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1.
Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease
Abhinav Sharma Adrian Coles Nishant K. Sekaran Neha J. Pagidipati Michael T. Lu Daniel B. Mark Kerry L. Lee Hussein R. Al-Khalidi Udo Hoffmann Pamela S. Douglas 《Journal of the American College of Cardiology》2019,73(8):893-902
Background
The optimal noninvasive test (NIT) for patients with diabetes and stable symptoms of coronary artery disease (CAD) is unknown.Objectives
The purpose of this study was to assess whether a diagnostic strategy based on coronary computed tomographic angiography (CTA) is superior to functional stress testing in reducing adverse cardiovascular (CV) outcomes (CV death or myocardial infarction [MI]) among symptomatic patients with diabetes.Methods
PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) was a randomized trial evaluating an initial strategy of CTA versus functional testing in stable outpatients with symptoms suggestive of CAD. The study compared CV outcomes in patients with diabetes (n = 1,908 [21%]) and without diabetes (n = 7,058 [79%]) based on their randomization to CTA or functional testing.Results
Patients with diabetes (vs. without) were similar in age (median 61 years vs. 60 years) and sex (female 54% vs. 52%) but had a greater burden of CV comorbidities. Patients with diabetes who underwent CTA had a lower risk of CV death/MI compared with functional stress testing (CTA: 1.1% [10 of 936] vs. stress testing: 2.6% [25 of 972]; adjusted hazard ratio: 0.38; 95% confidence interval: 0.18 to 0.79; p = 0.01). There was no significant difference in nondiabetic patients (CTA: 1.4% [50 of 3,564] vs. stress testing: 1.3% [45 of 3,494]; adjusted hazard ratio: 1.03; 95% confidence interval: 0.69 to 1.54; p = 0.887; interaction term for diabetes p value = 0.02).Conclusions
In diabetic patients presenting with stable chest pain, a CTA strategy resulted in fewer adverse CV outcomes than a functional testing strategy. CTA may be considered as the initial diagnostic strategy in this subgroup. (PROspective Multicenter Imaging Study for Evaluation of Chest Pain [PROMISE]; NCT01174550) 相似文献2.
Eric W. Dickson MD Gary V. Doern PhD Leo Trevino PhD Michelle Mazzoni PhD Stephen O. Heard MD 《Academic emergency medicine》2003,10(10):1019-1023
OBJECTIVES: Patients undergoing emergent endotracheal intubation are at increased risk for developing pneumonia. Although numerous strategies have been investigated to reduce ventilator-associated pneumonia (VAP), the incidence of VAP and its associated mortality remains high. This investigation tested the hypothesis that LiquiVent (Alliance Pharmaceutical, San Diego, CA-LV) delivered antibiotics (via spray-dried microspheres-SDM) would improve survival in a rat model of descending gram-negative pneumonia. METHODS: Wistar rats (n = 49) were randomized to receive prophylaxis with 1). nothing (controls); 2). intramuscular (IM) tobramycin, 3). intratracheal LV plus SDM shells (vehicle), 4). intratracheal LV plus SDM shells plus IM tobramycin, or 5). intratracheal LV plus SDM containing 1 mg/kg of tobramycin. All interventions were given 24 hours before a bacterial challenge with 10(8) colony-forming units of intratracheal Klebsiella pneumoniae. Mortality at ten days was the sole outcome measure. Survival in individual groups was compared with controls by Fisher's exact test with Bonferroni correction for multiple comparisons. RESULTS: All animals in the control group died of pneumonia within ten days of bacterial inoculation (0% survival). Prophylaxis with either IM tobramycin or SDM vehicle plus IM tobramycin provided no protection (0% survival). This is in sharp contrast to the cohort receiving pretreatment with tobramycin-containing SDM delivered via LV, in which 60% of the animals survived to study completion (p < 0.05). CONCLUSIONS: Prophylaxis with SDM containing antibiotics delivered in low-dose LV provided significant protection in a rat model of descending gram-negative pneumonia. These data support the hypothesis that perfluorocarbon-delivered intratracheal antimicrobials may be useful in the prevention of VAP. 相似文献
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动脉顺应性又称动脉弹性,反映血管内皮功能。已成为预测心血管疾病的重要危险因素。无创测量动脉弹性的方法在临床上已有一定程度的应用。各种方法具有其各自适用范围及局限性。多种干预手段可以影响动脉弹性。合理测量及维持正常的动脉弹性可延缓多种心血管疾病的发生及发展。 相似文献
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A total of 240 survivors of one or more myocardial infarctions were consecutively admitted to perform supine exercise radionuclide ventriculography. Within 3 years after the test, 22 died; this group was compared to an age-matched control group of 22 survivors for left and right ventricular function during rest, exercise, and simultaneously assessed exercise performance as well as ECG variables. Evaluation of 3-year survival by linear discriminant analysis revealed an accuracy of 82% for discriminant models using ECG and exercise performance variables. Implementation of resting left ventricular ejection fraction and change of right ventricular ejection fraction during exercise, as well as scintigraphic presence or absence of dyskinesia, improved the accuracy of the model to 91% of correctly classified patients. 相似文献
7.
目的比较山莨菪碱联合无创正压面罩通气(654-2+NIPPV)和传统机械通气(CMV)治疗急性呼吸窘迫综合征(ARDS)的临床效果,评估山莨菪碱联合无创正压通气在ARDS治疗中的作用。方法将各种原因所致ARDS患者42例随机分为654-2+NIPPV组(21例)和CMV组(21例),在给予病因治疗同时分别实施654-2+NIPPV和CMV。观察分析两组患者在治疗过程中动脉血气变化、并发症的发生率及治疗效果。结果654-2+NIPPV组有8例(38.1%)治疗失败转为气管插管实行CMV,其中6例(28.6%)死亡。CMV组死亡7例(33.3%),两组病死率无显著差异(P〉0.05)。两组治疗有效的患者在分别接受654-2+NIPPV和CMV治疗后1h和6h动脉血气有相似的显著改善。654-2+NIPPV组患者机械通气时间和住院时间短于CMV组(P〈0.05)。654-2+NIPPV组的并发症发生率低于CMV组(P〈0.05)。结论在经过选择的ARDS患者中,应用654-2+NIPPV治疗的临床效果与CMV相似。实施654-2+NIPPV可缩短机械通气和住院时间,减少并发症。654-2+NIPPV可作为经过选择的ARDS患者首选的通气支持治疗手段。 相似文献
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Eugene L. Dela Cruz DPM FACFAS Greg R. Brockbank DPM 《The Journal of foot and ankle surgery》2005,44(4):311-312
Talar dome lesions greater than 1 cm in diameter are often treated with ankle joint mosaicplasty. The purpose of this article is to present the use of a noninvasive ankle distractor that can improve access to the talus when used with a malleolar osteotomy. The use of the distractor allows for graft insertion at a more appropriate angle in relationship to the talar cartilage, avoidance of invasive distractor usage, and potential use of a smaller osteotomy. 相似文献
10.
Goto Y Takahashi K Harada J Sugiura Y Aso K Takanami C Nakajima K Yagi Y Urano H 《Journal of anesthesia》1987,1(2):178-182
Concerning the classification of ventilators, Elam (1958), Faireley (1959), and Hunter (1961) reported some simple ones such as pressure limited, volume limited, pressure preset, or volume preset models. Mapleson (1969) also classified them by the generating force or cycling together with the above-mentioned types.The latest ventilators applicable to patients with respiratory failure usually have some cut-off function at high airway pressures as a safety measure. Therefore, all of them belong to the pressure limited type. Some ventilators are of two types such as the time cycled and pressure cycled type.Therefore, we attempted to classify ventilators into four groups, i.e. the time cycled, volume cycled, pressure cycled and selective time-pressure cycled types according to the fundamental mode of ventilator function, the so-called change of cycling from inspiration to expiration. Each group was further divided into subgroups according to preset dials such as respiratory rate, I/E ratio, inspiration time, expiration time, tidal volume, flow rate and airway pressure.By this method, fifty one ventilators on the market in Japan can be classified without overlapping. Although this classification seems complex, it will be of use in selecting ventilators by emphasizing preset dials according to the users needs, ability or both.(Goto Y, Takahashi K, Harada J et al.: A consideration on the new classification of latest lung ventilators. J Anesth 1: 178–182, 1987) 相似文献