主动循环呼吸技术训练联合自信心培养对老年肺癌手术病人肺康复效果的影响

[目的]探讨主动循环呼吸技术训练联合自信心培养对老年肺癌手术病人肺康复效果的影响。[方法]选择140例于2018年5月—2019年4月在某院明确诊断为肺癌并准备行手术治疗的老年肺癌手术病人,并将其分成对照组与观察组,各70例。对照组(入院时间为2018年5月—2018年10月)开展胸外科常规呼吸训练,观察组(入院时间为2018年11月—2019年4月)开展主动循环呼吸技术训练联合自信心培养。比较两组病人术后前3 d的排痰量、肺部并发症以及干预前后中文版运动自我效能量表(Self-Efficacy for Exercise Scale,SEES-C)评分、6 min步行试验(6 MWT)、呼气峰流速状况。[结果]两组病人术后第1天排痰量比较差异无统计学意义(P0.05),观察组病人术后第2天、第3天排痰量多于对照组,差异有统计学意义(P0.05)。对照组发生肺部并发症12例,观察组5例,两组比较差异无统计学意义(P0.05)。两组病人干预前SEES-C评分、6 MWT、呼气峰流速比较差异无统计学意义(P0.05),干预后观察组病人SEES-C评分、6 MWT、呼气峰流速高于对照组,差异有统计学意义(P0.05)。[结论]对老年肺癌病人实施主动循环呼吸技术训练联合自信心培养,不但有助于肺康复,而且简单易实现,效果突出。     

主动循环呼吸训练应用于老年肺癌术后患者的效果

目的:探讨主动循环呼吸训练促进老年肺癌术后患者肺功能恢复及降低肺部并发症中的应用价值。方法:按照随机数字表法将105例老年肺癌术后患者分为对照组52例和观察组53例。对照组给予围术期管理和反馈式呼吸刺激,观察组在此基础上增加主动循环呼吸训练,对比两组肺功能、血气指标及并发症发生情况。结果:观察组训练2周后最大肺活量、用力肺活量、第1秒用力呼气容积、呼气峰流速、动脉血氧分压均较对照组高,动脉血二氧化碳分压、肺部并发症发生率较对照组低(P<0.05)。结论:主动循环呼吸训练可调节老年肺癌术后患者血气水平,改善肺功能,降低术后肺部并发症发生。     

主动呼吸循环技术对非小细胞肺癌手术患者心肺功能影响研究

目的 探讨主动呼吸循环技术对非小细胞肺癌患者术后心肺功能的影响。方法 选取2019年1月1日—12月31日入住北京协和医院胸外科的非小细胞肺癌患者作为研究对象,按住院时间先后分为对照组105例、观察组106例。对照组术后采用传统肺部物理治疗措施指导患者进行呼吸功能锻炼,观察组在此基础上加用主动呼吸循环技术的锻炼。比较2组患者的一秒用力呼气容积、用力肺活量、呼气峰值流速、6 min步行试验、首次咳痰时间、肺部并发症发生率等指标的差异。结果 患者术后肺功能情况（包括一秒用力呼气容积、用力肺活量、呼气峰值流速）以及6 min步行试验,在出院当天和术后第30天观察组均优于对照组（P<0.05）;观察组术后首次排痰时间、管留置时间以及术后住院天数较对照组明显缩短,差异均有统计学意义（P<0.05）。结论 主动呼吸循环技术能够明显改善非小细胞肺癌手术后患者心肺功能,促进患者早期高效清除患者气道内分泌物,缩短胸管留置时间,减少肺部并发症发生率,促进患者快速康复。     

术前肺康复运动训练对老年肺癌合并中度慢性阻塞性肺疾病病人肺康复的影响

[目的]探讨术前肺康复运动训练对老年肺癌合并中度慢性阻塞性肺疾病(COPD)病人肺功能、运动耐力、术后住院时间及肺部并发症的影响。[方法]选取86例诊断为肺癌,且肺功能提示中度COPD的老年病人,随机分为试验组和对照组,试验组病人术前在常规护理的同时完成为期2周的肺康复运动训练,于肺康复运动训练前后对两组病人分别进行肺功能、血气分析及6min步行试验(6-MWT)检测,同时观察其住院时间及术后肺部并发症的发生情况。[结果]试验组病人肺功能、二氧化碳分压(PaO2)、6-MWT在肺康复运动训练后均明显高于对照组病人(P0.05),住院时间短、术后肺部并发症少(P0.05)。[结论]术前行肺康复运动训练能够改善肺癌合并老年COPD病人肺功能、血氧饱和度及运动耐力,缩短术后住院时间,减少术后肺部并发症。     

术前肺康复运动训练对老年肺癌合并中度慢性阻塞性肺疾病病人肺康复的影响

[目的]探讨术前肺康复运动训练对老年肺癌合并中度慢性阻塞性肺疾病（COPD）病人肺功能、运动耐力、术后住院时间及肺部并发症的影响。[方法]选取86例诊断为肺癌,且肺功能提示中度COPD的老年病人,随机分为试验组和对照组,试验组病人术前在常规护理的同时完成为期2周的肺康复运动训练,于肺康复运动训练前后对两组病人分剐进行肺功能、血气分析及6min步行试验（6-MWT）检测,同时观察其住院时间及术后肺部并发症的发生情况。[结果]试验组病人肺功能、二氧化碳分压（PaO2）、6-MwT在肺康复运动训练后均明显高于对照组病人（P〈0．05）,住院时间短、术后肺部并发症少（P〈0．05）。[结论]术前行肺康复运动训练能够改善肺癌合并老年COPD病人肺功能、血氧饱和度及运动耐力,缩短术后住院时间,减少术后肺部并发症。     

振动呼气正压装置与诱发性肺量计在肺癌术后患者康复训练中的应用研究

目的 比较振动呼气正压装置（oscillatory positive expiratory pressure device, OPEPD）联合诱发性肺量计训练与主动循环呼吸技术（active cycle of breathing techniques, ACBT）训练对肺癌术后患者肺康复效果的影响。方法 选取2018年1月—2019年8月在郑州市某三级甲等医院胸外科行单孔胸腔镜下肺癌根治术的87例患者为研究对象, 采用随机数字表法将其分为试验组与对照组。试验组（44例）采用OPEPD联合诱发性肺量计进行肺康复训练, 对照组（43例）采用ACBT进行肺康复训练, 干预5 d, 比较两组术后并发症发生情况、6 min步行距离、肺活量、Borg呼吸困难评分、肺癌患者生活质量评分、衰弱评分及康复护理满意度。结果 两组的年龄、性别、急性生理与慢性健康状况评分、肺癌分期及合并症等一般资料比较, 差异无统计学意义（P>0.05）;试验组6 min步行距离远于对照组、肺活量高于对照组, 差异有统计学意义（P<0.05）;试验组术后呼吸功能不全发生率、Borg呼吸困难评分、肺癌患者生活质量评分及衰弱评分低于对照组, 差异有统计学意义（P<0.05）;试验组康复护理满意度高于对照组, 差异有统计学意义（P=0.034）。结论 OPEPD联合诱发性肺量计训练能够减轻肺癌术后患者的衰弱程度, 减少并发症, 提高其肺活量、运动耐量和康复护理满意度。     

主动呼吸循环技术视频教育在食管癌根治术后患者中的应用

目的 评价主动呼吸循环技术视频教育在食管癌根治术后患者的应用效果。方法 采用方便抽样方法,选取2021年1月至2022年12月入住本院胸外科行三切口食管癌根治术患者为研究对象,按住院时间先后顺序分为对照组和试验组,每组各44例。对照组接受传统呼吸功能训练,试验组实施主动呼吸循环技术的视频教育,两组干预时间从术后第1天至出院。比较两组患者6 min步行试验、排痰效果、胸腔闭式引流管留置时间和术后住院时间的差异。结果 患者出院前6 min步行试验和术后第3天排痰效果,试验组优于对照组（均P<0.05）;试验组胸腔闭式引流管留置时间和术后住院时间较对照组缩短（均P<0.05）。结论 主动呼吸循环技术视频教育可提升患者训练积极性并帮助患者正确进行训练,从而促进排痰,改善其心肺功能,缩短胸腔闭式引流管留置时间,促进患者快速康复。     

膈肌电刺激训练在肺癌术后患者肺康复中的应用

目的探讨膈肌电刺激训练对肺癌切除术后患者肺康复的效果。方法选取某肿瘤医院确诊肺癌并治疗的患者112例为研究对象,采用随机数字表法分为对照组58例,试验组54例。对照组患者采用常规护理治疗方法,试验组患者在常规护理治疗基础上实施4周膈肌电刺激训练,实施前对患者进行健康教育、实施中进行全程监管与指导等,比较两组患者术后第4周、第8周、第12周肺康复情况。结果试验组患者术后第4周、第8周、第12周的用力肺活量、1 s用力呼气容量、六分钟步行测试等指标均高于对照组(P0.01)。结论严格的膈肌电刺激训练可以改善肺癌切除术后患者肺功能及运动耐力指标,促进术后患者的肺康复,是一种有效的呼吸训练方法。     

术前护理干预对老年肺癌患者术后呼吸功能的影响

目的探讨术前护理干预对老年肺癌患者术后肺部并发症的影响。方法将50例65岁以上老年肺癌患者随机分为观察组和对照组,各25例。对照组术前采用常规护理方法。观察组在此基础上加强术前护理干预,包括强化健康教育,呼吸功能训练、建立按需排痰理念、有效咳嗽排痰法训练、增加排痰过程的舒适感等,比较2组患者术后咳嗽程度、痰液粘稠度、排痰难度和肺部啰音情况及肺部并发症的发生情况。结果术后观察组有效咳嗽排痰效果明显优于对照组（P〈0．05）,肺部并发症低于对照组（P〈0．01）。结论加强术前护理干预,可改善老年肺癌患者术后呼吸功能,减少肺部并发症的发生,提高手术后康复的成功率。     

肺切除术患者围手术期的呼吸道护理

总结了肺切除术患者围手术期的呼吸道护理体会。术前进行有针对性的心理护理,协助患者戒烟,根据痰培养结果给予抗生素雾化吸入,并指导进行腹式呼吸、缩唇式呼吸和咳嗽、咳痰训练,增强气道纤毛的清除功能;术后加强拍背、雾化吸入等协助患者咳嗽排痰,能有效预防术后肺不张、肺部感染,促进患者顺利康复。     

乳腺癌雌孕激素受体和c-erbB-2癌基因表达的临床意义

目的研究乳腺癌雌孕激素受体及cerbB2癌基因蛋白的表达情况及其临床意义。方法应用免疫组化技术研究了164例乳腺癌雌孕激素受体、cerbB2癌基因的表达。结果ER、PR的表达与腋淋巴结状况关系不大,但与临床分期呈明显负相关。癌基因cerbB2的阳性表达率与临床分期呈显著正相关。结论ER、PR的阳性表达是乳腺癌预后良好的指标,cerbB2的阳性表达是乳腺癌预后不良的指标。     

Evaluation of the accuracy and angular resolution of q-ball imaging

Q-ball imaging (QBI) has been proposed for the mapping of multiple intravoxel fiber structures using the Funk-Radon transform on high angular resolution diffusion images (HARDI). However, the accuracy and the angular resolution of QBI to define fiber orientations and its dependence on diffusion imaging parameters remain unclear. The phantom models, made up of sheets of parallel capillaries filled with water, were designed to evaluate the accuracy and the angular resolution of QBI at different |q| values. With an inner diameter of 20 mum and an outer diameter of 90 mum, the capillaries afforded a restrictive environment compared with the diffusion measurement scale. Further, the angular resolutions of QBI at various |q| value were also quantified on the corpus callosum in the human brain. The full width at half maximum (FWHM) of the main lobe of normalized orientation distribution function (nODF) was calculated and adopted to quantify the angular resolution of QBI. With the phantom model, a higher |q| value resulted in worse accuracy but better angular resolution for QBI. The same trend where a higher |q| value yielded a better angular resolution was also observed in the human study. Upon comparison of QBI with T2WI, QBI with |q|=277 cm(-1) (b=3000 s/mm(2)) was found to be insufficient to differentiate capillaries crossing at 45 degrees . However, when encoding with |q|=320, 358, and 392 cm(-1) (b=4000, 5000, and 6000 s/mm(2)), the deviation angles between the primary ODF and the 45 degrees phantoms were -4.91 degrees +/-2.72 degrees , -1.37 degrees +/-2.32 degrees , and -0.69 degrees +/-1.54 degrees with adequate signal-to-noise ratio (SNR). These results were consistent with the FWHM-nODF, which showed that a |q| value of 320 cm(-1) was the threshold to resolve capillaries intersecting at 45 degrees . Additionally, it was demonstrated in both the phantom model and the human brain that QBI encoding with lower |q| values may result in underestimation of the orientations of the crossing fibers. In conclusion, QBI was found to accurately resolve crossing fiber orientations and was highly dependent on the selected |q| value.     

不同允许总误差评价临床生化项目与用σ理论对质控进行管理

目的：选择合适的质量指标评估生化常规检验项目的分析性能,并运用6σ理论制定合适的质控规则。方法收集2015年常规项目室内质控及室间质评数据,TEa分别引用美国临床实验室改进修正法案（CLIA′88）和生物学变异质量规范要求。采用公式σ值＝（Tea－|Bias|）／CV ,计算不同标准下各检验项目的σ值,选择合适质量目标,设计最佳室内质量控制方案。结果该室大部分项目适合使用CLIA′88标准,其中17个项目需1‐3S规则,占68％（17／25）;3个项目需1‐3s｜2‐2s｜R‐4s｜4‐1s多规则,占12％（3／25）;5个项目需1‐3s｜2‐2s｜R‐4s｜4‐1s｜8‐x多规则且要求4个质控值监测,占20％（5／25）。Na、CL项目分析性能需改进。结论在使用合适的分析质量指标前提下,6σ质量标准的应用,可以使分析性能不同的项目,个性化选择能满足临床质量要求的控制方法,并且还是一项有效的实验室质量管理工具。     

Use of robust ZB and ZW to evaluate proficiency testing data

BackgroundIn PT program, mean is conventionally used as the target after deletion of values which exceed the mean ± 3SD. This computation fails if there are some outliers.MethodsCreatinine data were divided into Jaffe and enzymatic method groups in accordance with the analytical method used. The results tested by both methods were compared. The normality of standardized sum and difference was tested. The outliers in these data were deleted. The trimmed data were tested for normality. The performance of laboratories was assessed using ZB and ZW, whose values were considered acceptable when |ZB| or |ZW|≤2, questionable when 2<|ZB|<3 or 2<|ZW|<3 and unacceptable when |ZB| or |ZW|≥3.ResultsThe results tested using Jaffe and enzymatic methods were not comparable. The data of standardized sum and difference were not normally distributed. When the outliers in these data were removed, the trimmed data were normally distributed. In Jaffe group, the acceptable rates of between and within laboratories respectively were 90.2% and 86.0%. In enzymatic group, the acceptable rates of between and within laboratories respectively were 82.6% and 82.4%.ConclusionIt was reasonable to choose robust ZB and ZW as assessment indexes because robust z-scores were less influenced by outliers.     

经颅直流电刺激调节迷走神经兴奋性对脑卒中后吞咽障碍的效果

目的 研究经颅直流电刺激(tDCS)调节迷走神经兴奋性对卒中后吞咽功能障碍的疗效。方法 2020年9月至2021年2月,本院康复科卒中后吞咽障碍患者28例随机分为对照组和tDCS组,各14例。两组均行吞咽功能训练,tDCS组行迷走神经tDCS,对照组行迷走神经假刺激。治疗前后,采用改良曼恩吞咽能力评估量表(MMASA)和澳大利亚治疗结局量表(AusTOMs)吞咽功能评分进行评定。结果 治疗后,两组MMASA评分(|t| > 5.593, P < 0.001)和AusTOMs吞咽功能评分(|Z| > 2.121, P < 0.05)均提高,tDCS组优于对照组(|t| = 2.439, |Z| = 2.079, P < 0.05)。结论 tDCS调节迷走神经兴奋性可促进卒中后吞咽功能障碍恢复。     

三维斑点追踪成像技术评价子痫前期患者左心室收缩功能

目的 采用三维斑点追踪成像（3D-STI）技术检测子痫前期患者左心室收缩功能。方法 纳入轻度子痫前期患者73例（轻度组）、重度子痫前期患者64例（重度组）和年龄、孕周匹配的健康孕妇60例（对照组）。检测生化指标和常规超声参数,并运用3D-STI测量左心室收缩期整体纵向峰值应变（GLS）、整体径向峰值应变（GRS）、整体环向峰值应变（GCS）和整体面积峰值应变（GAS）,计算面积应变不同步指数（ASDI）。并分析三维应变参数与生化指标及超声参数的相关性。结果 与对照组比较,重度组左心房前后径（LAD）增大,二尖瓣口舒张期流速比值（E/A）减低,Tei指数在对照组、轻度组、重度组依次增高（P均<0.05）。与对照组比较,轻度组|GLS|、|GAS|降低,ASDI增高,重度组|GLS|、|GRS|、|GCS|、|GAS|和ASDI差异均有统计学意义（P均<0.05）。与轻度组比较,重度组GLS、GAS明显降低,ASDI明显增高（P均<0.05）。|GLS|与Tei指数呈负相关（r=-0.471,P=0.036）;|GAS|与LVEF呈正相关（r=0.051,P=0.028）,与Tei指数呈负相关（r=-0.612,P=0.017）;ASDI与心脏脂肪酸结合蛋白（H-FABP）呈负相关（r=-0.525,P=0.046）,与Tei指数呈正相关（r=0.489,P=0.037）。结论 子痫前期患者左心室收缩功能明显受损,心肌应变能力下降,3D-STI技术可早期无创评价子痫前期患者左心室收缩功能变化。     

Quantifying Lumbar Mobilization With Inertial Measurement Unit

ObjectiveLumbar mobilization is a standard intervention for the management of low back pain, yet ways to quantify lumbar mobilization are limited. An inertial measurement unit (IMU) is a small and inexpensive device that can be used to quantify lumbar mobilization. The objective of this study was to determine the validity and reliability of an IMU in measuring the amplitude of displacement of a clinician's hand movement during oscillatory lumbar mobilization.MethodsAn IMU was secured on a clinician's hand during application of mobilization forces at the L4 segment of 16 healthy participants. The validity of the IMU was tested against common laboratory methods of measurements (force plate and motion capture system). The reliability of the IMU measurements was determined between 2 clinicians (inter-rater reliability) and between 2 sessions (intra-rater reliability) by calculating percent error of measurement (%e) and limits of agreement (LOA). The reliability was considered high when |%e| ≤ 10% and |LOA| ≤ 20%; moderate when |%e| 10% to 20% and |LOA| 21% to 40%; and non-acceptable when |%e| > 20% and |LOA| > 40%.ResultsThe IMU measurements had high correlation with the force plate measurements (r_s = 0.94) and high agreement with the motion capture system measurements (%e = 4%, LOA = -11% and 20%). Both the inter-rater reliability (%e = 6%, LOA = -25% and 37%) and the intrarater reliability (%e = -1%, LOA = -29% and 27%) of IMU measurements were moderate.ConclusionThe IMU seems to be a valid device to measure the amplitude of a clinician's hand movement. The moderate reliability found in this study may not reflect poor reliability of the IMU as much as inconsistency in reapplication of lumbar mobilization.     

Photovoltaic and photocatalytic properties of bismuth oxyiodide–graphene nanocomposites

In this study, we evaluate the photovoltaic and photocatalytic properties of chemical vapor deposited bismuth oxyiodide (BiOI) and bismuth oxyiodide–graphene (BiOI–GR) nanocomposite thin films. The BiOI thin film has an average thickness of 574 nm and a bandgap of around 2 eV. The BiOI and BiOI–GR thin films exhibited nanoflake morphology. It was found that addition of graphene increases absorbance by causing vertical growth of nanoflakes, imparting anti-reflectance and light trapping properties. The photocatalytic activities of the thin films were evaluated by examining methylene blue (MB) degradation under visible light irradiation. BiOI–GR degraded 56.42% of MB in two hours while BiOI degraded 44.16%. Afterwards, FTO|BiOI|graphite|Al and FTO|BiOI–GR|graphite|Al solar cell devices were fabricated with photocurrent density values of 2.0 μA cm⁻² and 2.7 μA cm⁻², respectively. The improved properties of BiOI–GR are attributed to the anti-reflecting and light trapping properties of vertical BiOI–GR nanoflakes and the enhanced carrier separation due to graphene as an electron acceptor.

BiOI nanoflakes grown by air atmosphere chemical vapor deposition showed increased photocatalytic activity when deposited on a graphene coated substrate.     

A study of the association with blood pressure difference causing body temperature ≥37·5°C and hypertension in department of primary care

Previous studies reported the relationship between significant blood pressure difference (ΔBP) and early atherosclerotic markers. Although it is known that body temperature is associated with BP and blood flow, as measured on Korotkoff sound graph (KSG), as well as heart rate and sympathetic nerve activity, it remains unclear whether moderate fever (≥37·5°C) can be caused by significant ΔBP. ΔBP was calculated by subtracting the BP of the left arm from that of the right arm. The aim of our study was to investigate whether an association exists among ΔBP, body temperature, hypertension and KSG area ratio in 1802 new outpatients examined in a seated position in routine clinical practice. Our study documented that absolute systolic blood pressure difference (|ΔSBP|) ≥ 10 mmHg (observed in 14·6% of the patients) was associated with a significantly higher heart rate, moderate fever, tachycardia and hypertension. In multivariate analysis, the odds ratios (ORs) of |ΔSBP| ≥ 10 mmHg showed significant associated markers of body temperature and hypertension, while the ORs of KSG area ratio ≥ 170% showed significant associated markers of sex, age, body temperature, hypertension, diabetes mellitus, prior vascular event and smoking. In conclusion, our study of new outpatients in the department of primary care demonstrated that |ΔSBP| ≥ 10 mmHg and KSG area ratio ≥ 170% were associated with moderate fever and hypertension. Furthermore, our study suggests that the association of moderate fever with |ΔSBP| ≥ 10 mmHg and KSG area ratio ≥ 170% is physiologic as well as pathologic.     

Modified clot waveform analysis to measure plasma coagulation potential in the presence of the anti‐factor IXa/factor X bispecific antibody emicizumab

Essentials

• The activated partial prothrombin time (aPTT) cannot predict the activity of emicizumab (Emi).
• Adjusted clot waveform analyses using a prothrombin time (PT)/aPTT initiator were developed.
• Activity of Emi in the co‐presence of factor VIII or bypassing agents was quantified.
• This assay is useful for assessing coagulation potential in Emi‐treated hemophilia A.

Summary

Background

Emicizumab is an anti‐activated factor IX/FX bispecific antibody that mimics activated FVIII cofactor function. Emicizumab does not require activation by thrombin, and its effect on shortening the activated partial thromboplastin time (APTT) is much greater than that of FVIII. Therefore, the APTT has limited utility in hemophilia A (HA) patients treated with emicizumab.

Aim

To evaluate the global coagulation potential of emicizumab.

Methods

Clot waveform analysis (CWA) with prothrombin time (PT)/APTT mixed reagents was used to define hemostatic monitoring protocols in HA patients. A modified parameter, adjusted‐|min1| (Ad|min1|), was developed. Maximum and minimum percentage transmittance were defined as 100% and 0% in the precoagulation and postcoagulation phases, respectively. Ad|min1| was calculated as an index of the maximum velocity of the coagulation process.

Results

Ad|min1| obtained with mixed‐trigger reagent (PT/APTT/buffer, 1 : 15 : 135) in the presence of emicizumab optimally corresponded to the conversion rate estimated in animals; 0.2–0.4 IU dL^?1 equivalent FVIII per 1 μg mL^?1 emicizumab). Ex vivo addition of emicizumab to HA plasma with or without inhibitors resulted in concentration‐dependent increases in Ad|min1|, with some individual variations. The addition of various concentrations of FVIII to HA plasma mixed with emicizumab resulted in dose‐dependent increases in Ad|min1|. Similarly, mixtures of activated prothrombin complex concentrate and emicizumab added to HA plasma resulted in dose‐dependent increases in Ad|min1|. In contrast, enhanced coagulation potential appeared to be better defined by the clot time than by Ad|min1| in experiments using recombinant activated FVII.

Conclusion

The PT/APTT reagent‐triggered adjusted CWA could provide a useful means of assessing global coagulation potential in emicizumab‐treated HA patients, with enhanced activity neither masking nor being masked by FVIII or bypassing agents.