中药膳食配合运动干预对肥胖性脂肪肝的影响

目的探讨中药膳食配合运动干预对肥胖性脂肪肝的影响.方法将68例脂肪肝患者随机分为对照组和观察组各34例.对照组常规给予低脂饮食和易善复、大黄庶虫丸等降酶保肝治疗;观察组按常规方法治疗外,采用中医辨证施食予以活血化淤、健脾利湿的中药膳食疗法配合运动干预,疗程均为1年.结果治疗后观察组体重、甘油三酯、总胆固醇、谷丙转氨酶等显著低于对照组(均P<0.01).结论中药膳食配合运动干预对肥胖性脂肪肝疗效显著.     

生活方式干预对单纯肥胖性脂肪肝预后的影响

目的探讨生活方式干预对单纯肥胖性脂肪肝患者预后的影响。方法将124例单纯肥胖性脂肪肝患者随机分为观察组（66例）和对照组（58例）。对照组予常规降脂治疗，观察组在此基础上进行生活方式干预，包括健康教育、饮食与运动行为干预、记生活日记等，干预3个月后进行效果评价。结果观察组干预后减重效果、脂肪肝程度、肝功能恢复及血脂下降程度显著优于对照组（均P〈0．01）。结论生活方式干预能使患者建立良好的饮食与运动行为习惯，全面降低对患者预后不利的影响。     

生活方式干预对单纯肥胖性脂肪肝预后的影响

目的探讨生活方式干预对单纯肥胖性脂肪肝患者预后的影响.方法将124例单纯肥胖性脂肪肝患者随机分为观察组(66例)和对照组(58例).对照组予常规降脂治疗,观察组在此基础上进行生活方式干预,包括健康教育、饮食与运动行为干预、记生活日记等,干预3个月后进行效果评价.结果观察组干预后减重效果、脂肪肝程度、肝功能恢复及血脂下降程度显著优于对照组(均P<0.01).结论生活方式干预能使患者建立良好的饮食与运动行为习惯,全面降低对患者预后不利的影响.     

中药治疗单纯性肥胖患儿的家庭护理干预

目的探讨中药治疗单纯性肥胖患儿的家庭护理干预方法及效果。方法将50例服用自制中药减肥口服液的单纯性肥胖患儿随机分为干预组和对照组各25例。对照组予常规护理；干预组在此基础上，从饮食、运动、睡眠、心理行为方面给予3个月的家庭护理干预。结果干预组治疗效果显著优于对照组，干预3个月后BMI显著低于对照组（均P〈0．01）。结论家庭护理干预在中药治疗儿童单纯性肥胖中起到重要的强化作用，有利于患儿康复。     

中药治疗单纯性肥胖患儿的家庭护理干预

目的 探讨中药治疗单纯性肥胖患儿的家庭护理干预方法及效果.方法 将50例服用自制中药减肥口服液的单纯性肥胖患儿随机分为干预组和对照组各25例.对照组予常规护理;干预组在此基础上,从饮食、运动、睡眠、心理行为方面给予3个月的家庭护理干预.结果 干预组治疗效果显著优于对照组,干预3个月后BMI显著低于对照组(均P＜0.01).结论 家庭护理干预在中药治疗儿童单纯性肥胖中起到重要的强化作用,有利于患儿康复.     

肥胖与中青年舒张期高血压关系

目的:肥胖与中青年舒张期高血压的发生、发展及转归呈正相关。方法:80例单纯舒张期增高的中青年患者随机分为两组,对照组常规药物治疗,治疗组在常规治疗的基础上配合辅助运动,科学膳食减肥治疗。观察两组治疗前后体重指数(BMI)及血压达标情况。结果:治疗组总有效率95%,对照组总有效率47.5%。结论:肥胖与中青年舒张期高血压的发生、发展及转归呈正相关。     

中西结合治疗配合护理干预反复发作性上呼吸道感染

目的:观察中西医结合治疗配合护理干预反复发作性上呼吸道感染的疗效.方法:将患者随机分为观察组和对照组,观察组在采用阿奇霉素注射液治疗的基础上联合应用中药治疗并配合护理干预,对照组采用阿奇霉素注射液治疗和常规护理,7d后对比两组疗效.结果:观察组起效时间和症状消失时间明显少于对照组(P＜0.05)两组治疗费用相当.结论:在西药治疗的基础上加用中药口服治疗配合护理干预反复发作性上呼吸道感染效果良好,治疗费用未明显升高.     

循经刮痧与微信运动用于痰湿体质单纯性肥胖人群的干预效果

目的分析循经刮痧结合微信运动对痰湿体质单纯性肥胖人群的干预效果,为临床单纯性肥胖患者的健康管理提供思路。方法将80例痰湿体质单纯性肥胖患者随机分为两组各40例。对照组采用微信运动配合饮食调整及常规健康宣教进行干预,观察组在此基础上施以循经刮痧。分别在干预前,干预12周后比较两组的体质量、腰围、体重指数、中医痰湿体质评分、总胆固醇、甘油三酯、低密度脂蛋白。结果干预12周后,观察组体质量、腰围、体重指数、总胆固醇、中医痰湿体质评分显著优于对照组(P 0. 05,P 0. 01)。结论循经刮痧结合微信运动更能降低痰湿体质单纯性肥胖患者的体质量、腰围、体重指数、中医痰湿体质评分。     

综合护理干预对颈动脉型颈椎病患者的影响

目的探讨综合护理干预对职业人员颈动脉型颈椎病患者的影响。方法将102例患者随机分为观察组和对照组各51例。对照组采用常规治疗护理，观察组在此基础上加用认知干预、心理干预、日常生活行为干预及运动疗法干预等，6个月后行效果评价。结果观察组干预后颈性眩晕症状与功能评分显著优于对照组（均P〈0．01）；椎基底动脉血流调节效果显著优于对照组（均P〈0．01），总有效率显著高于对照组（P〈0．01）。结论日常生活行为干预、颈椎操等综合护理干预措施能有效改善职业人员颈动脉型颈椎病患者症状，达到提高疗效的目的。     

手术配合中药坐浴治疗陈旧性肛裂80例临床观察

为寻求治疗陈旧性肛裂可靠、效果满意的方法,将80例Ⅱ、Ⅲ期陈旧性肛裂患者随机分为两组,治疗组42例采用手术配合中药坐浴、缩肛运动治疗,对照组38例采用手术配合1：5000PP液坐浴治疗,观察两组疗效。结果显示,两组创口愈合时间差异有统计学意义（P〈0．05）,治愈率均为100％（P〉0．05）。均未出现肛门失禁及肛门功能障碍。结果表明,肛裂切除并扩肛术,配合中药冰朴散坐浴、缩肛运动治疗,减轻了患者术后痛苦,加快了创口愈合。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.