• 【基于人群的样本中肾脏血浆对血管紧张素II的血流反应与血压之间的关系。】 复制标题 收藏 收藏
    DOI:10.1097/00004872-199715050-00004 复制DOI
    作者列表:Turner ST,Kardia SL
    BACKGROUND & AIMS: OBJECTIVE:To assess whether interindividual variation in renal plasma flow or in its response to angiotensin II infusion is associated with interindividual differences in blood pressure in a population-based sample of 287 non-Hispanic whites (143 women and 144 men), aged 20-49.9 years.

    METHODS:After seven days of eating a high-sodium diet (260 mmol/day), the renal plasma flow was determined by measuring the clearance of p-aminohippurate before and after infusion of 3 ng/kg per min angiotensin II. Multiple linear regression methods were used to assess whether measures of the renal plasma flow and of its response to angiotensin II infusion were predictive of systolic or diastolic blood pressures measured prior to administration of the high-sodium diet, on day 6 of the high-sodium diet, or during the renal clearance procedure on day 7 prior to angiotensin II infusion.

    RESULTS:There was some evidence that measures of the renal plasma flow and of its response to angiotensin II infusion during the high-sodium diet were statistically significant predictors of measures of blood pressure in women; there was less evidence for this for blood pressures in men. Interindividual variation in measures of the renal plasma flow and of its response to angiotensin II infusion explained less than 10% of the interindividual variation in any measure of the blood pressure in both sexes.

    CONCLUSION:These results suggest that interindividual variation in renal plasma flow ad in its response to angiotensin II infusion during a high-sodium diet will be of limited utility in elucidating the basis for interindividual differences in blood pressure.

    背景与目标: 目的 : 在基于人群的287非西班牙裔白人 (143名女性和144名男性) 样本中,评估肾血浆流量或对血管紧张素II输注的反应的个体差异是否与血压的个体差异相关,年龄在20-49.9岁之间。
    方法 : 在食用高钠饮食 (260 mmol/天) 7天后,通过在每分钟输注3 ng/kg血管紧张素II之前和之后测量对氨基马尿酸盐的清除率来确定肾血浆流量。使用多元线性回归方法来评估肾血浆流量及其对血管紧张素II输注的反应的测量是否可以预测高钠饮食第6天在给予高钠饮食之前测得的收缩压或舒张压。钠饮食,或在输注血管紧张素II之前第7天的肾脏清除过程中。
    结果 : 有证据表明,高钠饮食期间肾脏血浆流量的测量及其对血管紧张素II输注的反应是女性血压测量的统计学显着预测指标; 男性血压的证据较少。肾血浆流量测量及其对血管紧张素II输注的反应的个体差异解释了男女血压测量中个体间差异的10%。
    结论 : 这些结果表明,在高钠饮食中对血管紧张素II输注的反应中,肾血浆流量ad的个体差异在阐明血压个体差异的基础方面将是有限的。
  • 【咖啡因对正常血压健康年轻人运动过程中血压反应的影响。】 复制标题 收藏 收藏
    DOI:10.1016/0002-9149(90)91435-9 复制DOI
    作者列表:Sung BH,Lovallo WR,Pincomb GA,Wilson MF
    BACKGROUND & AIMS: :The possible combined effects of caffeine and exercise on blood pressure (BP) regulation were examined in 34 healthy, normotensive (BP less than 135/85 mm Hg) young men (mean age 27 +/- 3 years) in a placebo-controlled, double-blind crossover design. Each subject performed submaximal and symptom-limited maximal supine bicycle exercise 1 hour apart after ingestion of placebo or caffeine (3.3 mg/kg). Heart rate, BP, cardiac output and peripheral vascular resistance were compared for placebo and caffeine days. Postdrug baseline showed that caffeine increased systolic and diastolic BP and peripheral vascular resistance (p less than 0.001 for each) and decreased heart rate (p less than 0.01) but did not change stroke volume or cardiac output. BP and vascular resistance effects of caffeine remained during submaximal exercise resulting in an additive increase in BP while negative chronotropic effects of caffeine disappeared. At maximal exercise substantially more subjects (15 on caffeine vs 7 on placebo, p less than 0.02) had systolic BP greater than or equal to 230 mm Hg and/or greater than or equal to 100 mm Hg for diastolic BP. Plasma norepinephrine levels were not significantly different across days, but epinephrine was higher at maximal exercise and cortisol was increased post-drug and throughout maximal exercise on caffeine days. Data indicate that caffeine increases BP additively during submaximal exercise and may cause excessive BP responses at maximal exercise for some individuals. The pressor effects of caffeine appear to be due to increasing vascular resistance rather than cardiac output.
    背景与目标: : 在安慰剂对照中,在34名健康,血压正常 (血压低于135/85mm Hg) 的年轻男性 (平均年龄27/- 3岁) 中检查了咖啡因和运动对血压 (BP) 调节的可能综合作用,双盲交叉设计。每个受试者在摄入安慰剂或咖啡因 (3.3 mg/kg) 后1小时间隔进行次最大和症状受限的最大仰卧自行车运动。比较安慰剂和咖啡因天数的心率,血压,心输出量和外周血管阻力。药物后基线显示,咖啡因增加收缩压和舒张压以及周围血管阻力 (每个p小于0.001) 和降低心率 (p小于0.01),但不改变中风量或心输出量。在次最大运动期间,咖啡因的BP和血管阻力效应仍然存在,导致BP的累加性增加,而咖啡因的负变时性效应消失了。在最大运动时,明显更多的受试者 (咖啡因组15例,安慰剂组7例,p小于0.02) 的收缩压大于或等于230毫米Hg和/或舒张压大于或等于100毫米Hg。血浆去甲肾上腺素水平在不同的日子没有显着差异,但肾上腺素在最大运动时较高,皮质醇在服药后和咖啡因的整个最大运动中增加。数据表明,咖啡因在次最大运动期间会增加BP,并可能导致某些人在最大运动时产生过多的BP反应。咖啡因的升压作用似乎是由于血管阻力增加而不是心输出量增加所致。
  • 【调整肥胖后,自我报告的体育锻炼是否与青少年的高血压有关?】 复制标题 收藏 收藏
    DOI:10.1080/02640414.2012.734631 复制DOI
    作者列表:Barros MV,Ritti-Dias RM,Honda Barros SS,Mota J,Andersen LB
    BACKGROUND & AIMS: :Studies show that both low physical activity (PA) and adiposity are associated with a higher risk of hypertension. However, the relationship between PA and blood pressure in adolescents is controversial and other studies have reported that no association was observed. Of particular interest is the evaluation of whether the association between PA and high blood pressure is independent of adiposity. A sample of 3764 Brazilian adolescents who attend high schools was selected using random cluster sampling. Data were collected using the Global School-based Student Health Survey, anthropometry, and blood pressure readings. The prevalence of high blood pressure was 14.6% (95% Confidence Interval (CI) 13.5-15.7), higher amongst males (20.0%; 95%CI 18.0-22.1) compared with females (10.9%; 95%CI 9.7-12.3). Sixty-six per cent of the adolescents were reported to be insufficiently active. The prevalence of high blood pressure was 12.8% (95%CI 11.0-14.7) amongst active compared with 15.4% (95%CI 14.0-16.9) amongst insufficiently active adolescents. The association between PA and high blood pressure was observed only amongst females after adjusting for waist circumference (odds ratio (OR) 1.67; 95%CI 1.21-2.31) and body mass index (OR 1.71; 95%CI 1.23-2.37). Notwithstanding levels of adiposity, higher PA levels are associated with a lower prevalence of high blood pressure amongst females, although not amongst males.
    背景与目标: : 研究表明,低体力活动 (PA) 和肥胖都与高血压的高风险相关。然而,PA与青少年血压之间的关系存在争议,其他研究报告未观察到关联。特别令人感兴趣的是评估PA与高血压之间的关联是否独立于肥胖。采用随机整群抽样的方法,选取了3764名就读高中的巴西青少年样本。数据是使用全球学校学生健康调查,人体测量学和血压读数收集的。高血压的患病率为14.6% (95% 置信区间 (CI) 13.5-15.7),男性 (20.0%; 95% CI 18.0-22.1) 高于女性 (10.9%; 95% CI 9.7-12.3)。据报告,66% 的青少年活动不足。在活跃的青少年中,高血压的患病率12.8% (95% CI 11.0-14.7),而在不活跃的青少年中,高血压的患病率为15.4% (95% CI 14.0-16.9)。仅在调整腰围 (比值比 (OR) 1.67; 95% CI 1.21-2.31) 和体重指数 (OR 1.71; 95% CI 1.23-2.37) 后,在女性中观察到PA与高血压之间的关联。尽管肥胖程度较高,但女性中PA水平较高与高血压患病率较低有关,尽管男性中并非如此。
  • 【预防医院获得性压力伤害策略的经济评估。】 复制标题 收藏 收藏
    DOI:10.1097/01.ASW.0000520289.89090.b0 复制DOI
    作者列表:Ocampo W,Cheung A,Baylis B,Clayden N,Conly JM,Ghali WA,Ho CH,Kaufman J,Stelfox HT,Hogan DB
    BACKGROUND & AIMS: GENERAL PURPOSE:To provide information from a review of literature about economic evaluations of preventive strategies for pressure injuries (PIs). TARGET AUDIENCE:This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES:After participating in this educational activity, the participant should be better able to:1. Identify the purpose and methods used for this study.2. Compare costs and effectiveness related to preventative strategies for PIs. ABSTRACT:BACKGROUND: Pressure injuries (PIs) are a common and resource-intensive challenge for acute care hospitals worldwide. While a number of preventive strategies have the potential to reduce the cost of hospital-acquired PIs, it is unclear what approach is the most effective. OBJECTIVE:The authors performed a narrative review of the literature on economic evaluations of preventive strategies to survey current findings and identify important factors in economic assessments. DATA SOURCES:Ovid, MEDLINE, NHS Economic Evaluation Databases, and the Cochrane Database of Systematic ReviewsSELECTION CRITERIA: Potentially relevant original research articles and systematic reviews were considered. DATA EXTRACTION:Selection criteria included articles that were written in English, provided data on cost or economic evaluations of preventive strategies of PIs in acute care, and published between January 2004 and September 2015. Data were abstracted from the articles using a standardized approach to evaluate how the items on the Consolidated Health Economic Evaluation Reporting Standards checklist were addressed. DATA SYNTHESIS:The searches identified 192 references. Thirty-three original articles were chosen for full-text reviews. Nineteen of these articles provided clear descriptions of interventions, study methods, and outcomes considered. CONCLUSIONS:Limitations in the available literature prevent firm conclusions from being reached about the relative economic merits of the various approaches to the prevention of PIs. The authors' review revealed a need for additional high-quality studies that adhere to commonly used standards of both currently utilized and emerging ways to prevent hospital-acquired PIs.
    背景与目标:
  • 【儿童踝关节软骨脂肪瘤: 一例报告。】 复制标题 收藏 收藏
    DOI:10.1053/j.jfas.2017.04.031 复制DOI
    作者列表:Ishibashi T,Nishio J,Kobayashi S,Shiramizu K,Yamamoto T
    BACKGROUND & AIMS: :Chondrolipoma is an extremely rare variant of lipoma with cartilaginous metaplasia. The presence of nonlipomatous components can lead to a variety of entities in the differential diagnosis from the radiologic findings. We describe an unusual case of a chondrolipoma occurring in the right ankle of a 9-year-old female. Physical examination showed a 3.5-cm, elastic-hard, poorly mobile, nontender mass adherent to the Achilles tendon. Plain radiographs revealed a faintly calcified soft tissue mass without bone involvement. Magnetic resonance imaging showed a well-defined mass with 2 components with heterogeneous signal intensity, suggesting the coexistence of a fatty area and another nonlipomatous component. Marginal excision of the tumor was performed. Histologically, the tumor was composed of mature adipose tissue studded with islands of mature hyaline cartilage. Based on these findings, the tumor was diagnosed as a chondrolipoma. The patient had no evidence of local recurrence within 9 months of follow-up. To the best of our knowledge, this is the first case of chondrolipoma originating from the ankle in a child.
    背景与目标: : 软骨脂肪瘤是脂肪瘤的一种极其罕见的变异型软骨化生。非脂肪瘤性成分的存在可导致放射学发现的鉴别诊断疾病中的各种实体。我们描述了一个9岁女性右脚踝发生软骨脂肪瘤的不寻常病例。体格检查显示跟腱附着有3.5厘米,弹性坚硬,移动不良,不柔软的肿块。X线平片显示微弱的钙化软组织肿块,没有骨受累。磁共振成像显示出一个明确的质量,其中有2个成分,信号强度不均匀,表明脂肪区域和另一种非脂肪瘤成分并存。进行了肿瘤的边缘切除术。从组织学上讲,肿瘤由成熟的脂肪组织组成,这些脂肪组织散布着成熟的透明软骨岛。根据这些发现,该肿瘤被诊断为软骨脂肪瘤。在随访的9个月内,患者没有局部复发的证据。据我们所知,这是第一例起源于儿童脚踝的软骨脂肪瘤。
  • 【Grieshaber空气系统在维持气管导管袖带压力中的应用。】 复制标题 收藏 收藏
    DOI:10.1016/0952-8180(90)90050-d 复制DOI
    作者列表:Vitkun SA,Lagasse RS,Kyle KT,Poppers PJ
    BACKGROUND & AIMS: :The Grieshaber Air System was designed to maintain intraocular pressure during ophthalmologic surgery. It also has been used to maintain pressure in leaking endotracheal tube cuffs. It is a very useful device, especially if the intubation is difficult or the patient's position precludes replacement of the endotracheal tube. Two patients are presented in whom the system was used to maintain endotracheal tube cuff pressure.
    背景与目标: : Grieshaber空气系统旨在在眼科手术期间保持眼内压。它也已用于维持气管导管袖口泄漏的压力。这是一种非常有用的设备,尤其是在插管困难或患者的位置无法更换气管插管的情况下。介绍了两名患者,其中该系统用于维持气管导管袖带压力。
  • 【血液透析患者踝臂指数随时间的下降和心血管结局。】 复制标题 收藏 收藏
    DOI:10.1097/MAJ.0b013e31825141bf 复制DOI
    作者列表:Chen SC,Chang JM,Liu WC,Huang JC,Chen YY,Yang TK,Su HM,Chen HC
    BACKGROUND & AIMS: INTRODUCTION:Abnormal ankle-brachial index (ABI) is associated with increased morbidity and mortality in hemodialysis patients. However, whether the decrease in ABI over time carries the prognostic value is unknown. The aim of this study was to assess whether the decrease in ABI over time was a good predictor of poor cardiovascular (CV) prognosis in hemodialysis patients. METHODS:This study enrolled 234 routine hemodialysis patients and 173 patients completed the follow-up. The ABI was measured by an ABI-form device at baseline and at the first year follow-up. The ΔABI was defined as ABI measured at the first year follow-up minus ABI measured at baseline. Progressors of ABI were defined as patients with ΔABI < -0.3. CV events were defined as CV death, hospitalization for unstable angina, nonfatal myocardial infarction, hospitalization for arrhythmia, hospitalization for congestive heart failure and stroke. RESULTS:The follow-up period was 37.8 ± 11.1 months. In the multivariate analysis, progressors of ABI (hazard ratio, 2.71; 95% confidence interval, 1.10-6.68, P = 0.03), decreased albumin and increased high-sensitivity C-reactive protein were associated with increased CV events. CONCLUSIONS:This longitudinal study showed ΔABI < -0.3 was independently associated with an increase in CV events. Hence, a great decrease in ABI over time might be a useful indicator of poor CV prognosis in hemodialysis patients.
    背景与目标:
  • 【模拟牙髓压力对牙本质多合一粘合强度的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.jdent.2006.08.001 复制DOI
    作者列表:Hosaka K,Nakajima M,Yamauti M,Aksornmuang J,Ikeda M,Foxton RM,Pashley DH,Tagami J
    BACKGROUND & AIMS: OBJECTIVES:To evaluate the durability of all-in-one adhesive systems bonded to dentine with and without simulated hydrostatic pulpal pressure (PP). METHODS:Flat dentine surfaces of extracted human molars were prepared. Two all-in-one adhesive systems, One-Up Bond F (OBF) (Tokuyama Corp., Tokyo, Japan), and Fluoro Bond Shake One (FBS) (Shofu Co., Kyoto, Japan) were applied to the dentine surfaces under either a PP of 0 or 15cm H(2)O. Then, resin composite build-ups were made. The specimens bonded under pressure were stored in 37 degrees C water for 24h, 1 and 3 months under 15cm H(2)O PP. Specimens not bonded under pressure were stored under zero PP. After storage, the specimens were sectioned into slabs that were trimmed to hourglass shapes and subjected to micro-tensile bond testing (muTBS). The data were analysed using two-way ANOVA and Holm-Sidak HSD multiple comparison tests (alpha=0.05). RESULTS:The muTBS of OBF fell significantly (p<0.05) when PP was applied during bonding and storage, regardless of storage time. In contrast, although the muTBS of OBF specimens bonded and stored without hydrostatic pressure storage fell significantly over the 3 months period, the decrease was less than half as much as specimens stored under PP. In FBS bonded specimens, although there was no significant difference between the muTBS with and without hydrostatic pulpal pressure at 24h, by 1 and 3 months of storage under PP, significant reductions were seen compared with the control group without PP. CONCLUSION:The muTBS of OBF bonded specimens was lowered more by simulated PP than by storage time; specimens bonded with FBS were not sensitive to storage time in the absence of PP, but showed lower bond strengths at 1 and 3 months in the presence of PP.
    背景与目标:
  • 【短暂的右心室压力超负荷后,右心室功能障碍持续存在。】 复制标题 收藏 收藏
    DOI:10.1016/s0008-6363(97)00038-2 复制DOI
    作者列表:Greyson C,Xu Y,Cohen J,Schwartz GG
    BACKGROUND & AIMS: OBJECTIVE:Acute pulmonary hypertension may cause right ventricular (RV) contractile failure. While it has been assumed that restoration of normal loading conditions after acute pulmonary hypertension is sufficient for complete recovery of RV function, this has not been rigorously examined. The purpose of this study was to test the hypothesis that acute RV pressure overload produces RV contractile dysfunction that persists following restoration of control loading conditions. METHODS:We subjected 18 autonomically-blocked, chloralose-anesthetized, open-chest pigs to 1 h of pulmonary artery constriction to increase RV systolic pressure from 35 +/- 1 to 55 +/- 1 mmHg, followed by 2 h of measurements after pulmonary artery constriction release. We determined regional RV free wall function from pressure-segment length loops and preload recruitable stroke work relations, and global RV function from stroke work vs. end-diastolic pressure relations. RESULTS:As expected, RV free wall systolic shortening diminished during pulmonary artery constriction, but the endo/epi blood flow ratio, lactate uptake, and coronary venous pH were not significantly changed. Following release of pulmonary artery constriction, RV systolic and diastolic pressure returned to control values. Nonetheless, contractile dysfunction persisted, with depressed RV free wall systolic shortening (70 +/- 22% of control), RV regional external work (59 +/- 11% of control at control end-diastolic length), and global RV stroke work (56 +/- 14% of control at control end-diastolic pressure). Depressed regional work was due to a parallel, rightward shift of the preload recruitable stroke work relation. Five pigs identically instrumented but not subjected to pulmonary artery constriction showed no significant over 3 h. CONCLUSIONS:Acute pulmonary hypertension causes RV contractile dysfunction that persists at least 2 h after restoration of control loading conditions. Contractile dysfunction is not attributable to RV ischemia during pressure overload.
    背景与目标:
  • 【三维导航门控全心脏MR冠状动脉造影的评估: 高心率受试者的收缩期成像的重要性。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejrad.2006.08.013 复制DOI
    作者列表:Wu YW,Tadamura E,Yamamuro M,Kanao S,Nakayama K,Togashi K
    BACKGROUND & AIMS: PURPOSE:To evaluate the influence of heart rate (HR) on magnetic resonance coronary angiography (MRCA) image quality in diastolic and systolic phases. MATERIALS AND METHODS:Twenty-seven healthy volunteers (9 men; 33+/-9 years, HR 53-110 bpm), were evaluated with the electrocardiography and three-dimensional navigator-gating MRCA in a 1.5-T MR scanner (Avanto, Siemens) in diastolic and systolic phases (steady-state free precession; TR/TE/flip angle=3.2 ms/1.6 ms/90 degrees). The timing of scanning was individually adapted to the cardiac rest periods obtained in the prescanning, by visually identifying when the movement of right coronary artery was minimized during diastole and systole. Images of two phases were side-by-side compared on a four-point scale (from 1=poor to 4=excellent visibility; score of 3 or 4 as diagnostic). RESULTS:Of 13 subjects with HR < or =65 bpm (low HR group, mean 59.8+/-4.9 bpm, range 53-65), the image quality scores were significantly better than that with higher heart rates (73.9+/-9.0 bpm, range 68-110) in diastolic MRCA. The image quality was significantly improved during systole in high HR group. Overall, 91.3% of low HR group had MRCA image of diagnostic quality acquired at diastole, while 88.3% of high HR group had diagnostic images at systole by segmental analysis (p=NS). CONCLUSIONS:MRCA at systole offered superior quality in patients with high heart rates.
    背景与目标:
  • 【接受蒽环类药物化疗的HER2/neu阴性乳腺癌患者的左心室收缩功能: 12个月内左心室射血分数和心肌应变成像的比较分析。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejca.2013.06.046 复制DOI
    作者列表:Stoodley PW,Richards DA,Boyd A,Hui R,Harnett PR,Meikle SR,Byth K,Stuart K,Clarke JL,Thomas L
    BACKGROUND & AIMS: AIM:Anthracycline agents are undermined by their cardiotoxicity. As life expectancy following treatment is greatly improved, techniques that ensure early detection and timely management of cardiotoxicity are essential. The aim of the present study was to evaluate left ventricular (LV) systolic function with LV ejection fraction (LVEF) and two-dimensional myocardial strain up to 12 months after anthracycline chemotherapy, specifically in HER2/neu negative breast cancer patients. METHODS:Seventy-eight consecutive anthracycline naïve breast cancer patients were studied before and immediately after anthracycline chemotherapy. Fifty HER2/neu negative patients were studied over 12 months with serial echocardiograms at four time points. All patients were treated with standard regimens containing anthracyclines. RESULTS:Global systolic strain was significantly reduced immediately after, and 6 months after anthracyclines (-19.0 ± 2.3% to -17.5 ± 2.3% (P<0.001) and -18.2 ± 2.2% (P=0.01) respectively). A non-uniform reduction in strain was observed each time with relative sparing of the LV apex. LVEF remained largely unchanged at both time points. Global strain normalised by 12 months in the majority of patients. Persistently reduced strain was observed in 16% (n=8); these patients had a greater reduction in strain at 6 months (≤ -17.2%), and had received higher cumulative anthracycline doses. CONCLUSION:Myocardial strain imaging is more sensitive than LVEF for the early detection and intermediate term monitoring of LV systolic function following anthracycline chemotherapy in HER2/neu negative breast cancer patients, and may aid in the development of improved monitoring protocols.
    背景与目标:
  • 【Nadolol在原发性高血压中的作用: 对动态血压,肾血流动力学和心功能的影响。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2125.1985.tb05037.x 复制DOI
    作者列表:Dupont AG,Vanderniepen P,Bossuyt AM,Jonckheer MH,Six RO
    BACKGROUND & AIMS: :Chronic administration of nadolol has been reported to reduce blood pressure either without or with a concomitant fall of renal blood flow. We therefore studied the effects of nadolol 80 mg once daily on ambulatory blood pressure, renal and systemic haemodynamics in patients with mild to moderate essential hypertension. Ten patients took part in this randomized, double-blind, placebo-controlled, crossover study, each phase of which lasted 4 weeks. Nadolol significantly reduced ambulatory blood pressure and heart rate, but had no effect on blood pressure variability. Cardiac output was significantly reduced by nadolol and total peripheral resistance increased but without reaching statistical significance. Despite the fall in blood pressure and cardiac output, renal blood flow and glomerular filtration rate remained unchanged. The fraction of cardiac output reaching the kidneys rose significantly and renal vascular resistance was significantly reduced. Body weight, urinary sodium excretion and urine flow rate remained unchanged. We conclude that nadolol 80 mg once daily lowers ambulatory blood pressure in patients with mild to moderate hypertension without impairment of renal blood flow, indicating a redistribution of cardiac output to the kidneys. The mechanism of the renal vasodilator effect of nadolol remains to be determined.
    背景与目标: : 据报道,长期服用nadolol可以降低血压,而不会或伴随肾血流下降。因此,我们研究了nadolol 80 mg每天一次对轻度至中度原发性高血压患者的动态血压,肾脏和全身血流动力学的影响。10名患者参加了这项随机,双盲,安慰剂对照,交叉研究,每个阶段持续4周。Nadolol显着降低了动态血压和心率,但对血压变异性没有影响。nadolol显着降低了心输出量,总外周阻力增加了,但没有达到统计学意义。尽管血压和心输出量下降,但肾血流量和肾小球滤过率保持不变。到达肾脏的心输出量的比例显着增加,肾脏血管阻力显着降低。体重,尿钠排泄和尿流率保持不变。我们得出的结论是,nadolol 80 mg每天一次可降低轻度至中度高血压患者的动态血压,而不会损害肾血流,这表明心输出量重新分布到肾脏。那多洛尔的肾血管扩张作用的机制仍有待确定。
  • 【由于左心室收缩功能降低而导致心力衰竭患者的贫血和相关的临床结局。】 复制标题 收藏 收藏
    DOI:10.1002/clc.22181 复制DOI
    作者列表:McCullough PA,Barnard D,Clare R,Ellis SJ,Fleg JL,Fonarow GC,Franklin BA,Kilpatrick RD,Kitzman DW,O'Connor CM,Piña IL,Thadani U,Thohan V,Whellan DJ,HF-ACTION Investigators.
    BACKGROUND & AIMS: BACKGROUND:Anemia is associated with decreased functional capacity, reduced quality of life, and worsened outcomes among patients with heart failure (HF) due to reduced left ventricular ejection fraction (HFREF). We sought to evaluate the independent effect of anemia on clinical outcomes among those with HFREF. HYPOTHESIS:Anemia is associated with cardiovascular events in patients with heart failure. METHODS:The HF-ACTION trial was a prospective, randomized trial of exercise therapy vs usual care in 2331 patients with HFREF. Patients with New York Heart Association class II to IV HF and left ventricular ejection fractions of ≤ 35% were recruited. Hemoglobin (Hb) was measured up to 1 year prior to entry and was stratified by quintile. Anemia was defined as baseline Hb <13 g/dL and <12 g/dL in men and women, respectively. Hemoglobin was assessed in 2 models: a global prediction model that had been previously developed, and a modified model including variables associated with anemia and the studied outcomes. RESULTS:Hemoglobin was available at baseline in 1763 subjects (76% of total study population); their median age was 59.0 years, 73% were male, and 62% were Caucasian. The prevalence of anemia was 515/1763 (29%). Older age, female sex, African American race, diabetes, hypertension, and lower estimated glomerular filtration rates were all more frequent in lower Hb quintiles. Over a median follow-up of 30 months, the primary outcome of all-cause mortality or all-cause hospitalization occurred in 78% of those with anemia and 64% in those without (P < 0.001). The secondary outcomes of all-cause mortality alone,cardiovascular (CV) mortality or CV hospitalization, and CV mortality or HF hospitalization occurred in 23% vs 15%, 67% vs 54%, and 44 vs 29%, respectively (P < 0.001). Heart failure hospitalizations occurred in 36% vs 22%, and urgent outpatient visits for HF exacerbations occurred in 67% and 55%, respectively (P < 0.001). For the global model, there was an association observed for anemia and all-cause mortality or hospitalization (adjusted hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 1.01-1.32, P = 0.04), but other outcomes were not significant at P < 0.05. In the modified model, the adjusted HR for anemia and the primary outcome of all-cause mortality or all-cause hospitalization was 1.25 (95% CI: 1.10-1.42, P < 0.001). There were independent associations between anemia and all-cause death (HR: 1.11, 95% CI: 0.87-1.42, P = 0.38), CV death or CV hospitalization (HR: 1.16, 95% CI: 1.01-1.33, P = 0.035), and CV death and HF hospitalization (HR: 1.27, 95% CI: 1.06-1.51, P = 0.008). CONCLUSIONS:Anemia modestly is associated with increased rates of death, hospitalization, and HF exacerbation in patients with chronic HFREF. After adjusting for other important covariates, anemia is independently associated with an excess hazard for all-cause mortality and all-cause hospitalization. Anemia is also associated with combinations of CV death and CV/HF hospitalizations as composite endpoints.
    背景与目标:
  • 【三尖瓣环形平面收缩偏移在法洛四联症修复后儿童和青少年右心室功能评估中的应用。】 复制标题 收藏 收藏
    DOI:10.1016/j.echo.2013.06.022 复制DOI
    作者列表:Mercer-Rosa L,Parnell A,Forfia PR,Yang W,Goldmuntz E,Kawut SM
    BACKGROUND & AIMS: BACKGROUND:Assessing right ventricular (RV) performance is essential for patients with tetralogy of Fallot (TOF). The aim of this study was to investigate the reliability and validity of tricuspid annular plane systolic excursion (TAPSE) against cardiac magnetic resonance imaging measures and cardiopulmonary exercise testing. METHODS:A retrospective study was performed in 125 outpatients with repaired TOF with available protocol-driven echocardiography, cardiac magnetic resonance imaging, and exercise stress testing obtained as part of a cross-sectional study. TAPSE was measured on the two-dimensional apical four-chamber view on echocardiography by two readers. Multivariate linear regression was used to examine the association between TAPSE and measures of RV function and exercise capacity. RESULTS:The mean age was 12.6 ± 3.3 years, 41 patients (33%) were female, and 104 (83%) were white. TAPSE averaged 1.6 ± 0.37 cm, with an interreader intraclass correlation coefficient of 0.78 (n = 18). TAPSE was significantly associated with cardiac magnetic resonance-based RV stroke volume after adjustment for gender and body surface area (β = 13.8; 95% confidence interval, 2.25-25.30; P = .02). TAPSE was not associated with cardiac magnetic resonance-based RV ejection fraction (P = .77). On exercise testing, TAPSE was not associated with peak oxygen consumption, percentage of predicted oxygen consumption, oxygen pulse, or the ventilatory equivalent for carbon dioxide in patients with maximal exercise stress testing (n = 73 [58%]). CONCLUSIONS:TAPSE is reproducibly measured by echocardiography in patients with TOF. It is not associated with RV ejection fraction or exercise performance, and its association with RV stroke volume may be confounded by body size. On the basis of these results, TAPSE is not representative of global RV performance in patients with TOF.
    背景与目标:
  • 【足底压力分布与鞋垫舒适度的关系。】 复制标题 收藏 收藏
    DOI:10.1016/0268-0033(94)90062-0 复制DOI
    作者列表:Che H,Nigg BM,de Koning J
    BACKGROUND & AIMS: :In this paper, four pairs of insoles with different comfort characteristics were used to investigate the relationship between the pressure distribution under the foot and running shoe comfort. Fourteen male subjects were tested in four insole conditions by walking and running on a treadmill. The pressure at the plantar surface of the foot was measured by using an EMED pressure-measuring insole. For walking there were significantly higher pressures and forces in the midfoot area and significantly lower pressures in the medial forefoot and hallux area by wearing the most comfortable insole compared with wearing the least comfortable insole. The shift of the pressure from forefoot to midfoot for the most comfortable insole provided an even distribution of the pressure at the plantar surface of the foot. The results also demonstrated that the path of centre of force at the plantar surface of the foot moved to the lateral aspect of the foot for the most comfortable insole. For running, only the pressure in the medial forefoot area was found significantly lower for the most comfortable insole than for the least comfortable insole. The results of this study indicated that the pressure distribution between the plantar surface of the foot and the shoe could detect the change of shoe comfort. Thus it is a suggestion that pressure measurement may be related to understand factors important for shoe comfort. Comfort of sport shoes is important for the appropriate execution of sport activities. Additionally, comfort may influence fatigue and possibly the development of injuries. The quantification of comfort of sport shoes and the understanding of mechanical and/or biological functions related to it may be enhanced with the use of pressure measurements between the plantar surface of the foot and the shoe sole.
    背景与目标: : 本文采用四对舒适特性不同的鞋垫,研究了脚底压力分布与跑鞋舒适度之间的关系。通过在跑步机上行走和跑步,在四种鞋垫条件下对十四名男性受试者进行了测试。使用EMED测压鞋垫测量脚的足底表面的压力。步行时,与穿着最不舒适的鞋垫相比,穿着最舒适的鞋垫,中足区域的压力和力量明显更高,而前足内侧和拇趾区域的压力明显更低。对于最舒适的鞋垫,压力从前脚向中脚的转移提供了脚的足底表面压力的均匀分布。结果还表明,对于最舒适的鞋垫,脚的足底表面的力中心路径移至脚的侧面。对于跑步,最舒适的鞋垫仅发现前脚内侧区域的压力明显低于最不舒适的鞋垫。这项研究的结果表明,足底和鞋子之间的压力分布可以检测到鞋子舒适度的变化。因此,建议压力测量可能与了解对鞋舒适性重要的因素有关。运动鞋的舒适性对于适当执行体育活动很重要。此外,舒适性可能会影响乏力,并可能影响伤害的发展。可以通过使用脚的足底表面和鞋底之间的压力测量来增强对运动鞋的舒适性的量化以及对与其相关的机械和/或生物学功能的理解。

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