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Anesthesiology Oral Board Flash Cards 2/E

為了解決Duke University的問題，作者Gadsden, Jeff,Jones, Dean 這樣論述：

A structured way for residents to prepare for random questions on the anesthesia oral boardsAnesthesiology Oral Board Flash Cards, Second Edition are the perfect way for residents to prepare for any random question that an examiner may ask on the anesthesia oral boards. The cards are designed to imp

art best patient care for a specific disease/condition or surgical procedure. Great for studying alone or with a partner, these cards teach residents how to think through an unexpected operating scenario. The set includes approximately 180 color-coded cards (30 more than the previous edition) plus a

n instruction booklet that includes tips on how to excel on the oral boards. The flip side of each card has been enhanced to include full-color figures, suggested readings, typical oral board questions, and tips. Jeff Gadsden, MD, is an attending anesthesiologist at Duke University Medical Center.

Dean R. Jones, MD, is an attending anesthesiologist at Columbia Presbyterian Medical Center.

Duke University進入發燒排行的影片

成人生命意義感與復原力之關係：以制握信念為調節變項

為了解決Duke University的問題，作者李育慈 這樣論述：

　　本研究主要目的在探究成人生命意義感（涵蓋存在意義感與尋找意義感二向度）與復原力之關係，並檢視制握信念在二者關係的調節效果，以網路問卷蒐集資料，研究參與者為401位台灣地區成人，年齡涵蓋18至65歲。研究重要結果摘要分析如下：一、生命意義感對復原力之預測力發現：對全體成人而言，生命意義感二個向度（存在意義感、尋找意義感）皆可以顯著預測復原力，其中：成人的存在意義感程度越高，其復原力程度越高；但成人的尋找意義感程度越高，其復原力的程度越低。然而，此結果尚未考量制握信念為調節變項產生不同結果之影響。二、制握信念之調節變項效果發現：（1）無論「內部制握信念組」、「無顯著制握信念組」及「外部制握信

念組」的成人，其存在意義感皆能正向預測復原力，並且，「內部制握信念組」（β = .45）與「外部制握信念組」（β = .42）的成人，其存在意義感對於復原力的預測力高於「無顯著制握信念組」（β = .29）的成人。（2）在「無顯著制握信念組」（β = -.20）與「外部制握信念組」（β = -.25），成人尋找意義感對於復原力有負向預測效果，但在「內部制握信念組」，成人尋找意義感無法顯著預測復原力。　　本研究發現成人生命意義感（存在意義感、尋找意義感）對於復原力的預測力，會因為制握信念傾向的不同而有不同之預測力，此結果對成人輔導實務工作有臨床之貢獻。

Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

為了解決Duke University的問題，作者 這樣論述：

Eduardo M. da Cruz is the Associate Medical Director of the Heart Institute, Head of the Pediatric Cardiac Critical Care Program and Director of the Cardiac Intensive Care Section and Inpatient Services at Children’s Hospital Colorado, University of Colorado Denver, School of Medicine. He has had an

international life career in Portugal, Costa Rica, France, United Kingdom, Switzerland and the United States of America. He trained in Medicine and then in Pediatrics at the Universidad de Costa Rica and the Hospital Nacional de Niños in San José, Costa Rica, and then pursued a fellowship in pediat

ric cardiology and intensive care in Paris, France (Hôpital Necker-Enfants Malades, Université René Descartes-Paris V- La Sorbonne). After completing his training, Eduardo stayed in Europe as an attending physician until 2007, when he joined the cardiovascular team at Children’s Hospital Colorado in

Denver, USA, where he currently holds the title of Tenured Professor of Pediatrics, Pediatric Cardiology & Intensive Care. He has close to 30 years of experience in the medical and perioperative management of neonates, children and young adults with complex congenital or acquired heart disease, inc

luding heart transplant, mechanical assistance and quality improvement, safety, clinical effectiveness, stewardship, and crew resource management. He is actively involved in clinical and translational research and teaching in the fields of pediatric cardiology and cardiac intensive care, has deliver

ed close to 300 international lectures, and is a reviewer for 28 peer-reviewed journals, and the Editor or Co-Editor of eight CICU textbooks, including the reference entitled Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care (Springer-Verlag UK), a major textbook and e-book/e-r

eference with 6 volumes and close to 4000 pages (Editor-in-Chief) and the first Textbook dedicated to the Intensive Care of Adults with Congenital Heart Disease (Editor-in-Chief). He has published 80 book chapters and more than 100 manuscripts in peer-reviewed journals. He is the Emeritus Founder of

the Working Group on Pediatric Cardiac Intensive Care of the Association for the European Pediatric and Congenital Cardiology (AEPC), Past-Chair and founder of the Section on Pediatric and Congenital Cardiac Intensive Care & Mechanical Circulatory Support of the European Society of Pediatric and Ne

onatal Intensive Care (ESPNIC), a former Board Member of the Congenital Domain of the European Association for Cardio-Thoracic Surgery (EACTS), member of the Society of Pediatric Research (SPR), the European Society of cardiology (ESC) and of multiple other international Societies. Eduardo da Cruz i

s also an Expert Reviewer for the European Commission Horizon 2020 Project, and the President and Chair of the Board of Surgeons of Hope Foundation, a United Nations-affiliated Non-Governmental Organization based in New York, USA. In 2019, he was the recipient of the American College of Cardiology D

istinguished Service Award.Dr. Dunbar Ivy began his medical career at Tulane University School of Medicine following his premedical studies at Davidson College. While at Tulane, he became excited about a career in Pediatric Cardiology under the mentorship of Dr Arthur Pickoff. He then obtained train

ing in General Pediatrics at the University of Colorado School of Medicine in Denver, Colorado. Early mentors in Pediatric Cardiology included Drs. Michael Schaffer and Henry Sondheimer. Interest in altitude related illness and pulmonary hypertension in congenital heart disease were fostered by Dr R

obert Wolfe on the clinical side and Drs Steve Abman and John Kinsella in the fetal sheep laboratory while a fellow in Pediatric Cardiology at the University of Colorado. Following fellowship, he became a research instructor under the guidance of Dr Mark Boucek, who encouraged him to pursue a career

as a clinician scientist. During his time as a Bugher fellow, he obtained early grants from the March of Dimes and American Heart Association regarding the role of endothelin in the perinatal pulmonary circulation. This work transitioned into a National Institutes of Health K-08 award to continue t

o study molecular derangements in the endothelin pathway in models of pulmonary hypertension. In 2003 Dr Ivy took the position of Chief of Pediatric Cardiology and Selby’s Chair of Pediatric Cardiology. His research focus became more clinical and translational. As Director of the Pediatric Pulmonary

Hypertension Program, he began early clinical studies of medical therapy in children, including the use of intravenous epoprostenol, subcutaneous treprostinil, and oral bosentan. He began to work with Dr Robin Shandas regarding measurement of right ventricular afterload in children with pulmonary h

ypertension in an NIH sponsored Specialized Centers of Clinically Oriented Research grant headed by Dr Kurt Stenmark. Further work on ventricular vascular coupling has continued with NIH funding. Dr Ivy was the inaugural Chairman of the first Pediatric Pulmonary Hypertension taskforce at the World S

ymposium of Pulmonary Hypertension in Nice, France in 2013. Dr. Ivy is a member of multiple societies, and has published over 250 peer reviewed manuscripts.Dr. James Jaggers was born and raised in Western Nebraska. He completed medical school at the University of Nebraska Medical Center in Omaha Neb

raska. He then completed General Surgery at the Oregon Health Sciences University in Portland Oregon and Thoracic Surgery training at the University of Colorado Health Sciences Center in Denver, where he also completed a Pediatric Cardiac Surgery Fellowship at The Childrens Hospital In Denver. From

there, his first Faculty position was as assistant professor of Surgery at Duke University Medical Center where he rose to the rank of Associate Professor with tenure and Chief of Pediatric Cardiac Surgery and Director of the Duke Pediatric Heart Institute. During his time as chief of Pediatric Card

iac Surgery at Duke, Dr. Jaggers directed the pediatric cardiovascular surgery laboratory and mentored many research fellows. He was principal and co-principal investigator on two basic Science NIH grants and one Pediatric Heart Network NHLBI sponsored multicenter study. In 2010, Dr. Jaggers moved t

o the University of Colorado and Children’s Hospital Colorado where he is now the Barton Elliman Chair of Congenital Cardiac Surgery and Professor of Surgery. Dr. Jaggers’s Clinical focus is in all areas of Congenital Cardiac Surgery including complex neonatal repairs, single ventricle surgery, hear

t transplantation and surgery for connective tissue disorders. He has special interest in quality, safety and effective care for children. He is also the program director for the University of Colorado’s Congenital cardiac surgery training program. His research interests include Stem cell delivery t

o improve heart function in children with complex congenital heart disease, and laboratory research in investigation into the protein signaling of aortic stenosis and uncompensated cardiac hypertrophy and myocardial dysfunction. Dr. Jaggers is a member of multiple Societies, and has published over 1

40 peer reviewed manuscripts, published 30 book chapters and is a reputed national and international educator and lecturer.

血衍嗎啡素 7 (LVV-hemorphin-7) 在酒精使用疾患中的疼痛異常上可能扮演的角色

為了解決Duke University的問題，作者洪浩淵 這樣論述：

酒精已被證實會對痛覺產生影響，但是詳細的作用機轉仍屬未知。而血衍嗎啡素-7（LVV-hemorphin-7，以下簡稱：LVV-H7）是由血紅素的 β-chain 切斷而來，被視為一非典型類鴉片胜肽。過去文獻已發現其可結合至多種受體，也被證實具有止痛作用，但詳細作用機轉仍未完全了解。過去離體實驗已經證實，酒精可活化 LVV-H7 的生成酶–cathepsin D，進而使 LVV-H7 大量產生。此外，研究也證實長期使用酒精可能增加貧血風險，因貧血會使血紅素減少，可能也會造成 LVV-H7 降低。綜整上述，我們推測長期使用酒精可改變血中及腦中 LVV-H7 之濃度，其含量變化可能在酒精依賴性及止

痛上扮演重要之角色。在本研究中，我們使用動物模式分別探討酒精給藥前、中、後 LVV-H7 濃度之變化。其後利用額外給予 LVV-H7 及 cathepsin D 抑制劑–pepstatin 來使 LVV-H7 的含量出現變化，藉此探討 LVV-H7 是否參與酒精造成之酬賞作用與止痛。此外，我們也藉由設計 retrospective matched cohort study 及使用健保資料庫的方式，來評估酒精使用疾患（alcohol use disorder，以下簡稱：AUD）日後罹患疼痛相關疾病及使用止痛藥的風險，藉此重複驗證我們在動物實驗的研究結果。簡而言之，本研究目的為探討 LVV-H7

在酒精使用疾患中的疼痛異常上所扮演之角色。在動物實驗中，我們使用腹腔注射的方式給予雄性 Sprague-Dawley 大鼠每公斤 0.5 克的酒精（濃度為10%），藉由先連續給予 15 天再戒斷 5 天的給予方式，成功建立 passive chronic alcohol exposure 的動物模式。此部分的結果顯示：在給予酒精的初期會先產生止痛作用，但是隨著給予時間的增加，這種止痛作用會逐漸消失，然後在戒斷期間引起痛覺過敏的作用；重要的是，我們發現上述的作用可能是由 LVV-H7 的含量變化所導致。我們的實驗結果證實 LVV-H7 的含量與止痛作用呈現正相關，若 LVV-H7 的含量明顯減少

則會產生痛覺過敏的作用。此外，我們也證實 LVV-H7 的含量是由 cathepsin D 的活性和紅血球/血紅素的含量所決定，而 cathepsin D 的活性與紅血球/血紅素都會受到酒精的影響。此外，在我們的 14-year cohort study，我們發現了與未曾罹患過 AUD 之對照組相比，AUD 患者日後發生疼痛相關疾病的風險較高 [adjusted hazard ratio (aHR) = 1.290, 95% confidence interval (CI): 1.045–1.591]，日後使用止痛藥的風險也較高（aHR = 1.081, 95% CI: 1.064–1.312

），而且無論在 opioids 或是 non-opioid analgesics 的使用都有相似的上升趨勢；AUD 患者在止痛劑使用天數、止痛劑使用劑量以及止痛劑所使用的成本，也均會明顯增加。此外，在此研究中我們也發現 AUD 患者日後有較高的風險罹患貧血（aHR=2.772，95% CI：2.581–2.872），與我們在動物實驗所發現的結果一致：長期使用酒精的確會導致貧血，使紅血球/血紅素的含量均減少。由這兩部分的研究結果可得知：酒精引起的疼痛惡化與 LVV-H7 的減少有關，這可能是由於酒精引起的貧血所導致。更證實了 AUD 病人日後容易罹患疼痛相關疾病，也會有更嚴重的 opioids/

analgesics misuse 之問題；如能盡早介入及控制疼痛，將可改善此類病人的生活品質。本研究可能有助於在未來開發一種基於 LVV-H7 結構的新型止痛劑，用於治療酒精引起的疼痛障礙，從而改善酗酒者的預後。