Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive e...Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.展开更多
Background Combinations of coronary heart disease(CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships bet...Background Combinations of coronary heart disease(CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey(DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9%(547 participants): 34%(185) were female CHD participants and 66%(362) male. In women, CHD was associated with hypertension(OR = 3.28(1.81-5.9)), lipid disorders(OR = 2.40(1.50-3.83)), diabetes mellitus(OR = 2.08(1.24-3.50)), kidney disease(OR = 2.66(1.101-6.99)), thyroid disease(OR = 1.81(1.18-2.79)), gout/high uric acid levels(OR = 2.08(1.22-3.56)) and osteoporosis(OR = 1.69(1.01-2.84)). In men, CHD patients were more likely to have hypertension(OR = 2.80(1.94-4.04)), diabetes mellitus(OR = 1.87(1.29-2.71)), lipid disorder(OR = 1.82(1.34-2.47)), and chronic kidney disease(OR = 3.28(1.81-5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.展开更多
Objective To observe the characteristics of sensory gating P50 in patients with first-episode schizophrenia(Sch). Methods Auditory evoked potentials P50 were recorded in 92 normal controls(NC)and 66 schizophrenia pati...Objective To observe the characteristics of sensory gating P50 in patients with first-episode schizophrenia(Sch). Methods Auditory evoked potentials P50 were recorded in 92 normal controls(NC)and 66 schizophrenia patients by the conditioning/testing paradigm presented with auditory double clicks stimuli, using American Nicolet Bravo instrument. Results Compared with NC, schizophrenia patients showed decreased S1-P50 amplitude(NC:[6±3]μV, Sch: [3±2]μV, P<0.01), increased S2-P50 amplitude(NC: [2±1]μV, Sch: [4±2]μV, P<0.01), higher S2/S1 ratio(NC: [42±21]%, Sch: [81±40]%, P<0.01), decreased S2-S1(NC: [3±2]μV, Sch: [2±1]μV, P<0.05) and 100(1-S2/S1) (NC: [58±21]%, Sch: [19±17]%, P<0.01), suggesting that patients had sensory gating deficits. Conclusion The first-episode schizophrenia patients had sensory gating deficits, reflecting by auditory evoked potential P50.展开更多
Objective To assess the effects of sleep deprivation (SD) on the whole night polysomnography (PSG) in healthy young men. Methods The whole night PSG was recorded by using Neurofax-1518K (Nihon Kohden, Japan) system be...Objective To assess the effects of sleep deprivation (SD) on the whole night polysomnography (PSG) in healthy young men. Methods The whole night PSG was recorded by using Neurofax-1518K (Nihon Kohden, Japan) system before and after 38 h of SD among 15 healthy male subjects. Results Compared with PSG before SD, post-SD PSG showed significantly shortened sleep latency (before SD: 19.7±9.3, after SD: 5.6±7.3, P<0.05), decreased stage 1 (S1) non-rapid eye movement (NREM) sleep [before SD: (9.2±1.9)%, after SD: (4.0±1.4)%, P<0.05], and increased stage 4 (S4) NREM sleep [before SD: (10.3±3.7)%, after SD: (26.2±4.3)%, P<0.01]. Conclusion During post-SD sleep, the proportion of S4 NREM sleep was increased as compensation in healthy male. In addition, SD was proved to affect electrophysiological brain activities in normal people.展开更多
It is a big topic on sleep research in China,current sleep research in China will be introduced from basic and clinic research in the paper.Basic researches Current sleep research in China began with the study on hybe...It is a big topic on sleep research in China,current sleep research in China will be introduced from basic and clinic research in the paper.Basic researches Current sleep research in China began with the study on hybernation using urchin at Peking University in the early 1950s.During 1960-2017,lots of agencies such as Shanghai Institute of Physiology of Academia Sinica,Institute of Psychology of Academia Sinica,Henan Medical University have accumulated large investigative and experimental data on sleep,but the most of those data focused on the descriptive researches of animal assortment(feline,dog,goat,mouce,rat and macque)and sleep classicification[1].展开更多
Background:In congenital heart disease(CHD)patients,detailed three-dimensional anatomy depiction plays a pivotal role for diagnosis and therapeutical decision making.Hence,the present study investigated the applicabil...Background:In congenital heart disease(CHD)patients,detailed three-dimensional anatomy depiction plays a pivotal role for diagnosis and therapeutical decision making.Hence,the present study investigated the applicability of an advanced cardiovascular magnetic resonance(CMR)whole heart imaging approach utilizing nonselective excitation and compressed sensing for anatomical assessment and interventional guidance of CHD patients in comparison to conventional dynamic CMR angiography.Methods:86 consecutive pediatric patients and adults with congenital heart disease(age,1 to 74 years;mean,35 years)underwent CMR imaging including a freebreathing,ECG-triggered 3D nonselective SSFP whole heart acquisition using compressed SENSE(nsWHcs).Anatomical assessability and signal intensity ratio(SIR)measurements were compared with conventional dynamic 3D-/4D-MR angiography.Results:The most frequent diagnoses were partial anomalous pulmonary venous drainage(17/86,20%),transposition of the great arteries(15/86,17%),tetralogy of Fallot(12/86,14%),and a single ventricle(7/86,8%).Image quality of nsWHcs was rated as excellent/good in 98%of patients.nsWHcs resulted in a reliable depiction of all large thoracic vessels(anatomic assessability,99%–100%)and the proximal segments of coronary arteries and coronary sinus(>90%).nsWHcs achieved a homogenously distributed SIR in all cardiac cavities and thoracic vessels without a significant difference between pulmonary and systemic circulation(10.9±3.5 and 10.6±3.4;p=0.15),while 3D angiography showed significantly increased SIR for targeted vs.non-targeted circulation(PA-angiography,15.2±8.1 vs.5.8±3.6,p<0.001;PV-angiography,7.0±3.9 vs.17.3±6.8,p<0.001).Conclusions:The proposed nsWHcs imaging approach provided a consistently high image quality and a homogeneous signal intensity distribution within the pulmonary and systemic circulation in pediatric patients and adults with a wide spectrum of congenital heart diseases.nsWHcs enabled detailed anatomical assessment and three-dimensional reconstruction of all cardiac cavities and large thoracic vessels and can be regarded particularly useful for preprocedural planning and interventional guidance in CHD patients.展开更多
Objective: To determine the sensitivity of multifocal visual evoked potentials (mVEP) in optic neuritis of an inflammatory or demyelinating nature. Design: Cross-sectional study. Participants: Sixty-four patients part...Objective: To determine the sensitivity of multifocal visual evoked potentials (mVEP) in optic neuritis of an inflammatory or demyelinating nature. Design: Cross-sectional study. Participants: Sixty-four patients participated who had a confirmed diagnosis of optic neuritis (ON) (past and acute). Based on the McDonald multiple sclerosis (MS) criteria,25 patients (27 eyes with ON) were deemed to have isolated optic neuritis and thus not have MS (i.e.,the not-MS group),and 19 patients (24 eyes with ON) had a diagnosis of MS (i.e.,the MS group). The remaining 20 patients (25 eyes with ON) were at a high risk of MS,but diagnostic evaluation was equivocal,and thus were classified as the possible MS group. A control group of 20 normal patients was enrolled. Testing: The mVEP test was performed using the Accumap. All ON patients had recent magnetic resonance imaging scans of the brain and spinal cord. Main Outcome Measures: Multifocal visual evoked potentials amplitude and latency values were analyzed within each group and were compared with the normal controls. Results: No abnormality was recorded on mVEP in the control group. Of all the ON eyes,74 (97.3% ) were abnormal on mVEP testing. Amplitude values were abnormal in 92.6% of not-MS eyes,92.0% of possible MS eyes,and 100% of those with MS,and latency was abnormal in 33.3% ,76.0% ,and 100% ,respectively. There was a significant difference in the mVEP latency z-scores among all ON groups (P < 0.01; Kruskal-Wallis test). Although distribution graphs of latency z-scores in the not-MS and MS groups had single peaks and were clearly separate from each other,the latency z-score distribution within the possible MS group in postacute patients was bimodal,with each peak corresponding to the distribution of the not-MS and MS group,respectively. The mVEP latency z-scores had a sensitivity and specificity of 100% in detecting patients with ON due to MS when compared with normal patients. Conclusions: ThemVEP test is a sensitive and specific tool for detecting optic neuritis. There was a significant difference in latency analysis findings between patient groups as classified according to the McDonald MS criteria. Latency results suggest a role in identifying a patient’ s risk for future MS.展开更多
Thrombotic complications appear to be a major predictor of death in COVID-19 patients,and multiple studies have shown that anticoagulants can help to improve the outcome.The Food and Drug Administration’s acceptance ...Thrombotic complications appear to be a major predictor of death in COVID-19 patients,and multiple studies have shown that anticoagulants can help to improve the outcome.The Food and Drug Administration’s acceptance of non-vitamin K antagonist oral anticoagulants(NOACs)has sparked much excitement about their potential as a replacement for existing oral anticoagulants.NOACs target a single clotting factor,often activated factor X or thrombin,and involve the coagulation factor Xa inhibitors including apixaban,edoxaban,and rivaroxaban,and the thrombin inhibitor dabigatran.COVID-19 is an infectious disease that causes thrombotic events by inducing a pro-inflammatory and prothrombotic condition.This article provides a comprehensive overview of the mechanism behind enhanced thrombogenicity accompanying COVID-19,the clinical range of NOACs,and the role of NOACs in treatment of COVID-19 based on recent investigations and clinical trials.展开更多
Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hy...Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hypothesis: This study analyzed intracardiac electrogram (IEGM) characteristics at implant and assessed patients’ response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Medically optimized patients in sinus rhythm, with ejection fraction (EF) 34 were included. Right ventricular (RV) leads were positioned mid-septum. LV leads were targeted to the latest mechanical activation on echocardiography. IEGMs were measured, assessing intrinsic RV-to-LV delay (int RV-LV), RV-paced delay (RVp-LV), and LV-paced delay (LVp-RV). The difference between LVp-RV and RVp-LV was recorded as delta-LV. Response was defined as improvement of EF > 10%, reduction in LVEDD > 15% and improvement of ≥1 NYHA class. Results: Overall RR was 79%. LV leads were placed in the target location in 91%. Int RV-LV was 101 ± 14 ms in responders;78 ± 11 ms in non-responders (p 100 had a RR of 87%;int RV-LV 40 ms had a RR of 56%;delta-LV < 40 ms had a RR of 85%. There was no significant correlation between lead position, DI, QRS duration or EF and IEGM measurements. Conclusions: IEGM measures at implant are easily obtained. Significant intrinsic electrical delay and shorter delta-LV both predict response, even when LV leads are implanted in the targeted mechanically-delayed segment. These assessments of electrical dyssynchrony may be used to determine optimal lead positions and response to CRT.展开更多
PURPOSE. To compare psychophysically determined spatial variations in photopic and scotopic sensitivity across the macula in patients with retinitis pigmentosa (RP) and normal visual acuity who manifest an abnormal hi...PURPOSE. To compare psychophysically determined spatial variations in photopic and scotopic sensitivity across the macula in patients with retinitis pigmentosa (RP) and normal visual acuity who manifest an abnormal high- density ring of fundus autofluorescence (AF). METHODS. Eleven patients with a clinical diagnosis of RP were examined. All had rod- cone dystrophy (International Society for Clinical Electrophysiology of Vision [ISCEVAbstract- standard ERGs), visual acuity of 6/9 or better, and an abnormal parafoveal annulus of high density AF. Finematrix mapping (FMM) was performed over macular areas of abnormal high- density AF under photopic and dark- adapted conditions. Pattern ERGs (PERGs) were performed in 9 of 11 patients, by using different sizes of circular checkerboards. RESULTS. Rings of high- density AF varied between patients (approximately 3° - 18° in diameter). Photopic sensitivity was preserved over central macular areas, but there was a gradient of sensitivity loss over high- density segments of the ring and severe threshold elevation outside the arc of the ring. Scotopic sensitivity losses were more severe, and they encroached on areas within the ring. The radius of the high- density ring correlated with the lateral extent of preserved photopic sensitivity (r=0.86) and PERG data. CONCLUSIONS. High- density rings of AF, which are present in some patients with RP with normal visual acuity, demarcate areas of preserved central photopic sensitivity. Scotopic sensitivity losses encroach on areas within the ring of high density and may reflect dysfunction before accumulation of lipofuscin.展开更多
Objective:To monitor the difference in conversion rates to multiple sclerosis(MS)in 46 patients with optic neuritis between patients with multifocal visual evoked potential latency delay and those with normal latency....Objective:To monitor the difference in conversion rates to multiple sclerosis(MS)in 46 patients with optic neuritis between patients with multifocal visual evoked potential latency delay and those with normal latency.Design:Prospective case series.Setting:Metropolitan neuroophthalmology clinic.Participants:Forty-six patients with optic neuritis who did not have a diagnosis of MS on enrollment in the study.Main Outcome Measures:Conversion to MS according to the McDonald criteria.Results:Analysis revealed that only 22 subjects had multifocal visual evoked potential latency delay.Over 1 year,36.4% of patients with optic neuritis with latency delays progressed clinically to MS compared with 0% of those with normal latencies(P=.03,χ 2).Conclusion:This may indicate that multifocal visual evoked potential latency delay can assist in predicting progression to future MS.展开更多
文摘Vasovagal syncope is a common cause of recurrent syncope. Clinically, these episodes may present as an isolated event with an identifiable trigger, or manifest as a cluster of recurrent episodes warranting intensive evaluation. The mechanism of vasovagal syncope is incompletely understood. Diagnostic tools such as implantable loop recorders may facilitate the identification of patients with arrhythmia mimicking benign vasovagal syncope. This review focuses on the management of vasovagal syncope and discusses the non-pharmacological and pharmacological treatment options, especially the use of midodrine and selective serotonin reuptake inhibitors. The role of cardiac pacing may be meaningful for a subgroup of patients who manifest severe bradycardia or asystole but this still remains controversial.
文摘Background Combinations of coronary heart disease(CHD) and other chronic conditions complicate clinical management and increase healthcare costs. The aim of this study was to evaluate gender-specific relationships between CHD and other comorbidities. Methods We analyzed data from the German Health Interview and Examination Survey(DEGS1), a national survey of 8152 adults aged 18-79 years. Female and male participants with self-reported CHD were compared for 23 chronic medical conditions. Regression models were applied to determine potential associations between CHD and these 23 conditions. Results The prevalence of CHD was 9%(547 participants): 34%(185) were female CHD participants and 66%(362) male. In women, CHD was associated with hypertension(OR = 3.28(1.81-5.9)), lipid disorders(OR = 2.40(1.50-3.83)), diabetes mellitus(OR = 2.08(1.24-3.50)), kidney disease(OR = 2.66(1.101-6.99)), thyroid disease(OR = 1.81(1.18-2.79)), gout/high uric acid levels(OR = 2.08(1.22-3.56)) and osteoporosis(OR = 1.69(1.01-2.84)). In men, CHD patients were more likely to have hypertension(OR = 2.80(1.94-4.04)), diabetes mellitus(OR = 1.87(1.29-2.71)), lipid disorder(OR = 1.82(1.34-2.47)), and chronic kidney disease(OR = 3.28(1.81-5.9)). Conclusion Our analysis revealed two sets of chronic conditions associated with CHD. The first set occurred in both women and men, and comprised known risk factors: hypertension, lipid disorders, kidney disease, and diabetes mellitus. The second set appeared unique to women: thyroid disease, osteoporosis, and gout/high uric acid. Identification of shared and unique gender-related associations between CHD and other conditions provides potential to tailor screening, preventive, and therapeutic options.
文摘Objective To observe the characteristics of sensory gating P50 in patients with first-episode schizophrenia(Sch). Methods Auditory evoked potentials P50 were recorded in 92 normal controls(NC)and 66 schizophrenia patients by the conditioning/testing paradigm presented with auditory double clicks stimuli, using American Nicolet Bravo instrument. Results Compared with NC, schizophrenia patients showed decreased S1-P50 amplitude(NC:[6±3]μV, Sch: [3±2]μV, P<0.01), increased S2-P50 amplitude(NC: [2±1]μV, Sch: [4±2]μV, P<0.01), higher S2/S1 ratio(NC: [42±21]%, Sch: [81±40]%, P<0.01), decreased S2-S1(NC: [3±2]μV, Sch: [2±1]μV, P<0.05) and 100(1-S2/S1) (NC: [58±21]%, Sch: [19±17]%, P<0.01), suggesting that patients had sensory gating deficits. Conclusion The first-episode schizophrenia patients had sensory gating deficits, reflecting by auditory evoked potential P50.
基金Supported by National High Technology Research and Development Program of China (863 Program, No.2007AA02Z420 and No.2008AA02Z412)Joint Key Project of New Frontier Technology in Shanghai Municipal Hospitals (No.SHDC12006105)+1 种基金Foundation of the National Natural Science Foundation of China (No.30770772)the Municipal Committee of Shanghai Science and Technology (No.09411968200)
文摘Objective To assess the effects of sleep deprivation (SD) on the whole night polysomnography (PSG) in healthy young men. Methods The whole night PSG was recorded by using Neurofax-1518K (Nihon Kohden, Japan) system before and after 38 h of SD among 15 healthy male subjects. Results Compared with PSG before SD, post-SD PSG showed significantly shortened sleep latency (before SD: 19.7±9.3, after SD: 5.6±7.3, P<0.05), decreased stage 1 (S1) non-rapid eye movement (NREM) sleep [before SD: (9.2±1.9)%, after SD: (4.0±1.4)%, P<0.05], and increased stage 4 (S4) NREM sleep [before SD: (10.3±3.7)%, after SD: (26.2±4.3)%, P<0.01]. Conclusion During post-SD sleep, the proportion of S4 NREM sleep was increased as compensation in healthy male. In addition, SD was proved to affect electrophysiological brain activities in normal people.
文摘It is a big topic on sleep research in China,current sleep research in China will be introduced from basic and clinic research in the paper.Basic researches Current sleep research in China began with the study on hybernation using urchin at Peking University in the early 1950s.During 1960-2017,lots of agencies such as Shanghai Institute of Physiology of Academia Sinica,Institute of Psychology of Academia Sinica,Henan Medical University have accumulated large investigative and experimental data on sleep,but the most of those data focused on the descriptive researches of animal assortment(feline,dog,goat,mouce,rat and macque)and sleep classicification[1].
文摘Background:In congenital heart disease(CHD)patients,detailed three-dimensional anatomy depiction plays a pivotal role for diagnosis and therapeutical decision making.Hence,the present study investigated the applicability of an advanced cardiovascular magnetic resonance(CMR)whole heart imaging approach utilizing nonselective excitation and compressed sensing for anatomical assessment and interventional guidance of CHD patients in comparison to conventional dynamic CMR angiography.Methods:86 consecutive pediatric patients and adults with congenital heart disease(age,1 to 74 years;mean,35 years)underwent CMR imaging including a freebreathing,ECG-triggered 3D nonselective SSFP whole heart acquisition using compressed SENSE(nsWHcs).Anatomical assessability and signal intensity ratio(SIR)measurements were compared with conventional dynamic 3D-/4D-MR angiography.Results:The most frequent diagnoses were partial anomalous pulmonary venous drainage(17/86,20%),transposition of the great arteries(15/86,17%),tetralogy of Fallot(12/86,14%),and a single ventricle(7/86,8%).Image quality of nsWHcs was rated as excellent/good in 98%of patients.nsWHcs resulted in a reliable depiction of all large thoracic vessels(anatomic assessability,99%–100%)and the proximal segments of coronary arteries and coronary sinus(>90%).nsWHcs achieved a homogenously distributed SIR in all cardiac cavities and thoracic vessels without a significant difference between pulmonary and systemic circulation(10.9±3.5 and 10.6±3.4;p=0.15),while 3D angiography showed significantly increased SIR for targeted vs.non-targeted circulation(PA-angiography,15.2±8.1 vs.5.8±3.6,p<0.001;PV-angiography,7.0±3.9 vs.17.3±6.8,p<0.001).Conclusions:The proposed nsWHcs imaging approach provided a consistently high image quality and a homogeneous signal intensity distribution within the pulmonary and systemic circulation in pediatric patients and adults with a wide spectrum of congenital heart diseases.nsWHcs enabled detailed anatomical assessment and three-dimensional reconstruction of all cardiac cavities and large thoracic vessels and can be regarded particularly useful for preprocedural planning and interventional guidance in CHD patients.
文摘Objective: To determine the sensitivity of multifocal visual evoked potentials (mVEP) in optic neuritis of an inflammatory or demyelinating nature. Design: Cross-sectional study. Participants: Sixty-four patients participated who had a confirmed diagnosis of optic neuritis (ON) (past and acute). Based on the McDonald multiple sclerosis (MS) criteria,25 patients (27 eyes with ON) were deemed to have isolated optic neuritis and thus not have MS (i.e.,the not-MS group),and 19 patients (24 eyes with ON) had a diagnosis of MS (i.e.,the MS group). The remaining 20 patients (25 eyes with ON) were at a high risk of MS,but diagnostic evaluation was equivocal,and thus were classified as the possible MS group. A control group of 20 normal patients was enrolled. Testing: The mVEP test was performed using the Accumap. All ON patients had recent magnetic resonance imaging scans of the brain and spinal cord. Main Outcome Measures: Multifocal visual evoked potentials amplitude and latency values were analyzed within each group and were compared with the normal controls. Results: No abnormality was recorded on mVEP in the control group. Of all the ON eyes,74 (97.3% ) were abnormal on mVEP testing. Amplitude values were abnormal in 92.6% of not-MS eyes,92.0% of possible MS eyes,and 100% of those with MS,and latency was abnormal in 33.3% ,76.0% ,and 100% ,respectively. There was a significant difference in the mVEP latency z-scores among all ON groups (P < 0.01; Kruskal-Wallis test). Although distribution graphs of latency z-scores in the not-MS and MS groups had single peaks and were clearly separate from each other,the latency z-score distribution within the possible MS group in postacute patients was bimodal,with each peak corresponding to the distribution of the not-MS and MS group,respectively. The mVEP latency z-scores had a sensitivity and specificity of 100% in detecting patients with ON due to MS when compared with normal patients. Conclusions: ThemVEP test is a sensitive and specific tool for detecting optic neuritis. There was a significant difference in latency analysis findings between patient groups as classified according to the McDonald MS criteria. Latency results suggest a role in identifying a patient’ s risk for future MS.
文摘Thrombotic complications appear to be a major predictor of death in COVID-19 patients,and multiple studies have shown that anticoagulants can help to improve the outcome.The Food and Drug Administration’s acceptance of non-vitamin K antagonist oral anticoagulants(NOACs)has sparked much excitement about their potential as a replacement for existing oral anticoagulants.NOACs target a single clotting factor,often activated factor X or thrombin,and involve the coagulation factor Xa inhibitors including apixaban,edoxaban,and rivaroxaban,and the thrombin inhibitor dabigatran.COVID-19 is an infectious disease that causes thrombotic events by inducing a pro-inflammatory and prothrombotic condition.This article provides a comprehensive overview of the mechanism behind enhanced thrombogenicity accompanying COVID-19,the clinical range of NOACs,and the role of NOACs in treatment of COVID-19 based on recent investigations and clinical trials.
文摘Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hypothesis: This study analyzed intracardiac electrogram (IEGM) characteristics at implant and assessed patients’ response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Medically optimized patients in sinus rhythm, with ejection fraction (EF) 34 were included. Right ventricular (RV) leads were positioned mid-septum. LV leads were targeted to the latest mechanical activation on echocardiography. IEGMs were measured, assessing intrinsic RV-to-LV delay (int RV-LV), RV-paced delay (RVp-LV), and LV-paced delay (LVp-RV). The difference between LVp-RV and RVp-LV was recorded as delta-LV. Response was defined as improvement of EF > 10%, reduction in LVEDD > 15% and improvement of ≥1 NYHA class. Results: Overall RR was 79%. LV leads were placed in the target location in 91%. Int RV-LV was 101 ± 14 ms in responders;78 ± 11 ms in non-responders (p 100 had a RR of 87%;int RV-LV 40 ms had a RR of 56%;delta-LV < 40 ms had a RR of 85%. There was no significant correlation between lead position, DI, QRS duration or EF and IEGM measurements. Conclusions: IEGM measures at implant are easily obtained. Significant intrinsic electrical delay and shorter delta-LV both predict response, even when LV leads are implanted in the targeted mechanically-delayed segment. These assessments of electrical dyssynchrony may be used to determine optimal lead positions and response to CRT.
文摘PURPOSE. To compare psychophysically determined spatial variations in photopic and scotopic sensitivity across the macula in patients with retinitis pigmentosa (RP) and normal visual acuity who manifest an abnormal high- density ring of fundus autofluorescence (AF). METHODS. Eleven patients with a clinical diagnosis of RP were examined. All had rod- cone dystrophy (International Society for Clinical Electrophysiology of Vision [ISCEVAbstract- standard ERGs), visual acuity of 6/9 or better, and an abnormal parafoveal annulus of high density AF. Finematrix mapping (FMM) was performed over macular areas of abnormal high- density AF under photopic and dark- adapted conditions. Pattern ERGs (PERGs) were performed in 9 of 11 patients, by using different sizes of circular checkerboards. RESULTS. Rings of high- density AF varied between patients (approximately 3° - 18° in diameter). Photopic sensitivity was preserved over central macular areas, but there was a gradient of sensitivity loss over high- density segments of the ring and severe threshold elevation outside the arc of the ring. Scotopic sensitivity losses were more severe, and they encroached on areas within the ring. The radius of the high- density ring correlated with the lateral extent of preserved photopic sensitivity (r=0.86) and PERG data. CONCLUSIONS. High- density rings of AF, which are present in some patients with RP with normal visual acuity, demarcate areas of preserved central photopic sensitivity. Scotopic sensitivity losses encroach on areas within the ring of high density and may reflect dysfunction before accumulation of lipofuscin.
文摘Objective:To monitor the difference in conversion rates to multiple sclerosis(MS)in 46 patients with optic neuritis between patients with multifocal visual evoked potential latency delay and those with normal latency.Design:Prospective case series.Setting:Metropolitan neuroophthalmology clinic.Participants:Forty-six patients with optic neuritis who did not have a diagnosis of MS on enrollment in the study.Main Outcome Measures:Conversion to MS according to the McDonald criteria.Results:Analysis revealed that only 22 subjects had multifocal visual evoked potential latency delay.Over 1 year,36.4% of patients with optic neuritis with latency delays progressed clinically to MS compared with 0% of those with normal latencies(P=.03,χ 2).Conclusion:This may indicate that multifocal visual evoked potential latency delay can assist in predicting progression to future MS.
基金This study was supported by the grants from the National Natural Science Foundation of China （No. 81271480, No. 81372122）, the emerging advanced technology projects from Shanghai Hospital Development Center （SHDC 12013116）, projects of Shanghai Shen Kang municipality hospital appropriate technology development and application （SHDC 12012234） and projects of promotion of advanced appropriate technology in health service in Shanghai （2013 SY069）.
基金This study was supported by the grants from the National Key Basic Research Science Foundation （973 Project, No. 2010CB529605） and the National Natural Science Foundation of China （No. 81000581 and No.30971046）.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 81471357） and Shanghai Natural Science Foundation （No. 13ZR1439300）.
基金This study was supported by the grants from the National Natural Science Foundation of China （No. 30770772 and No. 30971046）, the Fund of the Municipal Committee of Shanghai Science and Technology （No. 09411968200）, the Joint Key Project of New Frontier Technology in Shanghai Municipal Hospitals （No. SHDC12006105） and the National High Technology Research and Development Program of China （No. 2008AA02Z412 and No. 2007AA02Z420）.
