基于中国传统运动疗法的慢性筋骨病康复模式构建思路探析＊

中国传统运动疗法作为极具特色的康养健身运动疗法，在防病治病中的宝贵价值备受国际康复医学界关注。而慢性筋骨病是骨伤科临床中的常见病、多发病与疑难杂病，临床呈现出“一大五多五高”的特征，成为当前重大的健康问题与临床防治研究课题。本文通过深入探究中国传统运动疗法特点以及其在慢性筋骨病康复中的应用原理、原则及优势作用，提出以传统运动疗法为依托，构建慢性筋骨病防病治病应用方法模式；以三因制宜为指导，构建医院-社区-团体-患者为一体的康复管理模式；以“治未病”工程为支撑，构建慢性筋骨病管理信息资源共享平台模式；为切实提高防、控、治的能力与水平找准抓手与路径，为构建慢性筋骨病康复模式提供新的思路与方向。     

Effect of exercises according to the circadian rhythm in type 2 diabetes: Parallel-group,single-blind,crossover study

Background and aimTo evaluate the effectiveness of structured exercise appropriate the circadian rhythm in terms of blood sample test (BST), functionality and quality of life (QoL) in individuals with type 2 diabetes.Methods and resultsThis was a parallel-group, single-blind, crossover study. Thirty individuals with type 2 diabetes aged 35–65 years were enrolled in the study and allocated into 2 groups as the Morning Chronotype (MC) Group (n = 15) and the Evening Chronotype (EC) Group (n = 15) using Morningness-Eveningness Questionnaire which was used to determine the chronotypes. Participants were evaluated in terms of BST, functionality and QoL at the beginning of the study (T0), at 6 (T1), 12 (T2), and 18 (T3) weeks after the study started. A structured exercise program for 3 days a week over 6 weeks was applied in accordance with the chronotypes (T1-T2) and cross-controlled for the chronotypes (T2-T3). Significant differences were found in favor of the exercise given at the appropriate time for the chronotype in all parameters in both groups within groups (T0-T1-T2-T3) (p < 0.05). In the time1group interactions, exercise in accordance with the appropriate chronotype in both groups provided the highest statistical improvement in all parameters (p < 0.05).ConclusionIt was concluded that structured exercise performed at the appropriate time for chronotype improves HbA_1c, fasting blood glucose, HDL-LDL cholesterol, triglyceride, total cholesterol, functionality and quality of life in type 2 diabetes. This variation in blood values was observed to reflect the quantitative effects of exercise administered according to the circadian rhythm in individuals with type 2 diabetes.Trial registrationClinicalTrials.gov (NCT04427488). The protocol of the study was registered at ClinicalTrials.gov (NCT04427488).     

辐射事故应急演习准备与实施的规范化

通过回顾2014年以来全国各省辐射事故应急演习工作的成果和经验，结合国际原子能机构（IAEA）、生态环境部关于辐射事故应急演习的相关指导文件，总结了综合性辐射事故应急演习的开展流程。此外，基于演习实战化的要求，详细介绍演习规划、准备、实施、评估等环节的技术要求和规范方法，为开展辐射事故应急演习提供参考和借鉴。     

Effects of virtual Reality-Based Training and aerobic training on gaming disorder,physical activity,physical fitness,and anxiety: A randomized,controlled trial

Background and aimThe effects of physical activity and exercise on gaming disorder severity in individuals with gaming disorder are unknown. The present study aimed to address the empirical gap in the current literature by comparing the effects of virtual reality-based training (VRT) and aerobic training (AT) exercise programs on gaming disorder severity, physical activity, physical fitness, and anxiety versus control group.Materials and methodsForty-four young male adults (18–28 years) with gaming disorder and a sedentary lifestyle were included in the study. The primary outcomes of the study were changes in gaming disorder severity and physical activity, and secondary outcomes included changes in physical fitness and anxiety levels. The participants were randomly assigned to VRT (n = 15), AT (n = 14) and control (n = 15) groups. Training sessions were performed at 50–70% of the maximal heart rate. Exercise programs consisted of 6 weeks of training 3 times a week for 30 min.ResultsThere was a decrease in the severity of gaming disorder as well as an increase in the level of physical activity in the VRT and AT exercise groups compared to the control group. In addition, a reduction was observed in the gaming time and sedentary time in both exercise groups versus control group. VRT group experienced greater improvements in physical fitness parameters than the AT group.ConclusionVRT and AT were effective in reducing gaming time and the severity of gaming disorder in individuals with gaming disorder. The therapeutic effects of VRT and AT can be used for reducing the severity of gaming disorder.     

Utilization of and Outcomes Associated with Intravascular Ultrasound during Deep Venous Stent Placement among Medicare Beneficiaries

PurposeTo evaluate temporal trends, practice variation, and associated outcomes with the use of intravascular ultrasound (US) during deep venous stent placement among Medicare beneficiaries.Materials and MethodsAll lower extremity deep venous stent placement procedures performed between January 1, 2017, and December 31, 2019 among Medicare beneficiaries were included. Temporal trends in intravascular US use were stratified by procedural setting and physician specialty. The primary outcome was a composite of 12-month all-cause mortality, all-cause hospitalization, or repeat target vessel intervention. The secondary outcome was a composite of 12-month stent thrombosis, embolization, or restenosis.ResultsAmong the 20,984 deep venous interventions performed during the study period, 15,184 (72.4%) utilized intravascular US. Moderate growth in intravascular US use was observed during the study period in all clinical settings. There was a variation in the use of intravascular US among all operators (median, 77.3% of cases; interquartile range, 20.0%–99.2%). In weighted analyses, intravascular US use during deep venous stent placement was associated with a lower risk of both the primary (adjusted hazard ratio, 0.72; 95% confidence interval [CI], 0.69–0.76; P < .001) and secondary (adjusted hazard ratio, 0.32; 95% CI, 0.27–0.39; P < .001) composite end points.ConclusionsIntravascular US is frequently used during deep venous stent placement among Medicare beneficiaries, with further increase in use from 2017 to 2019. The utilization of intravascular US as part of a procedural strategy was associated with a lower cumulative incidence of adverse outcomes after the procedure, including venous stent thrombosis and embolization.     

模拟马术训练对脑卒中后共济失调的效果

目的 探索模拟马术训练对后循环卒中共济失调患者姿势控制、平衡、步行和日常生活活动能力的效果。     

The effects of multi-directional,high intensity exercise on the vestibular/ocular motor screening (VOMS) assessment in recreational athletes

ObjectiveIdentify the effects of multi-directional, high intensity exercise on VOMS symptom scores in male and female recreational, college-aged athletes.DesignCross-sectional study.SettingAthletic Therapy facility.ParticipantsA convenience sample of 29 (15 females, 14 males; 21.48 ± 1.40 years old) healthy recreational athletes.Main outcome measuresVOMS symptom scores pre, immediately post-, and 10 min post a multidirectional, high intensity intermittent exercise protocol (HIIP). Friedman tests and Wilcoxon Signed Rank tests identified significant differences at the time points. A Mann-Whitney U Test investigated the effect of sex.ResultsThe majority of component and overall VOMS symptom scores increased post-HIIP (p < 0.001–0.007, effect sizes 0.39–0.50) and 10 min post-HIIP (p = 0.003–0.015, effect sizes 0.32–0.39). Near point convergence distance increased immediately post-HIIP (p < 0.001, effect size 0.52). Females had higher smooth pursuits (z = −2.340, p = 0.019, r = 0.31), vertical vestibular ocular reflex (z = −2.81, p = 0.04, r = 0.39) visual motion sensitivity (z = −2.312, p = 0.021 r = 0.30) and overall VOMS symptom scores (z = −2.84, p = 0.04, r = 0.27) 10 min post-HIIP.ConclusionsMultidirectional, high intensity exercise can induce concussive-like changes in VOMS symptom scores in healthy, recreational athletes, particularly in females. These results may assist in SRC assessment and management of athletes involved in multidirectional, high intensity sports.     

妊娠期体育锻炼干预对自然分娩影响的Meta分析

背景 自然分娩是人类繁衍的正常生理过程，中国剖宫产率超出了世界卫生组织（WHO）提出的警戒线2倍多，而体育锻炼作为一种非药物性的健康干预方式，应引起相关部门的重视。 目的 运用Meta分析方法检验妊娠期体育锻炼对自然分娩影响的干预效果，并提出最优的锻炼方案。 方法 检索中国知网（CNKI）、中国生物医学文献服务系统（CBM）、维普网中文数据库和PubMed、EMBase、Web of Science、Cochrane Library英文数据库中有关妊娠期体育锻炼干预影响自然分娩结果的随机对照试验（其中干预组以体育锻炼干预为唯一干预方式，对照组进行常规护理知识教育或不进行有规律的体育锻炼），同时追踪相关系统评价所引用的参考文献，检索时间为1990—2021年。提取纳入文献资料，并对纳入文献进行方法学质量评价，采用RevMan 5.2软件进行Meta分析，运用GRADE工具对结局指标进行质量评价。 结果 共纳入30篇文献。Meta分析结果显示，干预组自然分娩发生率高于对照组〔RR=1.34，95%CI（1.28，1.40），P<0.000 01〕。亚组分析结果显示，锻炼开始节点对自然分娩的干预效果从高到低依次为：>24周、13~24周、≤12周；锻炼内容对自然分娩的干预效果从高到低依次为：盆底肌训练、运动课、体操、有氧运动、分娩球、瑜伽；锻炼频率对自然分娩的干预效果从高到低依次为：≥12次/周、3~5次/周、6~8次/周、9~11次/周；中等强度的锻炼较低强度的锻炼对自然分娩具有更大的影响；锻炼时长对自然分娩的干预效果从高到低依次为：30~<50 min/次、<30 min/次、≥50 min/次；锻炼周期对自然分娩的干预效果从高到低依次为：≤8周、17~24周、9~16周、25~34周。绘制体育锻炼干预对孕妇自然分娩影响的漏斗图，结果显示，漏斗图左右两侧基本对称，发表偏倚较小。运用GRADE工具对结局指标进行质量评价，结果显示，妊娠期体育锻炼影响自然分娩的评级为中等级。 结论 孕妇在妊娠期进行一定的体育锻炼对自然分娩结果具有良好的干预效果，且从妊娠期>24周开始锻炼、≥12次/周、30~<50 min/次、持续进行≤8周的中等强度的盆底肌训练、运动课、体操、有氧运动、分娩球以及瑜伽均对孕妇自然分娩的选择具有积极的影响。     

协同式早期运动干预在腹腔镜结直肠癌手术患者中的应用

目的 探讨协同式早期运动干预在腹腔镜结直肠癌手术患者中的应用效果。方法 使用随机数字表法将2020年5月-2021年5月于笔者所在医院进行腹腔镜结直肠癌手术的84例患者分为对照组和干预组,各42例。对照组术后采用常规运动干预,干预组术后采用协同式早期运动干预。比较2组术后恢复情况、身体状况、术后并发症发生情况。结果 干预组首次下床活动时间、术后排气时间、术后排便时间均早于对照组(χ²=11.823,P=0.001;χ²=4.687,P=0.001;χ²=7.611,P=0.001),术后7d干预组的多维度疲劳量表评分低于对照组(t=2.000,P=0.049),杜克活动指数高于对照组(t=2.256,P=0.027),2组术后并发症发生率比较,差异无统计学意义(χ²=0.343,P=0.558)。结论 协同式早期运动干预能够促进腹腔镜结直肠癌手术患者术后恢复,改善身体状况,值得推广应用。     

Endurance training may improve exercise capacity,lung function and quality of life in Fontan patients

Children born with univentricular hearts undergo staged surgical procedures to a Fontan circulation. Long-term experience with Fontan palliation has shown dramatically improved survival but also of a life-long burden of an abnormal circulation with significant morbidity. Many Fontan patients have reduced exercise capacity, oxygen uptake, lung function and quality of life. Endurance training may improve submaximal, but not maximal, exercise capacity, lung function and quality of life. Physical activity and endurance training is also positively correlated with sleep quality. Reviewing the literature and from our single-centre experience, we believe there is enough evidence to support structured individualised endurance training in most young Fontan patients.