Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercis...Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.展开更多
Three short performances from three regional operas present an eccentric comic image of Chenghuang城隍(City God).This serious and formidable god is performed by the role of chou丑(clown),and the role’s physical art s...Three short performances from three regional operas present an eccentric comic image of Chenghuang城隍(City God).This serious and formidable god is performed by the role of chou丑(clown),and the role’s physical art shatters the audience’s perception of this god’s traditional image.The role’s exaggerated and awkward body also results in a performance-centered structure in which negative aspects of human nature are vividly portrayed.The eccentric representation brings laughter,but the laughter is also fully charged with Confucian concepts of goodness,righteousness,justice,and tianli天理(the way of heaven).Turning a divine image into a hilarious one is an unconventional manner and also a peculiar tactic of these performers.Through this tactic,these performers not only hide their subtle criticism of the reality and the authority to survive censorship but also disseminate successfully traditional values and folk religious beliefs.This tactic indicates the cultural function of the theater and demonstrates how traditions can remain valid and functional through a force that arises from the interaction between Confucianism,folk religious beliefs,and performance.展开更多
Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women....Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women. Methods: Data analysis was performed in 95 healthy normotensive premeno-pausal women at baseline and 84 after 5-year follow-up (age, 49.9 ± 1.9 years;BMI, 23.3 ± 2.2 kg/m2;resting BP, 117/73 ± 11.8/7.6 mmHg). Blood pressure was measured at rest and during a progressive exercise test on treadmill. Women were divided into two groups according to their peak ESBP <190 mmHg vs. ≥190 mmHg. Other outcome measures were: cardiorespiratory fitness (VO2 peak), body composition, body fat distribution and fasting plasma lipids, glucose and insulin levels. Results: 15% and 27% of women presented an exaggerated peak ESBP response (≥190 mmHg) at baseline and year 5 respectively. Linear mixed model repeated measures analysis revealed higher values of fasting glucose, resting systolic and diastolic BP in women with an exaggerated peak ESBP (≥190 mmHg) compared to women with a peak ESBP (<190 mmHg). No significant difference was observed between the two groups for VO2 peak, body composition and body fat distribution indices and other cardiometabolic risk factors. Finally, baseline peak ESBP was not a significant risk factor for future resting hypertension (OR: 2.96, 95%CI [0.48 - 18.12];P = 0.24). Conclusion: Our results, despite being non significant, are of great interest because in healthy and active premenopausal women, exaggerated peak ESBP is not predictive of future hypertension after 5-year follow-up throughout menopause transition.展开更多
Showcasing the beauty of the English language within great works of literature,Ever since Mark Twain published The Adventures of Tom Sawyerin 1876,generations of readers have laughed at Tom's mischief.Here,Tom fac...Showcasing the beauty of the English language within great works of literature,Ever since Mark Twain published The Adventures of Tom Sawyerin 1876,generations of readers have laughed at Tom's mischief.Here,Tom faces a punishment:spending Saturday painting a fence in stead of playi ng like the other boys.But Tom pretends that the job is a great honor,and soon boys are lining up to trade their best treasures for a chanee to work.Twain's exaggerated Ianguage adds humor to this classic boyhood scene.展开更多
Tian Li’s work expresses a strong rhythm and inner tension His painting consists of dots and lines, full of the passion and imagination of modern society If you focus on the dots and lines, you can walk into the soul...Tian Li’s work expresses a strong rhythm and inner tension His painting consists of dots and lines, full of the passion and imagination of modern society If you focus on the dots and lines, you can walk into the soul of the painter. The flying bird has become a symbol of society For hundreds of thousands of years, humans, just like birds, farmed groups, passing through time and space The Forbidden City is deformed in Tian Li’s work Strong colors break the lirnita-展开更多
文摘Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.
文摘Three short performances from three regional operas present an eccentric comic image of Chenghuang城隍(City God).This serious and formidable god is performed by the role of chou丑(clown),and the role’s physical art shatters the audience’s perception of this god’s traditional image.The role’s exaggerated and awkward body also results in a performance-centered structure in which negative aspects of human nature are vividly portrayed.The eccentric representation brings laughter,but the laughter is also fully charged with Confucian concepts of goodness,righteousness,justice,and tianli天理(the way of heaven).Turning a divine image into a hilarious one is an unconventional manner and also a peculiar tactic of these performers.Through this tactic,these performers not only hide their subtle criticism of the reality and the authority to survive censorship but also disseminate successfully traditional values and folk religious beliefs.This tactic indicates the cultural function of the theater and demonstrates how traditions can remain valid and functional through a force that arises from the interaction between Confucianism,folk religious beliefs,and performance.
文摘Objective: To investigate if an exaggerated peak exercise systolic blood pressure (peak ESBP) is associated with alteration of cardiometabolic risk factors and predict future resting hypertension in middle aged women. Methods: Data analysis was performed in 95 healthy normotensive premeno-pausal women at baseline and 84 after 5-year follow-up (age, 49.9 ± 1.9 years;BMI, 23.3 ± 2.2 kg/m2;resting BP, 117/73 ± 11.8/7.6 mmHg). Blood pressure was measured at rest and during a progressive exercise test on treadmill. Women were divided into two groups according to their peak ESBP <190 mmHg vs. ≥190 mmHg. Other outcome measures were: cardiorespiratory fitness (VO2 peak), body composition, body fat distribution and fasting plasma lipids, glucose and insulin levels. Results: 15% and 27% of women presented an exaggerated peak ESBP response (≥190 mmHg) at baseline and year 5 respectively. Linear mixed model repeated measures analysis revealed higher values of fasting glucose, resting systolic and diastolic BP in women with an exaggerated peak ESBP (≥190 mmHg) compared to women with a peak ESBP (<190 mmHg). No significant difference was observed between the two groups for VO2 peak, body composition and body fat distribution indices and other cardiometabolic risk factors. Finally, baseline peak ESBP was not a significant risk factor for future resting hypertension (OR: 2.96, 95%CI [0.48 - 18.12];P = 0.24). Conclusion: Our results, despite being non significant, are of great interest because in healthy and active premenopausal women, exaggerated peak ESBP is not predictive of future hypertension after 5-year follow-up throughout menopause transition.
文摘Showcasing the beauty of the English language within great works of literature,Ever since Mark Twain published The Adventures of Tom Sawyerin 1876,generations of readers have laughed at Tom's mischief.Here,Tom faces a punishment:spending Saturday painting a fence in stead of playi ng like the other boys.But Tom pretends that the job is a great honor,and soon boys are lining up to trade their best treasures for a chanee to work.Twain's exaggerated Ianguage adds humor to this classic boyhood scene.
文摘Tian Li’s work expresses a strong rhythm and inner tension His painting consists of dots and lines, full of the passion and imagination of modern society If you focus on the dots and lines, you can walk into the soul of the painter. The flying bird has become a symbol of society For hundreds of thousands of years, humans, just like birds, farmed groups, passing through time and space The Forbidden City is deformed in Tian Li’s work Strong colors break the lirnita-
