Meta-Analysis of the Effects of Cardiac Rehabilitation on Exercise Tolerance and Cardiac Function in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.

OBJECTIVE: To evaluate the effects of cardiac rehabilitation on exercise tolerance and cardiac function in heart failure patients undergoing cardiac resynchronization therapy (CRT). METHODS: Randomized controlled trials were initially identified from systematic reviews of the literature about cardiac rehabilitation and heart failure patients with CRT. We undertook updated literature searches of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CBM, CNKI, and Wanfang databases until July 1, 2017. STATA12.0 software was used. RESULTS: Four randomized controlled studies were included. The total sample size was 157 patients, including 77 in the control group. Cardiac rehabilitation treatment affected the peak VO2 in heart failure patients with CRT (P heterogeneity=0.491, I 2 = 0%). The results lacked heterogeneity, and the data were merged in a fixed-effects model (WMD = 2.17 ml/kg/min, 95% CI (1.42, 2.92), P < 0.001). The peak VO2 was significantly higher in the cardiac rehabilitation group than in the control group. The sensitivity analysis showed that the results of the meta-analysis were robust. Cardiac rehabilitation treatment affected LVEF in heart failure patients with CRT (P heterogeneity=0.064, I 2 = 63.6%); the heterogeneity among the various research results meant that the data were merged in a random-effects model (WMD = 4.75%, 95% CI (1.53, 7.97), P=0.004). The LVEF was significantly higher in the cardiac rehabilitation group than in the control group. The sources of heterogeneity were analyzed, and it was found that one of the studies was the source of significant heterogeneity. After the elimination of that study, the data were reanalyzed, and the heterogeneity was significantly reduced. There were still significant differences in the WMD and 95% CI. CONCLUSION: Cardiac rehabilitation can improve exercise tolerance and cardiac function in heart failure patients with CRT. Future studies are needed to evaluate whether these beneficial effects of cardiac rehabilitation may translate into an improvement in long-term clinical outcomes among these patients.

[Clinical application of urodynamic study in patients with neurogenic bladder by pelvic fracture postoperative].

OBJECTIVE: To explore the clinical value of urodynamic study in patients with neurogenic bladder by pelvic fracture postoperative. METHODS: Postoperative 12 cases with pelvic fracture resulted in uroschesis, there were 8 males and 4 females,and age from 26 to 70 years with an average of 46.5 years. Urodynamic study was done in patients at 1 d,1,3 weeks after operation and compared with 12 cases normal subjects. RESULTS: There was a significant relationship between urodynamic parameter (including residual urine volume of bladder, max free flow, urethral closing pressure in filling end and so on) and course of disease. The residual urine volume of bladder and urethral closing pressure in filling end increased of urodynamic tests in all patients with uroschesis as compared with the normal subjects (P < 0.05); but max free flow decreased at 1 d, 1, 3 weeks after operation (P < 0.05). In the patients with uroschesis, residual urine volume of bladder markedly increased (P < 0.05) and urethral closing pressure in filling end markedly depressed (P < 0.05) at 1 week after operation than other time (at 1 d, 3 weeks after operation), but max free flow had not significant difference (P > 0.05). CONCLUSION: Urodynamic study might evaluate regenerate the degree of neurogenic bladder by pelvic fracture postoperative and predict the prognosis of the neurogenic bladder.

[Clinical application value of laryngeal electromyography and laryngeal somatosensory evoked potential in patients with recurrent laryngeal nerve paralysis by anterior elective cervical surgery].

OBJECTIVE: To determine the clinical evaluation role of laryngeal electromyography (LEMG) and laryngeal somatosensory evoked potential (LSEP) in the recurrent laryngeal nerve paralysis by anterior elective cervical surgery. METHODS: LEMG and LSEP were determined in 18 patients with recurrent laryngeal nerve paralysis by anterior elective cervical surgery at the 1st, 2nd and 4th week after operation. The comparison between the normal control (18 health adults) and the results of LEMG and LSEP were analyzed. RESULTS: The latency prolonged and the amplitude decreased of LSEP in all patients as compared with the control group. Furthermore, reinneration potential increased gradually in all patients at the 1st, 2nd and 4th week after operation (P<0.05). The results of LEMG showed increase of denervation potential. The higher the amplitude of LSEP and LEMG, the better the prognosis of the recurrent laryngeal nerve paralysis. CONCLUSION: LEMG and LSEP might evaluate regenerate the degree of recurrent laryngeal nerve injury caused by anterior elective cervical surgery and predict the prognosis of the recurrent laryngeal nerve paralysis.