OBJECTIVES: The purpose of this research was to identify the determinants of right ventricular(RV) dysfunction in overweight and obese subjects. BACKGROUND: Right ventricular dysfunction in obese subjects is usually a...OBJECTIVES: The purpose of this research was to identify the determinants of right ventricular(RV) dysfunction in overweight and obese subjects. BACKGROUND: Right ventricular dysfunction in obese subjects is usually ascribed to comorbid diseases, especially obstructive sleep apnea. We used tissue Doppler imaging to identify the determinants of RV dysfunction in overweight and obese subjects. METHODS: Standard and tissue Doppler echocardiography was performed in 112 overweight(body mass index [BMI] 25 to 29.9 kg/m2) or obese(BMI >30 kg/m2) subjects and 36 referents(BMI< 25 kg/m2), including 22 with obstructive sleep apnea but no obesity. Tissue Doppler was used to measure RV systolic(sm) and diastolic(em) velocities and strain indexes. RESULTS: Obese subjects with BMI >35 kg/m2 had reduced RV function compared with referent subjects, evidenced by reduced sm(6.5± 2.4 cm/s vs. 10.2± 1.5 cm/s, p< 0.001), peak strain(- 21± 4% vs.- 28± 4% , p< 0.001), peak strain rate(- 1.4± 0.4 s- 1 vs.- 2.0± 0.5 s- 1, p< 0.001), and em(- 6.8± 2.4 cm/s vs.- 10.3± 2.5 cm/s, p< 0.001), irrespective of the presence of sleep apnea. Similar but lesser degrees of reduced systolic function(p< 0.05) were present in overweight(BMI 25 to 29.9 kg/m2) and mildly obese(BMI 30 to 35 kg/m2) groups. Differences in RV em, sm, and strain indexes were demonstrated between the severely versus overweight and mildly obese groups(p< 0.05). Body mass index remained independently related to RV changes after adjusting for age, log insulin, and mean arterial pressures. In obese patients, these changes were associated with reduced exercise capacity but not the duration of obesity and presence of sleep apnea or its severity. CONCLUSIONS: Increasing BMI is associated with increasing severity of RV dysfunction in overweight and obese subjects without overt heart disease, independent of sleep apnea.展开更多
Purpose: To investigate the long-term outcome of using autogenous palmaris longus tendon (PLT) sling for correcting congenital ptosis in children. Methods: This is an observational case series involving 15 eyelids of ...Purpose: To investigate the long-term outcome of using autogenous palmaris longus tendon (PLT) sling for correcting congenital ptosis in children. Methods: This is an observational case series involving 15 eyelids of 14 consecutive children with congenital ptosis who underwent frontalis suspension surgery using PLT in a university teaching hospital. Results: One child had bilateral ptosis and the other children had unilateral ptosis. The age of patients at the time of surgery ranged from 2 to 7 years, with an average of 4.7 years. At a mean follow-up of 92 months (range, 80-104 months), all eyelids were successfully corrected with good lid height. No recurrence or other postoperative complications were encountered except one patient who developed a small skin fold over the PLT harvest site. Conclusion: Long-term lid position is remarkably stable after surgical correction using PLT. PLT sling appears to be a safe and effective treatment for children with congenital ptosis requiring frontalis sling operation. It could be a good alternative to autogenous fascia lata, and further studies, to compare these two sling materials seem warranted.展开更多
文摘OBJECTIVES: The purpose of this research was to identify the determinants of right ventricular(RV) dysfunction in overweight and obese subjects. BACKGROUND: Right ventricular dysfunction in obese subjects is usually ascribed to comorbid diseases, especially obstructive sleep apnea. We used tissue Doppler imaging to identify the determinants of RV dysfunction in overweight and obese subjects. METHODS: Standard and tissue Doppler echocardiography was performed in 112 overweight(body mass index [BMI] 25 to 29.9 kg/m2) or obese(BMI >30 kg/m2) subjects and 36 referents(BMI< 25 kg/m2), including 22 with obstructive sleep apnea but no obesity. Tissue Doppler was used to measure RV systolic(sm) and diastolic(em) velocities and strain indexes. RESULTS: Obese subjects with BMI >35 kg/m2 had reduced RV function compared with referent subjects, evidenced by reduced sm(6.5± 2.4 cm/s vs. 10.2± 1.5 cm/s, p< 0.001), peak strain(- 21± 4% vs.- 28± 4% , p< 0.001), peak strain rate(- 1.4± 0.4 s- 1 vs.- 2.0± 0.5 s- 1, p< 0.001), and em(- 6.8± 2.4 cm/s vs.- 10.3± 2.5 cm/s, p< 0.001), irrespective of the presence of sleep apnea. Similar but lesser degrees of reduced systolic function(p< 0.05) were present in overweight(BMI 25 to 29.9 kg/m2) and mildly obese(BMI 30 to 35 kg/m2) groups. Differences in RV em, sm, and strain indexes were demonstrated between the severely versus overweight and mildly obese groups(p< 0.05). Body mass index remained independently related to RV changes after adjusting for age, log insulin, and mean arterial pressures. In obese patients, these changes were associated with reduced exercise capacity but not the duration of obesity and presence of sleep apnea or its severity. CONCLUSIONS: Increasing BMI is associated with increasing severity of RV dysfunction in overweight and obese subjects without overt heart disease, independent of sleep apnea.
文摘Purpose: To investigate the long-term outcome of using autogenous palmaris longus tendon (PLT) sling for correcting congenital ptosis in children. Methods: This is an observational case series involving 15 eyelids of 14 consecutive children with congenital ptosis who underwent frontalis suspension surgery using PLT in a university teaching hospital. Results: One child had bilateral ptosis and the other children had unilateral ptosis. The age of patients at the time of surgery ranged from 2 to 7 years, with an average of 4.7 years. At a mean follow-up of 92 months (range, 80-104 months), all eyelids were successfully corrected with good lid height. No recurrence or other postoperative complications were encountered except one patient who developed a small skin fold over the PLT harvest site. Conclusion: Long-term lid position is remarkably stable after surgical correction using PLT. PLT sling appears to be a safe and effective treatment for children with congenital ptosis requiring frontalis sling operation. It could be a good alternative to autogenous fascia lata, and further studies, to compare these two sling materials seem warranted.
