A prospective evaluation of preoperative risk evaluation system for geriatric orthopedic patients

Objective To evaluate the correlation and efficacy of Preoperative Risk Evaluation System for Geriatric Orhopedic Patients (PRESGOP),Acute Physiology and Chronic Health Evaluation (APACHE) and Physiological and Operative Score for

Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange

BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.

International progress and evaluation on interactive coupling effects between urbanization and the eco-environment

Global urbanization is exerting severe stress and having far-reaching impacts on the eco-environment, and yet there exists a complex non-linear coupling relationship between the two. Research on the interactive coupling effect between urbanization and the eco-environment will be a popular area of study and frontier in international earth system science and sustainability science in the next 10 years, while also being a high-priority research topic of particular interest to international organizations. This paper systematically collates and summarizes the international progress made in research on interactive coupling theory, coupling relationships, coupling mechanisms, coupling laws, coupling thresholds, coupling models and coupling optimization decision support systems. The research shows that urbanization and eco-environment interactive coupling theories include the Kuznets curve theory, telecoupling theory, planetary boundaries theory, footprint family theory and urban metabolism theory; most research on interactive coupling relationships is concerned with single- element coupling relationships, such as those between urbanization and water, land, atmosphere, climate change, ecosystems and biodiversity; the majority of research on interactive coupling mechanisms and laws focuses on five research paradigms, including coupled human and nature systems, complex social-ecological systems, urban ecosystems, social-economic-natural complex ecosystems, and urbanization development and eco-environment constraint ring; the majority of interactive coupling simulations use STIRPAT models, coupling degree models, multi-agent system models and big data urban computer models; and research has been carried out on urbanization and eco-environment coupling thresholds, coercing risk and optimal decision support systems. An objective evaluation of progress in international research on interactive coupling between urbanization and the eco-environment suggests that there are six main research focal points and six areas lacking research： a lot of research exists on macroscopic coupling effects, with little research on urban agglomeration and scale coupling effects; considerable research exists on sin-gle-dimension coupling effects, with little on multiple-dimension coupling effects; a great deal exists on ＂one-to-one＂ dual- element coupling effects, with little on ＂many-to-many＂ multiple-element coupling effects; a lot exists on positive feedback coupling effects, and little on negative feedback coupling effects; a great deal exists on empirical coupling effects, and little on theoretical coupling effects; a great deal exists on the use of simple quantitative methods, and little on using integrated simulation methods. Future studies should focus on coupling effects between urbanization in urban agglomerations and the eco-environment, spatial scale coupling effects, multi-dimensional coupling effects, telecoupling effects, ＂one-to-many＂ and ＂many-to-many＂ element coupling effects, and positive and negative feedback coupling effects. There is also a need to strengthen the development and application of dynamic models for multi-element,-scale,-scenario,-module and-agent integrated spatiotemporal coupling systems and further improve theoretical innovations in coupling effect research and integrate and form complete and diverse coupling theoretical systems.

Prospective evaluation of gastric emptying using ^(13)C-octanoic breath test in relationship with the metabolic control in patients with type 1and type 2 diabetes

The aims were to prospectively evaluate the association of glycemic control (HbAlc) with gastric emptying in newly diagnosed Type 1 diabetic patients and subjects with longterm diabetes mellitus. Furthermore, the day to day variability of gastric emptying for solids should be assessed. Methods 13 C octanoic breath tests were performed in 15 type 1 diabetic subjects on two separate days within one week. The influence of metabolic control on gastric emptying was prospectively examined over a mean of 8 months in 14 patients with newly diagnosed type 1 diabetes and 44 long term diabetic patients (type 1: n=31; type 2: n=13).Patients with longterm diabetes were stratified according to their HbA 1c at follow up (group 1: HbA 1c U7.5%, n=17; group 2 HbA 1c >7.5%, n=27). 13 C octanoic breath tests were sampled with an isotope selective non dispersive infrared spectrometer. The gastric emptying parameters were calculated using nonlinear regression analysis of the time course of 13 CO 2 exhalation:half emptying time (t 1/2 ) and lag phase (t lag ). Results The intraindividuell coefficient of variation was 17.8% for t 1/2 , and 28.2% for t lag . Mean t 1/2 and t lag in newly diagnosed type 1 diabetics were normal at baseline and were significantly increased at follow up. In patients with longterm diabetes, gastric emptying was unchanged during follow up. Gastric emptying was significant delayed in group 2 compared with group 1 at baseline and follow up respectively. There was a significant correlation between HbA 1c and t 1/2 , t lag at follow up. Conclusions 13 C octanoic breath test has a relatively good reproducibility in patients with type 1 diabetes. Gastric emptying times are already significantly increased after few months in newly diagnosed type 1 diabetes. There is a more pronounced delay of gastric emptying in longterm diabetic subjects with poor compared to patients with good metabolic control.

A PROSPECTIVE STUDY TO EVALUATE THE SAFETY AND EFFICACY USING REMOVING BLOOD STASIS HERBALS FOR PATIENTS WITH INTRACRANIAL HEMORRHAGE OF HYPERACUTE STAGE AND RELATIVE FACTORS OF HEMATOMA ENLARGEMENT(A MULTICENTER PROSPECTIVE RANDOMIZED DOUBLE-BLIND PLACEBO

The aim was to investigate whether using a removing blood stasis method in hyperacute intracranial hemorrhage stage can lead to hematoma enlargement and its clinical efficacy.A multicenter retrospective randomized double-blind placebo-controlled clinical study.We recruited patients aged 18 years or older and presenting at less than 6 h from symptom onset in 8 research centers.All the patients