Endoskopische minimalinvasive Herzchirurgie

The present report extends the currently available literature by providing detailed insights on the characteristic advantages of 3D-FE and VA minimally invasive MVR, referring to a head-to-head comparison using a large and well-balanced sample size. Three-dimensional fully endoscopic surgery provides excellent visualization of valvular and subvalvular structures. Both approaches, video-assisted and 3D-fully-endoscopic, are suitable for providing good results in terms of hard clinical endpoints. Three-dimensional fully endoscopic MIMVS is associated with higher repair rates. In degenerative mitral valve regurgitation, 3D fully endoscopic surgery shows higher repair rates compared to the video assisted approach. In our cohort, the 3D-fully-endoscopic approach was associated with a lower rate of failed MV repair and MV replacement, at the price of longer operative times.Einleitung: Ziel dieser Studie war der Vergleich der klinischen Ergebnisse zwischen der dreidimensionalen vollendoskopischen (3D-FE) und der videoassistierten (VA) minimalinvasiven Mitralklappenoperation bei Patienten mit degenerativer Mitralinsuffizienz (DMR). Methodik: Von 2014 bis 2020 wurden insgesamt 710 Patienten mit Carpentier Typ II Mitralregurgitation (MR), die sich einer minimalinvasiven Mitralklappenreparatur unterzogen hatten (36,5% (n = 259) 3D-FE und 63,5% (n = 451) VA), zunächst in die Studie aufgenommen. Nach fünffacher multipler Imputation und anschließendem 1:1 Propensity Score (PS) Matching unter Berücksichtigung relevanter Ausgangsvariablen wurde eine ausgewogene Endkohorte von 484 Patienten gebildet. Alle klinischen Ergebnisparameter wurden auf einer Intention-to-treat-Basis analysiert. Ergebnisse: In der gematchten Kohorte wies der 3D-FE-Ansatz eine signifikant längere Aortenquerklemmungszeit (3D-FE: 74min [63-89], VA: 60min [50-77]; p<0,001), eine längere kardiopulmonale Bypasszeit (3D-FE: 118min [103-142], VA: 86min [73-116]; p<0,001) und eine längere Gesamtoperationszeit (3D-FE: 179min [158-210], VA: 126min [110-169]; p<0,001) auf. Der 3D-FE-Ansatz war mit einer signifikant niedrigeren Rate an fehlgeschlagenen Mitralklappenreparaturen (3D-FE: 0,4% (n=1), VA: 2,0% (n=5); p=0,007) und Mitralklappenersatz (3D-FE: 0,8% (n=2), VA: 5,4% (n=13); p=0,008) verbunden. Beide Gruppen zeigten hervorragende Ergebnisse in Bezug auf Myokardinfarkt (3D-FE: 0,0% (n=0), VA: 1,2% (n=3); p=0,250), Schlaganfall (3D-FE: 1,7% (n=4), VA: 1. 7% (n=4); p=1.000), 30-Tage- (3D-FE: 0,0% (n=0), VA: 0,4% (n=1); p=1.000) und 1-Jahres-Mortalität (3D-FE: 0,8% (n=2), VA: 1,2% (n=3); p=1.000). Schlussfolgerung: Der 3D-FE-Ansatz bei der minimalinvasiven Mitralklappenreparatur ist mit einer geringeren Rate an Reparaturversagen verbunden, allerdings zum Preis einer längeren Gesamtoperationszeit

Functional Outcome After Successful Internal Fixation Versus Salvage Arthroplasty of Patients With a Femoral Neck Fracture

Objectives: To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design: Secondary cohort study to a randomized controlled trial. Setting: Multicenter trial in the Netherlands, including 14 academic and nonacademic hospitals. Patients: Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention: None (observatory study). Main Outcome Measurements: Patient characteristics, SF-12, and Western Ontario McMaster osteoarthritis index scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamome

Continuous low- to moderate-intensity exercise training is as effective as moderate- to high-intensity exercise training at lowering blood HbA1c in obese type 2 diabetes patients

Aims/hypothesis: Exercise represents an effective interventional strategy to improve glycaemic control in type 2 diabetes patients. However, the impact of exercise intensity on the benefits of exercise training remains to be established. In the present study, we compared the clinical benefits of 6 months of continuous low- to moderate-intensity exercise training with those of continuous moderate- to high-intensity exercise training, matched for energy expenditure, in obese type 2 diabetes patients. Methods: Fifty male obese type 2 diabetes patients (age 59∈±∈8 years, BMI 32∈± ∈4 kg/m2) participated in a 6 month continuous endurance-type exercise training programme. All participants performed three supervised exercise sessions per week, either 55 min at 50% of whole body peak oxygen uptake left(VO2peak) (low to moderate intensity) or 40 min at 75% of VO2peak (moderate to high intensity). Oral glucose tolerance, blood glycated haemoglobin, lipid profile, body composition, maximal workload capacity, whole body and skeletal muscle oxidative capacity and skeletal muscle fibre type composition were assessed before and after 2 and 6 months of intervention. Results: The entire 6 month intervention programme was completed by 37 participants. Continuous endurance-type exercise training reduced blood glycated haemoglobin levels, LDL-cholesterol concentrations, body weight and leg fat mass, and increased VO2peak, lean muscle mass and skeletal muscle cytochrome c oxidase and citrate synthase activity (p∈<∈0. 05). No differences were observed between the groups training at low to moderate or moderate to high intensity. Conclusions/interpretation: When matched for energy cost, prolonged continuous low- to moderate-intensity endurance-type exercise training is equally effective as continuous moderate- to high-intensity training in lowering blood glycated haemoglobin and increasing whole body and skeletal muscle oxidative capacity in obese type 2 diabetes patients. © 2009 Springer-Verlag

Beyond 'Trimming the fat': the sub-editing stage of newswriting

Thus far, professional editing has not been researched extensively in writing research. This article zooms in on sub-editing in newswriting as a form of professional editing, addressing three research questions: (a) What are the ways in which a news article's text is altered?, (b) Are some types of news article altered more significantly than others?, and (c) Are certain news article sections more prone to alterations? Merging the contextualized insights of fieldwork with a corpus-based discourse analytic research perspective, we trace the differences (viz. additions, deletions, translocations, replacements) between the initial (right before sub-editing) and final (published) version of six different types of news article, (frontpage, headline, long, medium, short, and news wire article) in a corpus sample of 30 broadsheet articles. Our findings are first thatcontrary to popular belief that sub-editors mainly hack away at news stories, or merely trim the fatadditions prevail. Second, we found that most interventions occur in high-stakes articles. Third, we discovered the largest number of interventions in the entry points of an article, that is, whereaccording to eye-tracking researchreaders stop scanning and start reading. We discuss our findings in the light of training for professional newswriters