高原COPD患者夜间睡眠及SaO2变化特点及意义

探讨COPD夜间睡眠结构及血氧饱和度变化 ,以期为临床提供诊疗依据。方法 :应用多导睡眠记录仪进行睡眠监测 ,测定项目包括脑电图、眼动图、心电图、颏肌肌电图、口鼻气流、胸腹呼吸运动、血氧饱和度共 7个参数 ;结果 :与健康人组比较 ,COPD组Ⅰ期、Ⅱ期睡眠时间无显著性差异 (P >0 .0 5 ) ,但Ⅲ期、Ⅳ期时间、人睡后醒觉次数大于 5分钟 ,浅睡眠的比率、深睡眠的缺乏率及REM缺乏率均有显著性差异 (P <0 .0 1～ 0 .0 0 1 )。COPD组氧饱和度降低≥ 4% ,氧减饱和度 85 %～ 5 0 %频率分布 ,夜间最高、最低和平均氧饱和度、SIT85 %、△SaO2 均与健康人有显著性差异 (P <0 .0 0 1 )。结论 :COPD患者组存在有严重的睡眠呼吸紊乱和睡眠的破碎 ,同时存在有严重的夜间低氧血症和呼吸暂停 ,因此 ,加强对COPD患者夜间睡眠和SaO2 监测 ,对于提高患者的生命质量具有十分重要的意义。     

睡眠性呼吸暂停综合征及CT诊断

早在1937年Spitz就提出睡眠性呼吸暂停的临床特征。近十几年来,随着多导生理仪、连续血气测定等相对无创性监测应用于临床,人们对睡眠性呼吸暂停有了更深的了解。同时,放射诊断学方法也被广泛应用,主要包括上气道侧位平气和体层摄片、X线电影照相和CT检查。这些方法对睡眠性呼吸暂停综合征,尤其是阻塞性睡眠性呼吸暂停综合征的诊断和治疗方法的选择均有很大的帮助。一、正常睡眠、呼吸及上气道局部解割根据脑电图标准,正常睡眠可分为快动眼眠眠(REM)和非快动眼睡眠(NREM)。后者又可进一步分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期。通     

原发性癫痫90例睡眠结构及脑电事件分析

目的探讨原发性癫痫患者睡眠结构及脑电事件特点。方法对90例符合原发性癫痫诊断标准的患者进行多导睡眠图(PSG)检查,分析患者的睡眠结构、夜间激醒事件及异常脑电事件。结果本组病人PSG睡眠结构特点表现为患者睡眠阶段的转换增加,睡眠片断及睡眠效率减低,睡眠质量低下,结构紊乱。REM期比例减少例数76例(占84.44%),REM潜伏期增加例数70例(占77.78%),Ⅰ+Ⅱ期比例增加例数64例(占71.11%),Ⅲ+Ⅳ比例减少例数44例(占48.89%),入睡潜伏期增加例数为41例(占45.56%)。整夜激醒次数为(103.20±131.76)次,激醒次数增多者占88.89%。睡眠脑电图(EEG)监测结果显示有异常放电者占38.30%,尤其以浅睡期发放显著。结论原发性癫痫患者存在睡眠结构紊乱。     

飞行人员多导睡眠图初步分析

目的评价飞行人员正常睡眠结构和确定睡眠呼吸暂停综合征的诊断。方法应用多导睡眠图对20例飞行人员进行多导睡眠监测,分析多项睡眠参数。结果飞行人员正常睡眠分期分别是NREM睡眠占总睡眠时间的95%,其中Ⅰ相占26%、Ⅱ相占44%、Ⅲ＋Ⅳ相占25%;REM睡眠占总睡眠时间的5%。Ⅰ和Ⅱ相睡眠时间延长,REM睡眠时间缩短。检出5例患睡眠呼吸暂停综合征的飞行人员,其中阻塞型3例,中枢型2例。结论多导睡眠图可以确定飞行人员正常睡眠结构,能够正确诊断睡眠呼吸暂停综合征。     

海拔5380m居住一年青年睡眠呼吸障碍的特征及药物的调节作用

目的：探讨长期居住海拔5000m以上地区人群睡眠呼吸障碍的特征以及红景天复方和乙酰唑胺的调节作用;方法：对居住海拔5380m高原一年的24名青年随机分为A组（红景天组）、B组（乙酰唑胺组）和C组（红景天＋乙酰唑胺组）,每组8人,在服药前和服药24天后分别进行睡眠结构和睡眠呼吸监测;结果：服药24天后非快动眼睡眠（NREM）Ⅰ、Ⅱ期缩短,Ⅲ、Ⅳ期及快动眼睡眠（REM）期延长,均有非常显著性差异（P＜0．01）;服药后每小时周期性呼吸（PB）和呼吸停（SA）的次数及平均时间减少,均有显著性意义（P＜0．05或P＜0．01）;结论：红景天复方和乙酰唑胺均能明显改善高原睡眠结构和睡眠呼吸紊乱,抑制中枢性睡眠呼吸暂停（CSA）,但两种药物合用并无明显的协同作用。     

复方红景天对居住海拔5380m1年青年睡眠呼吸障碍的调节

目的　探讨长期居住海拔 5 0 0 0m以上地区人群睡眠呼吸障碍的特征以及复方红景天的调节作用。方法　居住海拔 5 3 80m高原 1年的 16名青年在口服复方红景天胶囊 ( 2粒 ,2次 /d)前和连续服药 2 4d后用上海海神医疗电子仪器厂生产的CFM 8型便携式脑电监测仪进行睡眠脑电C3/A1 、眼动图、心电图、颏肌肌电图、口鼻气流及胸腹部呼吸运动监测 ,每人每夜连续监测 7h。结果　 ( 1)受试者服药前睡眠各期百分率依次为 :非快动眼睡眠 (NREM )Ⅰ期 ( 5 5 .3 6± 1 5 1) %,Ⅱ期 ( 2 6.5 6± 0 .46) %,Ⅲ期 ( 7 0 2± 0 .5 6) %,Ⅳ期 ( 5 .81± 0 48) %,快动眼睡眠(REM )期 ( 5 2 5± 0 .2 0 ) %;( 2 )服药 2 4d后非快动眼睡眠Ⅰ期 ( 4 7.97± 1.5 7) %、Ⅱ期 ( 2 4.2 6± 0 .71) %明显缩短 ,Ⅲ期 ( 10 .46± 0 .68) %、Ⅳ期( 9.3 4± 0 .49) %以及快动眼睡眠期 ( 7.89± 0 84) %显著延长 ;( 3 )服药 2 4d后每小时周期性呼吸 (PB)的次数减少 [( 2 1.0 0± 9.65 ) ,( 11.75±6.2 5 ) ,P <0 .0 5 ] ,平均时间缩短 [( 5 5 .2 5± 9.3 0 )s ,( 4 2 .0 0± 3 .3 8)s,P <0 .0 1] ;( 4 )服药后每小时呼吸暂停 (SA)的次数亦减少 [( 8.5 0± 4.63 ) ,( 4 .2 5± 2 .76) ,P <0 .0 5 ] ,其平均时间缩短 [( 16.2 5± 3 .0 6)s     

冠心病人夜间睡眠时相特征及与病情的关系

用睡眠图、心电图及临床观察同步对冠心病人和健康人进行夜间睡眠时相及其与心绞痛、心律失常的关系以及苯二氮(艹卓)类药对睡眠时相的影响的观察。结果,冠心病人的睡眠时相具有潜伏期长,Ⅰ、Ⅳ期睡眠和总睡眠时间减少的特征;苯二氮革类药对Ⅳ期、REM期睡眠无明显影响。觉醒期,冠心病人发生心律失常较多;Ⅱ期睡眠中,两组的发生心律失常高于其它时相。     

海拔高度对人体睡眠结构和神经机能影响的对比研究

本文对青海省果洛州(海拔3730米)8名健康成年人和抵平原(苏州,海拔10米)的青海省天峻县(海拔3500～3700米)的12名健康成年人,分别连续7小时用多导仪临测夜间睡眠变化,进行对比研究。发现总睡眠时间A组较B组有减少趋势;总醒觉时间占实际记录百分比A组较B组明显增多(P<0.05);有效睡眠指数百分比,REM占总睡眠时间百分比A组较B组显著减少(P<0.01);N—REM占总睡眠时间百分比A组较B组明显增多(P<0.05)。慢性高原低氧对人体神经系统的影响主要为机能紊乱和大脑皮层功能失调。这些改变抵平原后随停留时间的延长而具有可变性。     

玉树灾后重建参建工人高原睡眠的研究——平原与高原对比

目的:平原工人进入玉树灾区重建期间普遍出现睡眠障碍,为此对比研究其在海平面和在高原的睡眠结构和血氧饱和变化。方法:对10名健康男性工人先在济南(50m)和在结古(3 750m)习服5个月后进行睡眠研究。应用多导睡眠监测仪(PSG)经行睡眠监测,按国际统一的睡眠监测方法实施。同时测定动脉血氧分压及动脉血氧饱和度。结果:在平原表现为正常的睡眠结构并有较高的睡眠血氧饱和能力。但到高原后出现明显的睡眠结构改变,总睡眠时间(TST,min)明显减少,1期非快眼动睡眠时间%(1-nREM)显著增加,而2nREM及3+4期快眼动睡眠时间%(REM)明显减少,反应处于浅睡眠状态。同时周期性呼吸活跃,伴有明显的睡眠低氧血症。但存在个体差异。在高原5个月后,受试工人的动脉血氧水平仍较低,而血红蛋白值则明显增高。结论:本研究证实平原健康工人尽管在海拔3 750m高原初步习服了5个月,但其睡眠生理结构仍未恢复至平原正常状态,长期处于浅睡眠使机体机能活动受到影响,而睡眠低氧血症导致高原红细胞增多是发生慢性高原病的病理途径。改善高原睡眠十分重要。     

阻塞性睡眠呼吸暂停低通气综合征

1 概述 成人睡眠呼吸暂停综合征包括阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypoapnea syndrome OSAHS）、中枢性睡眠呼吸暂停综合征、睡眠低通气综合征等。临床上以OSAHS最为常见,主要表现为睡眠时打鼾、呼吸暂停和呼吸表浅,夜间反复发生低氧血症、高碳酸血症和睡眠结构紊乱,从而导致白天嗜睡、心脑肺血管并发症乃至多脏器损害,严重影响患者的生活质量。睡眠呼吸暂停（sleep apnea SA）是指睡眠过程中,口鼻呼吸气流均停止10s以上;低通气是指睡眠过程中,口鼻呼吸气流强度（振幅）较基础水平降低50％以上,并伴有SaO2（血氧饱和度）较基础水平下降≥4％;OSAHS是指每夜7h睡眠中,呼吸暂停及低通气反复发作在30次以上,平均每小时睡眠中呼吸暂停加上低通气次数（AHI）≥5次。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.