Objective To evaluate whether cardiac resynchronisation therapy （CRT） implantation was feasible and safe in octogenarians and the asso- ciation with symptoms. Methods Consecutive patients undergoing CRT implantation...Objective To evaluate whether cardiac resynchronisation therapy （CRT） implantation was feasible and safe in octogenarians and the asso- ciation with symptoms. Methods Consecutive patients undergoing CRT implantation were recruited from two UK centers. Patients grouped according to age： 〈 80 ＆ ≥ 80 years. Baseline demographics, complications and outcomes were compared between those groups. Results A total of 439 patients were included in this study, of whom 26% were aged ≥ 80 years. Octogenarians more often received cardiac resynchronization therapy pacemaker in comparison to cardiac resynchronisation therapy-defibrillator. Upgrade from pacemaker was common in both groups （16% 〈 80 years vs. 22% ≥ 80 years, P = NS）. Co-morbidities were similarly common in both groups （overall diabetes： 25%, atrial fibrillation： 23%, hypertension： 45%）. More patient age ≥ 80 years had significant chronic kidney disease （CKD, estimated glomerular filtration rate 〈 45 mL/min per 1.73 m^2, 44% vs. 22%, P 〈 0.01 ）. Overall complication rates （any） were similar in both groups （16% vs. 17%, P = NS）. Both groups demonstrated symptomatic benefit. One-year mortality rates were almost four fold greater in octogenarians as compared with the younger cohort （13.9% vs. 3.7%, P 〈 0.01）. Conclusions CRT appears to be safe in the very elderly despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement appears to be meaningful. Strategies to increase the appropriate identification of elderly patients with CHF who are potential candidates for CRT are required.展开更多
Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in dev...Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery. Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments, we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effectiveand safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy. Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.展开更多
The incidence of hyperbilirubinemia is high clinically, which is difficult to cure by medication, surgery or interventional therapies. Non-bioartificial liver is the main alternative in the blood purification for hype...The incidence of hyperbilirubinemia is high clinically, which is difficult to cure by medication, surgery or interventional therapies. Non-bioartificial liver is the main alternative in the blood purification for hyperbilirubinemia, which includes plasma exchange, hemoperfusion, hemodialysis, molecular adsorbent recycling system and so on. The research results and clinical experiences in China show that these methods are effective in lowering high levels of bilirubin with fewer side effects. The hyperbilirubinemias of different causes, with different complications or accompanying different diseases can be treated by different methods. Bioartificial liver, hybrid artificial liver support system and adsorbent membrane material have also been studied and their development in reducing hyperbilirubinemias has been achieved. This article gives a brief overview on the actuality and research improvement in blood purification for hyperbilirubinemia in China.展开更多
Objective The aim of this study was to assess the value of palliative local treatment of incurable metastatic lesions in colorectal cancer(CRC) patients receiving chemotherapy plus bevacizumab.Methods Data of 105 pati...Objective The aim of this study was to assess the value of palliative local treatment of incurable metastatic lesions in colorectal cancer(CRC) patients receiving chemotherapy plus bevacizumab.Methods Data of 105 patients with histologically confirmed synchronous or metachronous metastatic CRC who received bevacizumab treatment from January 1, 2011 to January 31, 2017 were retrospectively reviewed. Sixteen(15%) patients who were treated with bevacizumab for less than 4 cycles were excluded, and finally, 89(85%) patients were enrolled. Among them, 33(37%) patients who received palliative local treatment were categorized into the palliative local treatment group, and the remaining 56(63%) patients were categorized into the chemotherapy plus bevacizumab group. The primary endpoint was overall survival(OS), which was calculated using Kaplan-Meier survival analyses. Factors possibly influencing survival were evaluated by univariate and multivariate analyses. Adverse events(AEs) were graded according to Common Terminology Criteria for Adverse Events, version 4.0. Grades 1–2 and 3–4 AEs of the two groups were compared and analyzed using the Fisher's exact test and χ~2 analysis.Results The median follow-up period was 20.4 months, ranging from 1 to 60 months. The median OS in the palliative local treatment group was 36.3 months(95% CI, 33.5–39.2), and that in the chemotherapy plus bevacizumab group was 20.5 months(95% CI, 17.6–23.4). Both the univariate(HR 0.13, 95% CI, 0.05–0.30, P < 0.001) and multivariate(HR 0.16, 95% CI, 0.07–0.39, P < 0.001) analyses showed that the addition of palliative local treatment could prolong survival compared with chemotherapy plus bevacizumab alone. There were no significant differences in the rates of common chemotherapy-or bevacizumab-related AEs between the two groups.Conclusion These findings suggest palliative local treatment is an effective and safe method for treating patients with incurable metastatic CRC receiving chemotherapy plus bevacizumab.展开更多
From the knowledge exile of the 19th century, the profile changed towards the political refugee in 1908. French was then recognized as the official language in administration. Iranian migration later took on another d...From the knowledge exile of the 19th century, the profile changed towards the political refugee in 1908. French was then recognized as the official language in administration. Iranian migration later took on another dimension after the 1953 Coup, a politicization that reached a peak with the arrival in Paris of Khomeini on August 2, 1978. In spite of this migratory tradition, about 4,000 persons before the revolution, the majority being from the political and financial elite, these migratory flows amplified in the middle of the 1980s, in such a way that at the end of December 2014, there were 31,000 Iranians in France. This new phase which included four waves, from a sociological point of view, can be called the diasporaisation of Iranian migration. The socio-economic profile goes from the urban elite： lawyers, officials, journalists, teachers, doctors, nurses, magistrates, military officials, company directors, political exiles, etc., to artisans such as shopkeepers, garage owners, building contractors.., and finally from the skilled labourer, on through to unskilled workers in building, restauration or removals,展开更多
The political theatre in the Arab world emerged from rough seas of opposition and state monitoring schemes. Some critics may claim that political tendencies in Arab theatre can be traced to the early contributors to A...The political theatre in the Arab world emerged from rough seas of opposition and state monitoring schemes. Some critics may claim that political tendencies in Arab theatre can be traced to the early contributors to Arab theatre Others attribute the emergence of this theatre to the revolution of Egypt＇s Nasir. However, the Syrian playwright Sa＇d Allah Wannus may be viewed as the true representative of this kind of theatre in the Arab world. Shocked by the defeat of the Arabs by Israel in 1967, he began what he coined ＂theatre of politicization＂, aiming to attack Arab governments and blaming them for the defeat, and at the same time, insighting his audience to revolt against existing political ideas. In this kind of theatre, the audience assumed ever-increasing importance. Wannus wrote several plays, the aim of which was to develop a mentality and strengthen a collective consciousness in an Arab historical context. This article aims to exploring the concept of theatre of politicization and the impact of that on Arab political theatre展开更多
I have read the article entitled ＂Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？＂ by Olechowski, et al. with great interest, recently published in Journal of Geriatric Cardi...I have read the article entitled ＂Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？＂ by Olechowski, et al. with great interest, recently published in Journal of Geriatric Cardiology. The investigators reported that implantation of cardiac resynchronisation therapy （CRT） is feasible and safe in very elderly despite extensive co-morbidity.展开更多
The substantive characteristics of the connotation of ＂State＂ include two parts： （I） the relatively perpetual and impersonalized political system; （II） the ductility of organization forms within the space and p...The substantive characteristics of the connotation of ＂State＂ include two parts： （I） the relatively perpetual and impersonalized political system; （II） the ductility of organization forms within the space and politics. And the later part is the absolute attribute of this connotation while the former part tends to show with different forms. Therefore, it is more suitable for the former one to be the objective for study on the evolution process of the connotation of ＂State＂ at different stages. Based on this understanding, the author discusses the specific political system at different stages and the relatively perpetual and impersonalized methods for the realization of the system, then tries to define the connotation of the early state, ancient state and modem state in Chinese history.展开更多
We read the research article entitled Is cardiac resyn- chronisation therapy feasible, safe and beneficial in the very elderly？ with great interest. The authors emphasized that despite the average age of heart failur...We read the research article entitled Is cardiac resyn- chronisation therapy feasible, safe and beneficial in the very elderly？ with great interest. The authors emphasized that despite the average age of heart failure was 77 years in the general population of UK,patients receiving cardiac re- synchronisation therapy [with pacemaker alone （CRT-P） or with additional defibrillator capabilities （CRT-D）] were on younger ages at 72 and 67 years respectively. In the lights of this data, we agree with the authors that CRT seems to be undemtilized in the elderly patients with heart failure.展开更多
文摘Objective To evaluate whether cardiac resynchronisation therapy （CRT） implantation was feasible and safe in octogenarians and the asso- ciation with symptoms. Methods Consecutive patients undergoing CRT implantation were recruited from two UK centers. Patients grouped according to age： 〈 80 ＆ ≥ 80 years. Baseline demographics, complications and outcomes were compared between those groups. Results A total of 439 patients were included in this study, of whom 26% were aged ≥ 80 years. Octogenarians more often received cardiac resynchronization therapy pacemaker in comparison to cardiac resynchronisation therapy-defibrillator. Upgrade from pacemaker was common in both groups （16% 〈 80 years vs. 22% ≥ 80 years, P = NS）. Co-morbidities were similarly common in both groups （overall diabetes： 25%, atrial fibrillation： 23%, hypertension： 45%）. More patient age ≥ 80 years had significant chronic kidney disease （CKD, estimated glomerular filtration rate 〈 45 mL/min per 1.73 m^2, 44% vs. 22%, P 〈 0.01 ）. Overall complication rates （any） were similar in both groups （16% vs. 17%, P = NS）. Both groups demonstrated symptomatic benefit. One-year mortality rates were almost four fold greater in octogenarians as compared with the younger cohort （13.9% vs. 3.7%, P 〈 0.01）. Conclusions CRT appears to be safe in the very elderly despite extensive co-morbidity, and in particular frequent severe CKD. Symptomatic improvement appears to be meaningful. Strategies to increase the appropriate identification of elderly patients with CHF who are potential candidates for CRT are required.
文摘Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery. Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments, we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effectiveand safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy. Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.
文摘The incidence of hyperbilirubinemia is high clinically, which is difficult to cure by medication, surgery or interventional therapies. Non-bioartificial liver is the main alternative in the blood purification for hyperbilirubinemia, which includes plasma exchange, hemoperfusion, hemodialysis, molecular adsorbent recycling system and so on. The research results and clinical experiences in China show that these methods are effective in lowering high levels of bilirubin with fewer side effects. The hyperbilirubinemias of different causes, with different complications or accompanying different diseases can be treated by different methods. Bioartificial liver, hybrid artificial liver support system and adsorbent membrane material have also been studied and their development in reducing hyperbilirubinemias has been achieved. This article gives a brief overview on the actuality and research improvement in blood purification for hyperbilirubinemia in China.
文摘Objective The aim of this study was to assess the value of palliative local treatment of incurable metastatic lesions in colorectal cancer(CRC) patients receiving chemotherapy plus bevacizumab.Methods Data of 105 patients with histologically confirmed synchronous or metachronous metastatic CRC who received bevacizumab treatment from January 1, 2011 to January 31, 2017 were retrospectively reviewed. Sixteen(15%) patients who were treated with bevacizumab for less than 4 cycles were excluded, and finally, 89(85%) patients were enrolled. Among them, 33(37%) patients who received palliative local treatment were categorized into the palliative local treatment group, and the remaining 56(63%) patients were categorized into the chemotherapy plus bevacizumab group. The primary endpoint was overall survival(OS), which was calculated using Kaplan-Meier survival analyses. Factors possibly influencing survival were evaluated by univariate and multivariate analyses. Adverse events(AEs) were graded according to Common Terminology Criteria for Adverse Events, version 4.0. Grades 1–2 and 3–4 AEs of the two groups were compared and analyzed using the Fisher's exact test and χ~2 analysis.Results The median follow-up period was 20.4 months, ranging from 1 to 60 months. The median OS in the palliative local treatment group was 36.3 months(95% CI, 33.5–39.2), and that in the chemotherapy plus bevacizumab group was 20.5 months(95% CI, 17.6–23.4). Both the univariate(HR 0.13, 95% CI, 0.05–0.30, P < 0.001) and multivariate(HR 0.16, 95% CI, 0.07–0.39, P < 0.001) analyses showed that the addition of palliative local treatment could prolong survival compared with chemotherapy plus bevacizumab alone. There were no significant differences in the rates of common chemotherapy-or bevacizumab-related AEs between the two groups.Conclusion These findings suggest palliative local treatment is an effective and safe method for treating patients with incurable metastatic CRC receiving chemotherapy plus bevacizumab.
文摘From the knowledge exile of the 19th century, the profile changed towards the political refugee in 1908. French was then recognized as the official language in administration. Iranian migration later took on another dimension after the 1953 Coup, a politicization that reached a peak with the arrival in Paris of Khomeini on August 2, 1978. In spite of this migratory tradition, about 4,000 persons before the revolution, the majority being from the political and financial elite, these migratory flows amplified in the middle of the 1980s, in such a way that at the end of December 2014, there were 31,000 Iranians in France. This new phase which included four waves, from a sociological point of view, can be called the diasporaisation of Iranian migration. The socio-economic profile goes from the urban elite： lawyers, officials, journalists, teachers, doctors, nurses, magistrates, military officials, company directors, political exiles, etc., to artisans such as shopkeepers, garage owners, building contractors.., and finally from the skilled labourer, on through to unskilled workers in building, restauration or removals,
文摘The political theatre in the Arab world emerged from rough seas of opposition and state monitoring schemes. Some critics may claim that political tendencies in Arab theatre can be traced to the early contributors to Arab theatre Others attribute the emergence of this theatre to the revolution of Egypt＇s Nasir. However, the Syrian playwright Sa＇d Allah Wannus may be viewed as the true representative of this kind of theatre in the Arab world. Shocked by the defeat of the Arabs by Israel in 1967, he began what he coined ＂theatre of politicization＂, aiming to attack Arab governments and blaming them for the defeat, and at the same time, insighting his audience to revolt against existing political ideas. In this kind of theatre, the audience assumed ever-increasing importance. Wannus wrote several plays, the aim of which was to develop a mentality and strengthen a collective consciousness in an Arab historical context. This article aims to exploring the concept of theatre of politicization and the impact of that on Arab political theatre
文摘I have read the article entitled ＂Is cardiac resynchronisation therapy feasible, safe and beneficial in the very elderly？＂ by Olechowski, et al. with great interest, recently published in Journal of Geriatric Cardiology. The investigators reported that implantation of cardiac resynchronisation therapy （CRT） is feasible and safe in very elderly despite extensive co-morbidity.
文摘The substantive characteristics of the connotation of ＂State＂ include two parts： （I） the relatively perpetual and impersonalized political system; （II） the ductility of organization forms within the space and politics. And the later part is the absolute attribute of this connotation while the former part tends to show with different forms. Therefore, it is more suitable for the former one to be the objective for study on the evolution process of the connotation of ＂State＂ at different stages. Based on this understanding, the author discusses the specific political system at different stages and the relatively perpetual and impersonalized methods for the realization of the system, then tries to define the connotation of the early state, ancient state and modem state in Chinese history.
文摘We read the research article entitled Is cardiac resyn- chronisation therapy feasible, safe and beneficial in the very elderly？ with great interest. The authors emphasized that despite the average age of heart failure was 77 years in the general population of UK,patients receiving cardiac re- synchronisation therapy [with pacemaker alone （CRT-P） or with additional defibrillator capabilities （CRT-D）] were on younger ages at 72 and 67 years respectively. In the lights of this data, we agree with the authors that CRT seems to be undemtilized in the elderly patients with heart failure.
