (P < 0.01), male sex (P = 0.03), higher RER (P = 0.02), lower submaximal HR z-score (P < 0.01), and higher chronotropic responsiveness (P < 0.0001). Exercise test duration z-score was associated with lower submaximal HR z-score (P = 0.02) and higher chronotropic responsiveness (P = 0.02). CONCLUSIONS:Fontan patients exhibited a lower submaximal V˙O2 and HR responsiveness at a given workload than healthy controls did during standardized exercise testing. Thus, they may be better adapted to perform submaximal exercise. Although peak exercise capacity is limited, Fontan patients are able to perform submaximal physical activities at the same level as their healthy peers.
    背景与目标: 目的:进行丰坦手术后,儿童的峰值运动能力下降,但其次最大运动反应仍不清楚。这项研究试图确定丰坦患者亚最大和最大运动能力与身体活动之间的关系。
    方法:这项横断面研究招募了50名Fontan患者(男性占59%),中位年龄为9岁(范围= 6-12岁)。丰坦手术的中位年龄为2.9岁(范围= 1.6-9.1岁)。研究评估包括病史,运动测试和加速度计。
    结果:标准化工作量下的最大摄氧量(V˙O2)和HR显着低于健康儿童的公布值(平均值±SD)的-1.72±5.24(P <0.001)和-1.45±1.98(P <0.001) )分别表明,在接受Fontan治疗后,该组患者的工作效率得到了提高。较高的V subO2 z评分较高与较高的HR z评分较低(P = 0.02)和较低的体重指数z评分(P = 0.01)相关。较高的V˙O2peak与较高的V˙O2z分数(P <0.01),男性(P = 0.03),较高的RER(P = 0.02),较低的最大HR z分数(P <0.01)和较高的Z分数相关。更高的变时响应性(P <0.0001)。运动测试持续时间z分数与较低的最大心率z分数(P = 0.02)和较高的变时反应性(P = 0.02)相关。
    结论:在标准的运动测试中,与健康对照组相比,在一定的工作量下,Fontan患者表现出低于最大的V˙O2和HR反应性。因此,它们可能更好地适于进行次最大运动。尽管峰值运动能力有限,但Fontan患者能够以与健康同龄人相同的水平进行次最大的体育锻炼。
  • 【通过循环电外科切除术成功治疗由于囊性宫颈内异症破裂而引起的大量出血。】 复制标题 收藏 收藏
    DOI:10.1016/j.fertnstert.2007.04.011 复制DOI
    作者列表:Iwase A,Goto M,Kurotsuchi S,Harata T,Kaseki S,Kikkawa F
    BACKGROUND & AIMS: OBJECTIVE:To report a case of cystic cervical endometriosis that caused a massive hemorrhage due to rupture of a cyst and successful management with a loop electrosurgical excision procedure (LEEP). DESIGN:Case report. SETTING:University Hospital. PATIENT:A 37-year-old nulliparous woman. INTERVENTION(S):Medical management including surgical treatment. MAIN OUTCOME MEASURE(S):Clinical follow-up and pathologic diagnosis. RESULT(S):A hemorrhagic cystic cervical mass was excised with emergent LEEP. The mass was found to be cervical endometriosis. There was no evidence of recurrence until 1 year after excision. CONCLUSION(S):Cystic formation of cervical endometriosis--like ovarian endometrioma, which causes a massive hemorrhage due to rupture--is extremely rare, although cervical endometriosis is generally asymptomatic. Hysterectomy is considered in such cases but can be avoided via LEEP that incorporates partial excision of the uterine cervix.
    背景与目标: 目的:报道一例因囊肿破裂而导致大出血的囊性宫颈子宫内膜异位症患者,并采用环行电外科切除术(LEEP)成功治疗。
    设计:病例报告。
    单位:大学医院。
    患者:一位37岁的未产妇。
    干预措施:医疗管理,包括外科治疗。
    主要观察指标:临床随访和病理诊断。
    结果:出血的囊性宫颈肿块被紧急LEEP切除。发现该肿块是宫颈子宫内膜异位症。直到切除后1年,才有复发的迹象。
    结论:尽管通常子宫内膜异位症无症状,但很少发生膀胱内膜异位症的囊性形成(如卵巢内膜瘤,由于破裂而引起大量出血)。在这种情况下,可以考虑行子宫切除术,但可以通过合并子宫部分切除的LEEP手术来避免。
  • 【肾上腺静脉采样作为原发性醛固酮增多症的诊​​断程序:来自三级转诊中心的经验。】 复制标题 收藏 收藏
    DOI:10.14310/horm.2002.1342 复制DOI
    作者列表:Salem V,Hopkins TG,El-Gayar H,Zac-Varghese S,Goldstone AP,Todd JF,Dhillo W,Field BC,Martin N,Hatfield E,Donaldson M,Palazzo F,Meeran K,Jackson J,Tan T
    BACKGROUND & AIMS: CONTEXT:Adrenal vein sampling (AVS) is recommended in all patients with hyperaldosteronism to whom surgery would be offered if the results indicated unilateral hypersecretion. OBJECTIVE:To assess the performance of AVS against radiological findings and to evaluate the Endocrine Society's Practice Guidelines for diagnostic cut-offs. PATIENTS:Retrospective study of 41 patients with hyperaldosteronism who underwent both AVS and computed tomography (CT) imaging. RESULTS:CT and AVS results were concordant in 73.7%. Unilateral lesions on CT had a greater positive predictive value (85%) than non-unilateral lesions (50%). In patients with subsequently confirmed adrenal adenomas, a lateralisation ratio >2 when comparing cortisol-corrected aldosterone ratios from the affected versus unaffected side was 100% sensitive. Patients who were managed surgically experienced significant reductions in blood pressure and medication burden and 46% were cured. CONCLUSIONS:AVS is important in establishing unilateral or bilateral adrenal secretion of aldosterone in patients with primary hyperaldosteronism. However, it may not be essential for the work-up in patients below the age of 40, in whom adrenal incidentalomas adrenal incidentalomas are known to be rarer, and a unilateral lesion on CT therefore has a greater positive predictive value.
    背景与目标: 背景:对于所有醛固酮过多症患者,如果结果表明单侧分泌过多,建议进行手术,建议进行肾上腺静脉采样(AVS)。
    目的:评估AVS对放射学表现的表现,并评估内分泌学会的诊断临界值实践指南。
    患者:回顾性研究41例同时接受AVS和计算机断层扫描(CT)成像的醛固酮过多症患者。
    结果:CT和AVS结果一致率为73.7%。 CT上的单侧病变比非单侧病变(50%)具有更高的阳性预测值(85%)。在随后确认的肾上腺腺瘤患者中,当比较患侧和未患侧的皮质醇校正的醛固酮比率时,侧斜率> 2是100%敏感的。接受手术治疗的患者的血压和药物负担明显降低,治愈率达到46%。
    结论:AVS对于原发性醛固酮过多症患者建立醛固酮的单侧或双侧肾上腺分泌很重要。但是,对于40岁以下的患者进行检查可能不是必需的,因为肾上腺偶发瘤已知肾上腺偶发瘤少见,因此CT上的单侧病变具有更大的阳性预测价值。
  • 【Fontan手术的年龄会影响青少年的运动表现:儿童心脏网络多中心研究的结果。】 复制标题 收藏 收藏
    DOI:10.1016/j.ahj.2013.04.013 复制DOI
    作者列表:Madan P,Stout KK,Fitzpatrick AL
    BACKGROUND & AIMS: BACKGROUND:Most single ventricle patients undergo Fontan procedure in a staged manner. However, optimal timing of Fontan completion after an intermediate staging surgery is controversial. Therefore, we investigated the long-term impact of age at Fontan completion on the exercise performance in adolescents. METHODS:We analyzed National Institutes of Health/National Heart, Lung and Blood Institute Pediatric Heart Network Fontan Cross-Sectional Study dataset consisting of children and adolescents 6 to 18 years of age recruited in 2003 to 2004. Multivariate linear regression techniques were used to evaluate association of age at Fontan procedure with percent predicted VO2 maximum, percent predicted maximum O2 pulse, and heart rate reserve in patients who achieved ventilatory anaerobic threshold (VAT). RESULTS:Of the 405 patients who had undergone only one Fontan operation and ramp cycle ergometry, 72% had prior intermediate surgery. Mean age at Fontan completion and exercise testing was 3.4±2 and 12.4±3.2 years. Three hundred twelve patients reached VAT suggesting adequate cardiopulmonary effort. In patients who reached VAT, each year increase in age at Fontan completion was associated with a decline of 1.5 (95% CI -2.5 to -0.5) points in percent-predicted VO2 maximum and a decline of 4.1 (95% CI -6.0 to -2.1) beat/min in heart rate reserve after adjusting for all pertinent variables. CONCLUSIONS:Fontan completion at a younger age is associated with better exercise performance in adolescents.
    背景与目标: 背景:大多数单心室患者分阶段接受Fontan手术。然而,中级分期手术后丰坦完成的最佳时机存在争议。因此,我们调查了丰坦完成年龄对青少年运动表现的长期影响。
    方法:我们分析了美国国立卫生研究院/国家心脏,肺和血液研究所儿科心脏网络Fontan跨部门研究数据集,该数据集由2003年至2004年招募的6至18岁的儿童和青少年组成。使用多元线性回归技术进行评估达到通气性无氧阈值(VAT)的患者中Fontan手术的年龄与预计最大VO2百分比,最大预期O2脉冲百分比和心率储备的相关性。
    结果:在仅接受过一次丰坦手术和斜波测功的405例患者中,有72%曾接受过中级手术。丰坦完成和运动测试的平均年龄为3.4±2岁和12.4±3.2岁。 312名患者达到了增值税,表明有足够的心肺功能。在达到增值税的患者中,丰坦完成时年龄的每年增加与百分比最大预测VO2值下降1.5(95%CI -2.5至-0.5)点相关,而下降4.1(95%CI -6.0至95%CI -6.0)。 -2.1)调整所有相关变量后,心跳储备的心跳/分钟。
    结论:年轻时的丰坦完成与青少年更好的运动表现有关。
  • 【电极位移弹性成像与声辐射力脉冲成像的比较,描绘了手术后的消融区域。】 复制标题 收藏 收藏
    DOI:10.1016/j.ultrasmedbio.2017.04.021 复制DOI
    作者列表:Yang W,Varghese T,Ziemlewicz T,Alexander M,Lubner M,Hinshaw JL,Wells S,Lee FT Jr
    BACKGROUND & AIMS: :We compared a quasi-static ultrasound elastography technique, referred to as electrode displacement elastography (EDE), with acoustic radiation force impulse imaging (ARFI) for monitoring microwave ablation (MWA) procedures on patients diagnosed with liver neoplasms. Forty-nine patients recruited to this study underwent EDE and ARFI with a Siemens Acuson S2000 system after an MWA procedure. On the basis of visualization results from two observers, the ablated region in ARFI images was recognizable on 20 patients on average in conjunction with B-mode imaging, whereas delineable ablation boundaries could be generated on 4 patients on average. With EDE, the ablated region was delineable on 40 patients on average, with less imaging depth dependence. Study of tissue-mimicking phantoms revealed that the ablation region dimensions measured on EDE and ARFI images were within 8%, whereas the image contrast and contrast-to-noise ratio with EDE was two to three times higher than that obtained with ARFI. This study indicated that EDE provided improved monitoring results for minimally invasive MWA in clinical procedures for liver cancer and metastases.
    背景与目标: :我们将准静态超声弹性成像技术(称为电极位移弹性成像(EDE))与声辐射力脉冲成像(ARFI)进行了比较,以监测诊断为肝肿瘤的患者的微波消融(MWA)程序。在MWA程序后,入组本研究的49名患者接受了Siemens Acuson S2000系统的EDE和ARFI。根据两名观察者的可视化结果,结合B型成像,平均20例患者可识别ARFI图像中的消融区域,而平均4例患者可产生明显的消融边界。使用EDE,平均可对40例患者进行消融区域描述,而对成像深度的依赖性较小。对组织模拟体模的研究表明,在EDE和ARFI图像上测得的消融区域尺寸在8%以内,而EDE的图像对比度和对比度噪声比是ARFI获得的图像对比度和对比度噪声的两倍至三倍。这项研究表明,EDE在肝癌和转移瘤的临床程序中为微创MWA提供了改进的监测结果。
  • 【[磁共振程序诊断骨髓炎。其价值及与骨骼闪烁显像的比较]。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:1991-12-01
    来源期刊:Rofo
    DOI:10.1055/s-2008-1033308 复制DOI
    作者列表:Zynamon A,Jung T,Hodler J,Bischof T,von Schulthess GK
    BACKGROUND & AIMS: :61 patients with clinical findings suspicious for an osteomyelitis were examined by MRI between January 1985 and November 1989. All results were verified either by surgery or by the clinical course. MRI criteria of a musculoskeletal infection were: decreased signal intensity of the lesions on short TR, short TE images and increased signal to intensity on long TR, long TE images when compared to the intensity of normal bone marrow, adipose tissue and muscles. 35 of 61 patients had been examined by 99mTc-MDP three phase bone scans prior to the MRI examination. Sensitivity and specificity of the MRI examinations were superior to those of bone scans. We therefore recommend MRI examinations as the method of choice in the diagnosis of the early musculoskeletal infections and in all chronic complicated cases.
    背景与目标: 在1985年1月至1989年11月之间,通过MRI检查了61例临床表现可疑为骨髓炎的患者。所有结果均通过手术或临床过程进行了验证。肌肉骨骼感染的MRI标准是:与正常骨髓,脂肪组织和肌肉的强度相比,短TR,短TE图像上的病变信号强度降低,长TR,长TE图像上的信号强度增强。在MRI检查之前,对61位患者中的35位进行了99mTc-MDP三相骨扫描检查。 MRI检查的敏感性和特异性优于骨扫描。因此,我们建议将MRI检查作为诊断早期肌肉骨骼感染以及所有慢性复杂病例的首选方法。
  • 【使用5至7个插入的微刺激器进行卒中后上肢康复:植入程序,安全性和恢复功能的功效。】 复制标题 收藏 收藏
    DOI:10.1016/j.apmr.2008.05.010 复制DOI
    作者列表:Davis R,Sparrow O,Cosendai G,Burridge JH,Wulff C,Turk R,Schulman J
    BACKGROUND & AIMS: OBJECTIVE:To investigate the feasibility of implanting microstimulators to deliver programmed nerve stimulation for sequenced muscle activation to recover arm-hand functions. DESIGN:By using a minimally invasive procedure and local anesthesia, 5 to 7 microstimulators can be safely and comfortably implanted adjacent to targeted radial nerve branches in the arm and forearm of 7 subjects with poststroke paresis. The microstimulators' position should remain stable with no tissue infection and can be programmed to produce effective personalized functional muscle activity with no discomfort for a preliminary 12-week study. Clinical testing, before and after the study, is reported in the accompanying study. SETTING:Microstimulator implantations in a sterile operating room. PARTICIPANTS:Seven adults, with poststroke hemiparesis of 12 months or more. INTERVENTION:Under local anesthesia, a stimulating probe was inserted to identify radial nerve branches. Microstimulators were inserted by using an introducer and were retrievable for 6 days by attached suture. Each device was powered via a radiofrequency link from 2 external cuff coils connected to a control unit. MAIN OUTCOME MEASURES:To achieve low threshold values at the target sites with minimal implant discomfort. Microstimulators and external equipment were monitored over 12 weeks of exercise. RESULTS:Seven subjects were implanted with 41 microstimulators, 5 to 7 per subject, taking 3.5 to 6 hours. Implantation pain levels were 20% more than anticipated. No infections or microstimulator failures occurred. Mean nerve thresholds ranged between 4.0 to 7.7 microcoulomb/cm(2)/phase over 90 days, indicating that cathodes were within 2 to 4 mm of target sites. In 1 subject, 2 additional microstimulators were inserted. CONCLUSIONS:Microstimulators were safely implanted with no infection or failure. The system was reliable and programmed effectively to perform exercises at home for functional restoration.
    背景与目标: 目的:探讨植入微刺激器以提供程序性神经刺激以进行顺序肌肉激活以恢复手臂功能的可行性。
    设计:通过微创手术和局部麻醉,可以安全舒适地将5至7种微刺激器植入7名卒中后轻瘫患者的手臂和前臂的radial骨目标神经分支附近。微刺激器的位置应保持稳定,没有组织感染,并且可以进行编程,以产生有效的个性化功能性肌肉活动,而不会进行为期12周的初步研究。在研究之前和之后的临床测试报告在随附的研究中。
    地点:在无菌手术室中植入微刺激器。
    参与者:七名成年人,卒中后偏瘫为12个月或更长时间。
    干预:在局部麻醉下,插入刺激探针以识别radial神经分支。通过使用导引器插入微刺激器,并通过缝合线将其恢复6天。每个设备都通过射频链路由连接到控制单元的2个外部袖带线圈供电。
    主要观察指标:在目标部位达到低阈值,并使植入物不适感降至最低。在运动的12周内对微刺激器和外部设备进行了监测。
    结果:七名受试者植入了41种微刺激器,每名受试者5至7个,时间为3.5至6个小时。植入疼痛水平比预期高20%。没有发生感染或微刺激器故障。在90天内,平均神经阈值范围在4.0至7.7微库仑/ cm(2)/阶段之间,表明阴极位于目标部位的2至4 mm之内。在1名受试者中,插入了2个额外的微刺激器。
    结论:微刺激器被安全植入,没有感染或失败。该系统可靠且编程有效,可以在家中进行锻炼以恢复功能。
  • 【经尿道输尿管造口术作为辅助性抗反流方法,适用于患有严重反流的神经源性膀胱的接受膀胱增大的儿童。】 复制标题 收藏 收藏
    DOI:10.1016/j.jpurol.2019.12.006 复制DOI
    作者列表:Jacob TJK,James Sam C,Jacob Kurian J,Karl IS,Kisku SMC,Sen S
    BACKGROUND & AIMS: INTRODUCTION:Transureteroureterostomy (TUU) provides urinary drainage of both renal systems to the bladder via a single ureter and is useful in selected situations of complex urological reconstructions. Herein we discuss its use, advantages and complications in children with neurogenic bladders and high-grade (4/5) reflux who have undergone augmentation cystoplasty. PATIENTS AND METHODS:Children with neurogenic bladder complicated by unilateral or bilateral high-grade vesicoureteric reflux (VUR), who underwent TUU along with augmentation cystoplasty (BA), were selected from two institutions. Eighteen children with an average age of 5 years at presentation were identified from a retrospective chart review. RESULTS:All had bilateral hydroureteronephrosis (HUN) of which there were 30 refluxing megaureters. While BA reduced bladder pressure, VUR was managed by refluxing to non-refluxing TUU in six cases with unilateral VUR and unilateral reimplantation with TUU to the reimplanted ureter in 12 cases of bilateral VUR, thus minimizing reimplantation to 12 of 30 ureters. The average time of follow-up was 51 months. Follow-up cystograms showed complete resolution of VUR in all. HUN improved/stabilized in all but one child. Serum creatinine remained normal in all but two cases. Other advantages of TUU include the use of the distal ureter as a catheterizable channel and ease of undiversion when the ureter has been diverted as a ureterostomy. An unusual complication of a TUU site stricture is discussed and the innovative technique of using a cecal patch to salvage the anastomosis is detailed. CONCLUSION:We conclude that a TUU is a safe and useful adjunctive procedure in children undergoing BA for neurogenic bladder with high-grade VUR, minimizing the need for ureteric reimplant in an unhealthy bladder.
    背景与目标: 简介:经尿道输尿管造口术(TUU)可通过单个输尿管将两个肾脏系统的尿液引流至膀胱,在某些复杂的泌尿系统重建情况下很有用。在这里,我们讨论了其在接受了扩大性膀胱成形术的神经源性膀胱和高位(4/5)反流的儿童中的使用,优点和并发症。
    患者与方法:从两个机构中选择接受TUU并同时行膀胱扩大成形术(BA)的神经源性膀胱并发单侧或双侧高级别膀胱输尿管反流(VUR)的儿童。通过回顾性图表审查确定了18名平均年龄为5岁的儿童就诊。
    结果:所有患者均患有双侧输尿管肾盂积水(HUN),其中有30例回流的大输尿管。虽然BA降低了膀胱压力,但在6例单侧VUR的情况下,通过回流至非回流TUU来处理VUR,而在12例双侧VUR的单侧再植入输尿管的情况下,将TUU单侧再植入,从而最大限度地减少了再植入30例输尿管中的12例。平均随访时间为51个月。随访的膀胱造影显示所有VUR均已完全消退。除一名儿童外,所有儿童的HUN均得到改善/稳定。除两例外,其余所有患者的血清肌酐均保持正常。 TUU的其他优点包括将远端输尿管用作可导管插入的通道,当输尿管已被转移为输尿管造口术时,易于转移。讨论了TUU部位狭窄的异常并发症,并详细介绍了使用盲肠贴片修复吻合的创新技术。
    结论:我们得出结论,对于接受高级别VUR的神经源性膀胱BA的患儿,TUU是一种安全而有用的辅助手术,可最大程度地减少不健康膀胱中输尿管再植的需要。
  • 【3叶螺旋桨泵的性能,可在丰坦循环​​失败时提供腔肺帮助。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2008.06.026 复制DOI
    作者列表:Throckmorton AL,Ballman KK,Myers CD,Frankel SH,Brown JW,Rodefeld MD
    BACKGROUND & AIMS: PURPOSE:We hypothesized that a propeller pump design would function optimally to provide cavopulmonary assist in a univentricular Fontan circulation. DESCRIPTION:The hydraulic and hemolysis performance of a rigid three-bladed propeller prototype (similar to a folding propeller design) was characterized. Pressure and flow measurements were taken for flow rates of 0.5 to 3 liters per minute (LPM) for 5,000 to 7,000 revolutions per minute (RPM) using a blood analog fluid. Hemolysis testing was performed using fresh bovine blood for 2 LPM at 6,000 RPM for a 6-hour duration. EVALUATION:The prototype performed well over the design operating range by producing a pressure rise of 5 to 50 mm Hg. Plasma free hemoglobin concentration remained less than 15 mg/dL. The normalized index of hemolysis peaked during the first hour, and then remained less than 10 mg/dL thereafter. CONCLUSIONS:A propeller pump has the pressure-flow characteristics and minimal risk of hemolysis and venous pathway obstruction which make it ideal for temporary cavopulmonary assist. This type of device has the potential to provide a new therapeutic option for patients with failing univentricular Fontan physiology as a bridge-to-recovery or transplantation.
    背景与目标: 目的:我们假设螺旋桨泵的设计可以最佳地发挥功能,以在单心室芳坦循环中提供腔肺辅助。
    描述:表征了刚性三叶螺旋桨原型的液压和溶血性能(类似于折叠式螺旋桨设计)。使用血液模拟液,以每分钟0.5至3升(LPM)的流量进行压力和流量测量,每分钟5,000至7,000转(RPM)。使用新鲜牛血以6,000 RPM的速度进行2 LPM的溶血测试,持续6小时。
    评估:通过产生5至50 mm Hg的压力上升,该原型在设计工作范围内表现良好。血浆游离血红蛋白浓度仍低于15 mg / dL。溶血标准化指数在第一个小时达到峰值,然后保持低于10 mg / dL。
    结论:螺旋桨泵具有压力流量特性,溶血和静脉通路阻塞的风险最小,因此非常适合临时腔肺辅助。这种类型的设备有可能为单心室Fontan生理功能不佳的患者(作为通往康复或移植的桥梁)提供一种新的治疗选择。
  • 【诺伍德手术后肺动脉的发育:Blalock-Taussig分流器与右心室-肺动脉导管之间的比较。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2008.06.016 复制DOI
    作者列表:Caspi J,Pettitt TW,Mulder T,Stopa A
    BACKGROUND & AIMS: BACKGROUND:The Norwood-Sano procedure for hypoplastic left heart syndrome (HLHS) has been associated with improved postoperative hemodynamics and outcome. This study compared the effect of a Blalock-Taussig shunt with right ventricular-pulmonary artery (RV-PA) conduit before bidirectional Glenn on the development of the PAs. METHODS:Between January 2000 and June 2007, 42 patients with HLHS underwent bidirectional Glenn: 19 (mean age, 7 +/- 1.5 months) had a Blalock-Taussig shunt (3.5 mm in 15; and 4 mm in 4); 23 patients (mean age, 5 +/- 1 month) had RV-PA conduit (5-mm tube). Patients underwent postoperative cardiac catheterization and echocardiograms. RESULTS:Total PA (Nakata) index was 192 +/- 10 mm2/m2 in the Blalock-Taussig group and 238 +/- 18 mm2/m2 in the RV-PA conduit group (p = 0.03). In the RV-PA conduit patients, the left and right PAs had comparable diameters. In the Blalock-Taussig group, the left PA was smaller than the right (p = 0.02). The mean PA pressure at the end of the operation was 14 +/- 2 mm Hg in the Blalock-Taussig group and 11 +/-1 mm Hg in the RV-PA conduit group (p = 0.06). Persistent pleural effusion occurred in 4 Blalock-Taussig patients (21%) and in 1 (4%) with RV-PA conduit (p < 0.05). Postoperative arterial oxygen saturation was 80% +/- 2% in the RV-PA conduit group and 74% +/- 2% in the Blalock-Taussig group (p < 0.05). CONCLUSIONS:The Norwood procedure with RV-PA conduit may have favorable effects on the development of the PA due to even distribution of pulmonary blood flow.
    背景与目标: 背景:Norwood-Sano手术治疗左心发育不全综合征(HLHS)与改善术后血流动力学和预后相关。这项研究比较了双向双向Glenn之前Blalock-Taussig分流器与右心室-肺动脉(RV-PA)导管对PA发育的影响。
    方法:在2000年1月至2007年6月之间,对42例HLHS患者进行了双向Glenn治疗:19例(平均年龄7 /-1.5个月)进行了Blalock-Taussig分流术(15mm时3.5mm; 4mm时4mm)。 23例患者(平均年龄5 /-1个月)使用RV-PA导管(5毫米管)。患者接受了术后心脏导管检查和超声心动图检查。
    结果:Blalock-Taussig组的总PA(中和)指数为192 /-10 mm2 / m2,RV-PA导管组的总PA(中和)指数为238 /-18 mm2 / m2(p = 0.03)。在RV-PA导管患者中,左PA和右PA具有可比较的直径。在Blalock-Taussig组中,左PA小于右PA(p = 0.02)。手术结束时,Blalock-Taussig组的平均PA压力为14 /-2 mm Hg,RV-PA导管组的平均PA压力为11 / -1 mm Hg(p = 0.06)。持续性胸腔积液发生在4例Blalock-Taussig患者(21%)和1例(4%)RV-PA导管中(p <0.05)。 RV-PA导管组的术后动脉血氧饱和度为80%/-2%,Blalock-Taussig组为74%/-2%(p <0.05)。
    结论:RV-PA导管的Norwood手术可能由于肺血流的均匀分布而对PA的发展产生有利的影响。
  • 【瓣膜保留术成功治疗了巨大的瓦萨尔瓦动脉瘤破裂窦-病例报告。】 复制标题 收藏 收藏
    DOI:10.1186/s13019-020-1061-1 复制DOI
    作者列表:Pólos M,Șulea CM,Benke K,Ágg B,Kovács A,Hartyánszky I,Merkely B,Schäfers HJ,Szabolcs Z
    BACKGROUND & AIMS: BACKGROUND:Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. CASE PRESENTATION:A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. CONCLUSIONS:Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.
    背景与目标: 背景:窦静脉窦动脉瘤(SVA)是一种罕见的心脏异常,其发病率不到心脏直视手术病例的1%。它的进化通常是沉默的,偶然发现或在其急性破裂时被发现。由于未破裂的巨型SVA伸入心腔或冠状动脉受压,可能会导致异常的临床表现,并经常伴有各种严重程度的主动脉瓣关闭不全。 SVA的金标准治疗包括完全替换主动脉根部和瓣膜。但是,在某些情况下,阀保持程序可能被证明是更合适的选择。
    病例介绍:一名68岁的男性患者,由于Valsalva动脉瘤的右窦大(> 5cm)而出现呼吸困难。动脉瘤占据了右心室的大部分,并伴有严重的主动脉瓣关闭不全。病情的外科治疗包括保留瓣膜的根部重建程序(重塑技术),并通过缝合线瓣环成形术通过主动脉瓣环的外部稳定来完成。经过平稳的干预,患者表现良好,病情得到改善。术后1个月进行的经胸超声心动图检查显示主动脉瓣完全干competent,无反流。
    结论:尽管主动脉根和瓣膜完全置换被认为是大型SVA并发主动脉瓣关闭不全的最安全方法,但如果主动脉根未扩张而主动脉瓣未钙化,则不应该忽视瓣膜保留程序。通过应用瓣膜成形术完成的重塑技术进行瓣膜保留术,可减少主动脉瓣膜功能不全,避免与植入瓣膜有关的副作用。
  • 【串联亲和纯化(TAP)方法:蛋白质复合物纯化的一般程序。】 复制标题 收藏 收藏
    DOI:10.1006/meth.2001.1183 复制DOI
    作者列表:Puig O,Caspary F,Rigaut G,Rutz B,Bouveret E,Bragado-Nilsson E,Wilm M,Séraphin B
    BACKGROUND & AIMS: :Identification of components present in biological complexes requires their purification to near homogeneity. Methods of purification vary from protein to protein, making it impossible to design a general purification strategy valid for all cases. We have developed the tandem affinity purification (TAP) method as a tool that allows rapid purification under native conditions of complexes, even when expressed at their natural level. Prior knowledge of complex composition or function is not required. The TAP method requires fusion of the TAP tag, either N- or C-terminally, to the target protein of interest. Starting from a relatively small number of cells, active macromolecular complexes can be isolated and used for multiple applications. Variations of the method to specifically purify complexes containing two given components or to subtract undesired complexes can easily be implemented. The TAP method was initially developed in yeast but can be successfully adapted to various organisms. Its simplicity, high yield, and wide applicability make the TAP method a very useful procedure for protein purification and proteome exploration.
    背景与目标: :鉴定生物复合物中存在的成分需要将其纯化至接近均一。纯化方法因蛋白质而异,因此无法设计适用于所有情况的通用纯化策略。我们已经开发了串联亲和纯化(TAP)方法作为一种工具,即使在其天然水平表达时,该方法也可以在复合物的天然条件下进行快速纯化。不需要复杂的组成或功能的先验知识。 TAP方法需要将TAP标签的N端或C端融合到目标靶蛋白上。从相对少量的细胞开始,可以分离出活性大分子复合物并将其用于多种应用。可以容易地实现各种方法的变型,以专门纯化包含两种给定组分的复合物或减去不希望的复合物。 TAP方法最初是在酵母中开发的,但可以成功地适应各种生物。它的简单性,高收率和广泛的适用性使TAP方法成为蛋白质纯化和蛋白质组学探索中非常有用的程序。
  • 【验证心包液中可卡因和代谢物的气相色谱-质谱分析方法的有效性。】 复制标题 收藏 收藏
    DOI:10.1093/jat/31.2.75 复制DOI
    作者列表:Contreras MT,González M,González S,Ventura R,Valverde JL,Hernández AF,Pla A,Vingut A,Segura J,de la Torre R
    BACKGROUND & AIMS: :A method is described for the simultaneous quantification of cocaine, benzoylecgonine, and cocaethylene in pericardial fluid. Pericardial fluid samples from autopsy casework involving cocaine-related deaths and deaths unrelated to drug abuse were collected. The extraction of cocaine and its metabolites was performed using Bond-Elut Certify columns. Pericardial fluid samples were adjusted to pH 7 and applied to the pre-conditioned cartridges. After the washing steps, compounds were eluted with a mixture of chloroform/isopropanol (80:20) with 2% ammonium hydroxide. The dry extracts were derivatized with pentafluoropropionic anhydride and hexafluoroisopropanol and analyzed by gas chromatography-mass spectrometry using electron impact ionization and selective ion monitoring acquisition. Deuterated internal standards were used. The analytical method developed was linear, sensitive, selective, accurate, and sufficiently precise to be applied routinely in forensic toxicology. In this study, the procedure has been successfully applied to a number of forensic cases involving cocaine intoxication.
    背景与目标: :描述了一种同时定量心包液中可卡因,苯甲酰芽子碱和可卡因的方法。从涉及可卡因相关死亡和与药物滥用无关的死亡的尸检案例中收集心包液样品。可卡因及其代谢物的提取使用Bond-Elut Certify色谱柱进行。将心包液样品的pH值调节至7,然后将其施加到预处理过的药筒上。洗涤步骤后,将化合物用氯仿/异丙醇(80:20)与2%氢氧化铵的混合物洗脱。将干燥的提取物用五氟丙酸酐和六氟异丙醇衍生化,并通过使用电子碰撞电离和选择性离子监测采集的气相色谱-质谱分析。使用氘代内标。所开发的分析方法是线性,灵敏,选择性,准确且足够精确的,可常规用于法医毒理学。在这项研究中,该程序已成功应用于许多涉及可卡因中毒的法医案件。
  • 【机械腔静脉辅助在MRI衍生的患者特定font门构型中的稳定流动分析。】 复制标题 收藏 收藏
    DOI:10.1111/j.1525-1594.2012.01510.x 复制DOI
    作者列表:Downs EA,Moskowitz WB,Throckmorton AL
    BACKGROUND & AIMS: :This numerical study examined the performance of an intravascular axial flow blood pump for mechanical hemodynamic support of patients in the setting of Fontan failure, which presently has few treatment options. Three anatomically accurate geometries of the total cavopulmonary connection (TCPC) were generated using patients' magnetic resonance imaging data. These patient-specific geometries, as well as an idealized version with cylindrical vessels, were computationally analyzed with and without a pump in the inferior vena cava. Pressure flow characteristics, energy gain calculations, and blood damage analyses were performed for each model. The pump produced pressures of 1-14 mm Hg for 1500-4000 revolutions per minute, flow rates of 1-4 L/min, and pulmonary artery pressures of 8-24 mm Hg. Comparison of pump performance among the four models showed minimal intermodel differences (<5% deviation) in the pressure rise generated by the pump, the IVC pressure, and the energy imparted to the system by the pump. Blood damage analysis showed maximum fluid scalar stress values of 372 Pa or less, and the blood damage index was less than 2% in all of the models. These results suggest that this axial flow blood pump performs consistently in a variety of TCPC vessel geometries with low risk of blood trauma.
    背景与目标: :这项数值研究检查了在Fontan衰竭的情况下血管内轴流式血液泵对患者进行机械血流动力学支持的性能,目前尚无治疗选择。使用患者的磁共振成像数据生成了总腔肺连接(TCPC)的三个解剖学精确的几何形状。在下腔静脉中有无泵的情况下,对这些特定于患者的几何形状以及带有圆柱形血管的理想版本进行了计算分析。对每个模型进行压力流量特性,能量获取计算和血液损伤分析。泵以每分钟1500-4000转的速度产生1-14 mm Hg的压力,1-4 L / min的流速以及8-24 mm Hg的肺动脉压力。四个模型之间的泵性能比较显示,泵产生的压力上升,IVC压力和泵传递给系统的能量之间存在最小的模型间差异(偏差小于5%)。血液损伤分析显示所有模型的最大液体标量应力值为372 Pa或更低,血液损伤指数小于2%。这些结果表明,这种轴流式血泵在各种TCPC血管几何形状中均具有一致的性能,且血液外伤的风险较低。
  • 15 Procedure for the decerebration of the rat. 复制标题 收藏 收藏

    【大鼠去脑程序。】 复制标题 收藏 收藏
    DOI:10.1016/0361-9230(78)90016-3 复制DOI
    作者列表:Sapru HN,Krieger AJ
    BACKGROUND & AIMS: :A procedure for the decerebration of the rat was devised. The internal and external carotid arteries were ligated under halothane anesthesia. A transection was made at the mid-collicular level of the brain and the transected forebrain was removed. The posterior communicating arteries were occluded by suction and oxidized cellulose was packed around these vessels. The cut surface of the brain was covered with oxidized cellulose and the cranial cavity was filled with cotton balls. Head-up tilt, carotid occlusion and sodium cyanide responses indicated that the orthostatic, baro-, and chemo- reflexes were intact in these preparations. The stability of the preparation (for at least 8-10 hr) and the integrity of these reflexes indicate that the decerebrate rat may be a suitable alternative for studies involving brain stem regulatory mechanisms in this species when it is desirable to avoid general anesthetics.
    背景与目标: :设计了大鼠去脑程序。在氟烷麻醉下结扎颈内动脉和颈外动脉。在大脑的中枢神经层横切,切除横断的前脑。抽气阻塞了后交通动脉,氧化纤维素堆积在这些血管周围。大脑的切面被氧化的纤维素覆盖,颅腔内充满了棉球。抬头向上倾斜,颈动脉闭塞和氰化钠反应表明这些制剂的体位性,气压反射和化学反射完好无损。制剂的稳定性(至少8-10小时)和这些反射的完整性表明,当需要避免全身麻醉时,去脑大鼠可能是该物种脑干调节机制研究的合适选择。

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