Wingate试验初始负荷比较分析

目的 应用Wingate无氧试验评价无氧能力，探讨改进起始负荷方法，使该法更趋合理。方法 青年运动员91名采用顺序交叉方法分别完成经典Wingate试验（TestW1）和改进的Wingate试验（TestW2)，两次实验相隔24h左右，分别在Monark834E功率车上交义完成两次比较试验。结果 在HRmax和LA不增加的条件下，TestW2的PP，AP明显增高，Pd明显降低（r=0.58-0.93,P&;lt;0.01），两次实验间呈高度相关（r=0.83-0.96)；增加了起始加速功指标，更符合速度性项群的要求。结论 TestW2更符合实验方法的近似原则，有利于发挥受试者的最大无氧能力和运动肌功率输出效率，并可改善实验方法的可重复性，更适合于速度类项群的功能评定。     

优秀女子短跑运动员有氧-无氧能力特征及训练效应

目的:通过女子短跑运动员1年训练中有氧-无氧能力的跟踪观察,为训练监控中的综合分析评定提供参考。方法:21名优秀女子短跑(100～400m)运动员和10名中跑(800～1500m)运动员参加预期性研究;分别在Max-1气体代谢分析仪上完成最大有氧能力试验;在Monark834E功率车上完成改进的Wingate无氧试验。根据年训练周期,共进行3次该组合试验并分析其间的关系。结果:在基本能力评定中,短跑组VO2max显著低于中跑组(平均为2.41和2.74L/min,P<0.05);最大无氧功(PeakPower,P-peak)和平均无氧功(AveragePower,P-ave)显著高于中跑组(分别为744.2和584.2W,P<0.01;517.7和427.8W,P<0.01)。在跟踪测试中,短跑组显示前半周期最大输出功率(MaximalOutputPower,Wmax)、最大通气量(MaximalVoluntaryVentilation,VEmax)和P-ave显著提高,后半周期VO2max,VEmax和最小无氧功(LowPower,P-low)明显下降,而起始无氧功(StartofLoading,P-sta)和P-peak显著提高。中跑组仅在后半周期VO2max显著提高;VO2max,Wmax和VEmax分别与P-low,P-ave呈正相关(r=0.47～0.70,P<0.05)。结论:速度耐力是短跑的关键素质,不仅与无氧代谢能力有直接关系,也离不开有氧供能基础.短跑成绩的提高,需重视最大速度和专项耐力的协调发展。对有氧-无氧能力的组合监测,有     

优秀女子短跑运动员有氧-无氧能力特征及训练效应

目的：通过女子短跑运动员1年训练中有氧-无氧能力的跟踪观察，为训练监控中的综合分析评定提供参考。方法：21名优秀女子短跑(100～400m)运动员和10名中跑(800～1500m)运动员参加预期性研究；分别在Max-1气体代谢分析仪上完成最大有氧能力试验；在Monark834E功率车上完成改进的Wingate无氧试验。根据年训练周期，共进行3次该组合试验并分析其间的关系。结果：在基本能力评定中，短跑组VO2max显著低于中跑组(平均为2．41和2．74L／min，P&;lt;0．05)；最大无氧功(Peak Power，P-peak)和平均无氧功(Average Power,P-ave)显著高于中跑组(分别为744．2和584．2W，P&;lt;0．01；517．7和427．8W，P&;lt;0．01)。在跟踪测试中，短跑组显示前半周期最大输出功率(Maximal Output Power，Wmax)、最大通气量(Maximal Voluntary Ventilation，VEmax)和P-ave显著提高，后半周期VO2max,VEmax和最小无氧功(Low Power，P-low)明显下降，而起始无氧功(Start of Loading，P-sta)和P-peak显著提高。中跑组仅在后半周期VO2max显著提高；VO2max，Wmax和VEmax分别与P-low，P-ave呈正相关(r=0.47～0．70．P&;lt;0．05)。结论：速度耐力是短跑的关键素质，不仅与无氧代谢能力有直接关系，也离不开有氧供能基础．短跑成绩的提高，需重视最大速度和专项耐力的协调发展。对有氧-无氧能力的组合监测，有于助短跑训练安排更加符合生物学原理。     

髋受力后蹬式骑行无氧功率测试:与传统Wingate法骑行方式的对比

背景:前下蹬式骑行方式不适合以后蹬、后趴为主要技术特征的奔跑类运动,但迄今为止还未见模拟奔跑后扒或后蹬动作的无氧功率测试方法.目的:通过自主研发的髋受力装置实现后蹬式功率自行车抗阻骑行模式,并通过与传统Wingate法骑行方式的对比,以探索奔跑类运动项目无氧功率测试法的适宜骑行方式.方法:采用瑞士Monark自行车功量计和髋受力前伸式座椅,运用自身对比法对10名短跑运动员进行后蹬式骑行方式和经典前下蹬骑行方式无氧功率实验.观察两种骑行方式所测得的无氧功率之间的差异,并分析造成差异的生物学原因.结果与结论:髋受力后蹬式骑行方式所获得的无氧功率明显低于传统的Wingate法前下蹬骑行方式(P＜0.05).后蹬式骑行方式无论是动作结构还是肌群动员配比均较Wingate传统前下蹬骑行方式更加接近奔跑技术动作.实验结果证明用后蹬式骑行方式测得的无氧功率能够更真实地反映奔跑运动时的无氧能力.     

不同专项运动员无氧代谢能力特征

目的分析不同专项运动员的无氧代谢能力特征,以及无氧与有氧能力之间的关系,为无氧代谢能力的评价提供参考。方法采用改进的Wingate无氧试验测定江苏省级短跑(n=24)、中长跑(n=23)、场地自行车(n=11)、赛艇(n=18)运动员的无氧能力(按大功率,平均功量,疲劳度),用直接法测定其有氧能力。结果(1)最大功率(PP/kg)、平均功率(AP/kg),属于短距离项目的场地自行车犤(15.1±1.1)W/kg,(10.4±0.7)W/kg犦和短跑运动员犤(14.9±1.5)W/kg,(10.1±0.8)w/kg犦高于属于长距离项目的赛艇犤(11.8±2.8)W/kg,(9.1±0.5)w/kg犦和中长跑运动员犤(2.9±1.5)W/kg,(9.1±0.5)w/kg犦,除场地自行车与短跑运动员之间和赛艇与中长跑运动员之间无显著性差异外,其他各组间均有显著性差异。疲劳度中长跑(64±9)%/kg>场地自行车(60±5)%/kg大于赛艇(59±5)%/kg>短跑(53±4)%/kg运动员。结论不同专项运动员的无氧代谢能力存在一定的差异;相同的项目不同的距离间,相同的距离不同的项目间均不相同;无氧代谢能力与肌肉量有关;有氧能力和无氧能力之间无此消彼涨的负相关,而是协同增加的。     

冠心病康复有氧运动不同强度设定方法的一致性研究

目的探讨冠心病康复不同有氧运动强度设定方法的一致性,为基层康复机构的冠心病患者进行有氧运动提供安全有效的强度设定方法。方法 2016年7月至2017年7月选取本院低、中危冠心病患者25例,采集安静心率和年龄等基本信息,进行心肺运动试验获取无氧阈和峰值摄氧量。休息1 d后,进行6分钟步行试验。分别使用无氧阈法、峰值摄氧量法、心率储备法、年龄预计法和安静心率+20法计算靶心率,比较不同方法确定靶心率的相关性与一致性。结果年龄预计法确定的靶心率与无氧阈法无显著性相关(r=-0.131,P0.05),两者存在非常高度显著性差异(P0.001);安静心率+20法所推算的靶心率与无氧阈法无显著性相关(r=0.372,P0.05);峰值摄氧量法确定的靶心率与无氧阈法之间存在非常显著性相关(r=0.872,P0.01),两者无显著性差异(P0.05),Bland-Altman检验显示两种方法具有一致性;心率储备法确定的靶心率与无氧阈法之间存在非常高度显著性相关(r=0.836,P0.001),两者无显著性差异(P0.05),Bland-Altman检验显示两种方法具有一致性。结论年龄预计法、安静心率+20法确定的有氧运动靶强度与无氧阈法不具有相关性和一致性;心率储备法、峰值摄氧量法确定的有氧运动靶强度与无氧阈法相关,具有一致性。     

不同体育专项大学生的无氧工作能力

背景：无氧工作能力是影响许多运动项目成绩发挥的重要因素，测量和评价人体无氧工作能力对于客观地分析与评价人体运动能力、检测训练效果等具有重要意义。目的：了解体育教育专业不同专项的大学生无氧能力特征。设计、时间及地点：试验于2006-12在山东理工大学体育学院运动人体科学实验室进行。参试者：选择山东理工大学体育学院体育教育系2002级学生48名，受试时身体状态良好，均无专业训练经历。方法：48名学生按其专项运动分为长跑组、体操组、投掷组、短跑跳跃组，每组12名。采用Wingate无氧功率试验法，利用瑞典产的Monark894E无氧功率自行车，在一定的负荷下以最大负荷完成30S的快速蹬车，所获测试数据运用SPSS10．0软件进行统计分析。主要观察指标：峰值功率、平均无氧功率、无氧功率递减率、最小无氧功率。结果：①与短跑跳跃组相比，投掷组和长跑组的无氧峰值功率降低（P=O．008，P=0．005）：与体操组相比，投掷组和长跑组的无氧峰值功率亦降低（P=0．007，P=0．004）。②投掷组平均无氧功率低于短跑跳跃组（尸=0．024）。③投掷组的无氧功率递减率均高于其他3组（P=O．046）；但其他3组间相比，差异无显著性意义（P〉0．05）。④各组间最小无氧功率差异无显著性意义（P〉0．05）。结论：体育专业不同专项大学生在无氧工作能力方面存在一定差异，短跑跳跃组的无氧工作能力较强，疲劳指数较低，而投掷组的无氧工作能力较差，疲劳指数较高。     

补肾益元中药对运动员的抗疲劳作用

目的 评价补肾益元中药增强运动功能及抗疲劳效应。方法 采用计算机随机发生器分组，安慰剂对照，双盲观察试验方案对51名运动员进行了抗疲劳的系统观察研究。受试服药前后分别测定4mmol乳酸无氧阈率、Wingate实验、血清睾酮、游离睾酮及疲劳症状计分。结果 对照组实验前后上述指标无明显变化，服用补肾益元方药组无氧阈功率、无氧功峰值与平均值均有不同程度的提高，而疲劳度下降，力竭时间延长，血清睾酮、游离睾酮水平升高有显性差异，疲劳症状明显改善。结论 补肾益元中药能显增强运动员的运动能力和抗疲劳能力，提高血清激素水平，对运动性疲劳症状亦有明显改善作用。     

补肾益元中药对运动员的抗疲劳作用

目的评价补肾益元中药增强运动功能及抗疲劳效应。方法采用计算机随机发生器分组,安慰剂对照,双盲观察试验方案对51名运动员进行了抗疲劳的系统观察研究。受试者服药前后分别测定4mmol乳酸无氧阈率、Wingate实验、血清睾酮、游离睾酮及疲劳症状计分。结果对照组实验前后上述指标无明显变化,服用补肾益元方药组无氧阈功率、无氧功峰值与平均值均有不同程度的提高,而疲劳度下降,力竭时间延长,血清睾酮、游离睾酮水平升高有显著性差异,疲劳症状明显改善。结论补肾益元中药能显著增强运动员的运动能力和抗疲劳能力,提高血清激素水平,对运动性疲劳症状亦有明显改善作用。     

四肢联动在脑卒中患者心肺适能评估中运用的可行性

目的:分析四肢联动在脑卒中患者心肺适能评估中运用的可行性,探索评估脑卒中患者心肺功能的适宜设备。方法:19位脑卒中患者均先后使用功率自行车和四肢联动两种设备进行两次症状限制性最大递增心肺运动试验,并用配对t检验分析两次试验获得的峰值摄氧量(VO2peak)以及峰值心率(HRpeak)之间的差异,并采用Pearson相关系数检验它们的相关性。结果:两次试验获得的VO2peak以及HR peak存在高度相关(分别r=0.95和r=0.96),使用四肢联动获得的VO2peak明显高于功率自行车[(14.51±3.13)vs(12.60±3.52)m L·kg-1·min-1],HR peak也明显增加[(116.26±10.98)vs(104.53±11.79)min-1],且差异均有统计学意义(P0.05)。使用四肢联动的患者疲劳程度较自行车轻(Borg呼吸困难:9.95±0.85 vs 14.79±1.23;Borg腿部疲劳:13.53±0.70 vs 15.95±0.85)。纳入研究的19位患者均能顺利完成两次试验,没有发生任何不良事件。结论:四肢联动在评估卒中患者心肺适能方面是安全、有效、可行的,其测试结果更贴近患者真实的心肺功能,并且不容易引起患者疲劳。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.