慢性阻塞性肺病缓解期患者营养状况及对呼吸肌力量的影响

目的探讨慢性阻塞性肺病（ＣＯＰＤ）缓解期患者的营养状况与呼吸肌力量的关系，以及饮食补充对营养状况和呼吸肌力量的影响。方法测定７６例ＣＯＰＤ缓解期患者的营养指标和最大口腔吸气压（ＭＩＰ）以及最大口腔呼气压（ＭＥＰ）。４１例低体重患者中随机选取２４例分两组，对照组（１２例）维持原先饮食，饮食补充组（１２例）摄入热量平均增加３５％，２周后随访两组患者各营养指标和ＭＩＰ、ＭＥＰ。结果单因素相关分析显示ＭＩＰ占预计值百分比、ＭＥＰ占预计值百分比分别与１秒钟用力呼气容积占预计值百分比、１秒钟用力呼气容积占用力肺活量百分比、每日摄入热量占正常人标准供给量百分比、体重占理想体重身高百分比、体重身高指数和白蛋白呈正相关（Ｐ＜０．０５）。饮食补充组２周后各营养指标、ＭＩＰ和ＭＥＰ均有明显增加。对照组各项指标差异均无显著性。结论ＣＯＰＤ缓解期患者呼吸肌力量减弱与营养不良有关。饮食补充后随着营养状况改善，呼吸肌力量也有所增强     

甲地孕酮对慢性阻塞性肺病缓期患者的疗效观察

为了观察食欲刺激剂甲地孕酮（ｍｅｇｅｓｔｒｏｌａｃｅｔａｔｅ，ＭＡ）对慢性阻塞性肺病（ＣＯＰＤ）缓解期患者营养状况，呼吸肌力及免疫功能的影响，将３１例患者随机分为两组，治疗组１６例，口服ＭＡ１６０ｍｇ／ｄ；对照组１５例，口服多酶片３片，治疗前后测定饮食营养指标，肺功能，呼吸肌力和有关免疫学参数，２周后发现每日摄入热能和蛋白质有显著增加；人体测量值如体重，理想体重百分比，三头肌皮褶厚度，血清蛋白测定     

慢性阻塞性肺疾病患者呼吸肌肌力和耐力的测定

呼吸肌功能测定通常包括呼吸肌肌力（ＲＭＳ）和呼吸肌耐力（ＲＭＥ）。应用自行研制的ＲＭＳＥ－１型呼吸肌功能测定仪对健康正常人和缓解期慢性阻塞性肺疾病（ＣＯＰＤ）患者进行测定。如果表明，缓解期ＣＯＰＤ患者ＲＭＳ指标如最大吸气口腔压（ＭＩＰ）和最大呼气口腔压（ＭＥＰ）与正常人组差异无显著性；而ＲＭＥ指标如最大吸气负荷（Ｌｏａｄ＿ｍ）、最大负荷时的平均口腔压（Ｐ＿（ｍｅａｎ））以及最大负荷时的最大持续吸气压（ＳＩＰ＿ｍ）与ＭＩＰ之比（ＳＩＰ＿ｍ／ＭＩＰ）较正常人组明显减低，差异非常显著。提示ＲＭＥ测定较ＲＭＳ测定更为敏感。认为ＲＭＥ测定作为呼吸肌功能评定的客观方法，对观察ＣＯＰＤ患者呼吸肌锻炼效果和指导呼吸康复治疗有重要意义。     

慢性阻塞性肺疾病患者呼吸肌力和耐力的测定

呼吸肌功能测定通常包括呼吸肌肌力（ＲＭＳ）和呼吸肌耐力（ＲＭＥ）。应用自行研制的ＲＭＳＥ－１型呼吸肌功能测定仪对健康正常人和缓解期慢性阻塞性肺疾病（ＣＯＰＤ）患者进行测定。结果表明，缓解期ＣＯＰＤ患者ＲＭＳ指标如最大吸气口腔压（ＭＩＰ）和最大呼气口腔压（ＭＥＰ）与正常人组差异无显著性；而ＲＭＥ指标如最大吸气负荷（Ｌｏａｄｍ）、最大负荷时的平均口腔压（Ｐｍｅａｎ）以及最大负荷时的最大持续吸气压（ＳＩ     

呼吸体操改善呼吸肌功能的量化研究

为改善慢性阻塞性肺疾病（ＣＯＰＤ）缓解期患者呼吸肌肌力，兹选取３２４例ＣＯＰＤ患者进行呼吸体操锻炼。将ＣＯＰＤ患者随机分为呼吸体操组（１６５例）及安慰剂组（１５９例）。呼吸体操组患者经过１～２０个月的锻炼后，进行呼吸压及跨膈压的对比。结果发现最大吸气口腔压（ＭＩＰ）提高３０．４２％，最大呼气口腔压（ＭＥＰ）提高３２．１０％，跨膈压（Ｐｄｉ）提高３０．９４％，最大跨膈压（Ｐｄｉｍａｘ）次提高６５．５９％，与治疗前比较，差异有非常显著性（Ｐ＜０．００１）；对照组患者的ＭＩＰ、ＭＥＰ、Ｐｄｉ和Ｐｄｉｍａｘ提高６．９５％、２．９２％、１４．６３％及９．０５％，与治疗前比较，差异无显著性（Ｐ＞０．０５）。经量化标定后阐明呼吸体操可以作为ＣＯＰＤ缓解期患者防止复发和治疗方法之一，似为国内外首创。     

慢性阻塞性肺病患者呼吸肌功能变化及其意义

慢性阻塞性肺病患者呼吸肌功能变化及其意义山东省胸科医院（２５００１３）曲仪庆山东医科大学附属医院于钦凤薛玉文许仁和我们采用ＲＭＳＥ－Ⅱ型呼吸肌功能微电脑测定仪测定慢性阻塞性肺病（ＣＯＰＤ）患者缓解期的呼吸肌肌力和耐力，旨在探讨ＣＯＰＤ患者呼吸肌功能的...     

饮食调整对COPD缓解期营养不良患者的影响

大约３０％～５０％的缓解期ＣＯＰＤ患伴有营养不良，对营养不良的ＣＯＰＤ缓解期患进行饮食调整可改善其营养状况。从而提高免疫功能，增加呼吸肌和外周骨骼肌的收缩力，提高其生命质量，饮食调整期间每日摄入总热卡约为基础能量的消耗量的１５０％～１７０％，蛋白质，脂肪、碳水化合物所供热量分别占１５％，３５％，５０％左右，饮食调整疗程长短不等，一般３周左右即可见效。     

口服同化类固醇6个月对慢性阻塞性肺疾病伴营养不良的患者体重和呼吸肌的影响

[英 ]/ＦｅｒｒｅｉｒａＩＭ…∥Ｃｈｅｓｔ 1 998,1 1 4( 1 ) 1 9～ 2 8 慢性阻塞性肺疾病 (ＣＯＰＤ)患者有 1 0 %～2 6%伴有营养不良。低体重的ＣＯＰＤ患者死亡率高于体重正常的患者。作者研究 2 3例ＣＯＰＤ伴营养不良的患者服用睾酮制剂对体重指数(ＢＭＩ)、肌肉重量、呼吸肌强度和运动耐量的影响。病人和方法　 2 3例男性ＣＯＰＤ患者 ,其ＢＭＩ小于 2 0ｋｇ/ｍ2 ,最大吸气压 (ＰＩＭＡＸ)低于预测值 60 % ,随机分为 2组。对照组给予安慰剂 ,实验组在开始时给予 2 5 0ｍｇ睾酮肌注 1次 ,随后口服睾酮制剂司坦唑醇 (Ｓｔａｎｏｚｏ…     

血清瘦素对慢性阻塞性肺疾病患者营养状态影响的初步研究

目的 探讨血清瘦素及肿瘤坏死因子α（ＴＮＦ－α）的慢性阻塞性肺疾病（ＣＯＰＤ）患者营养不良发生中的意义。方法 测定３１例ＣＯＰＤ患者（分为营养不良组１２例,非营养不良组１９例）及１１名正常人的血清瘦素、ＴＮＦ－α浓度、体重指数（ＢＭＩ）、理想体重百分比（ＮＷ％）、三头肌皮皱厚度（ＴＳＦ）、肩胛下皮皱厚度（ＳＳＦ）、上臂中部臂围（ＭＡＣ）,血清白蛋白（ＡＬＢ）、总淋巴细胞计数（ＬＹＭ）等指标。瘦素与     

自由基与慢性阻塞性肺疾病患者淋巴细胞线粒体膜磷脂改变的研究

为了探讨自由基对慢性阻塞性肺疾病（ＣＯＰＤ）的细胞病理损伤部位，我们以外周血淋巴细胞为模型，观察ＣＯＰＤ患者淋巴细胞线粒体膜磷脂超微结构定位改变与血清中过氧化物歧化酶（ＳＯＤ）、丙二醛（ＭＤＡ）变化的关系，为今后预防和治疗ＣＯＰＤ提供理论根据。对象１...     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.