心梗患者12周运动心脏康复活动后摄氧量与心率、主观用力感觉的相关关系变化

目的:探讨12周运动心脏康复活动后心梗患者(PMIP)心率(HR)、摄氧量(VO2)、主观用力感觉(RPE)的相关关系,据此为其以后的康复活动提供强度控制和自身有氧工作能力评定的合理方法和依据。方法:36名PMIP(其中服用β-阻断剂者(blockade)17名,未服用β-阻断剂者(non-blockade)19名)在活动跑台上进行递增负荷运动实验,测定其HR、VO2、RPE。建立HR/VO2/RPE的相关关系,并对实施12周运动心脏康复活动前后的这些关系进行对比分析。结果:(1)康复活动前HR/VO2及RPE/VO2相关关系的数据分布较集中,康复活动后其数据有沿回归线向两端扩展的趋势。(2)康复活动后HR/%VO2pk及RPR/%VO2pk关系的回归线平行下移(P<0.05)。(3)康复活动后RPE/HR回归线的斜率增大(P<0.05)。结论:康复活动后PMIP的机能能力有所提高,运动可达到较高的强度,而低强度运动时PMIP只表现较小的心肺机能反应。建议在不同心脏康复期,采用不同方程预测PMIP的%VO2pk。     

心梗后患者递增负荷运动中ST段降低与VO_2、VE、BL和RPP变化的关系

目的:探讨心梗后(PMI)患者递增负荷运动中生理反应与心电图ST段水平变化的关系,旨在根据服用和不服用β-受体阻滞剂患者的不同反应,为心脏康复中适宜运动强度的制定提供依据。方法:46名服用β-受体阻滞剂的和55名不服用β-受体阻滞剂的男性PMI患者,依据改良布鲁斯方案在活动跑台上进行递增负荷运动试验。运动中每30s测量一次摄氧量(VO2)和通气量(VE),每3min记录一次心率血压乘积(RPP)和血乳酸浓度(BL),并连续监测12导心电图。结果:(1)ST段下降水平与VO2、VE和BL的关系,两组患者间无显著差异(P>0.05)。但两组在相同RPP时,其ST段水平却存在显著差异(P<0.01);(2)ST段下降1mm时,患者的VO2、VE和BL分别约为30ml.kg-1.min-1、63L.min-1和5.3mmol.L-1;(3)ST段下降1mm时,服用和不服用β-受体阻滞剂患者的RPP分别为190beats.mmHg.100-1和230 beats.mmHg.100-1。结论:为了减少心肌缺血的发生,结果(2)和(3)中生理指标的数值,应被作为心脏康复中PMI患者运动强度的上限。     

心梗后患者12周康复锻炼后一次递增负荷运动中VO2、HR、%HRmax、RPP、ST、RPE变化及其相互关系

目的:探讨12周运动心脏康复锻炼对心梗后患者(PMI患者)心脏机能的影响。方法:112名男性PMI患者(均进行了12周运动心脏康复锻炼)进行一次递增负荷运动实验(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级负荷跑速分别为1.7、1.7、1.7、2.5、3.5mph;坡度分别为0.5 %、10 %、12 %、14 %,每一级负荷运动3分钟) ,其间记录每级负荷时的VO2、HR、血压和自我用力感觉(RPE) ,计算心率血压乘积(RPP) ,并持续监测12导联心电图(ECG) ,然后对上述指标进行相关分析并建立了用HR和RPE推测VO2和RPP的回归方程。结果:(1)相邻两级负荷间的VO2、HR、RPP、RPE具有显著差异(P<0.01) ;(2)VO2、HR、最大心率百分数( %HRmax)、RPP、ST段水平(ST)和RPE的峰值分别为26.4±7.1ml·kg-1·min-1、126.8±20.3beats·min-1、80.4±12.9 %、209.0±46.3beats·mmHg·100-1、-1.0±0.7mm和14.9±2.1;(3)运动中VO2、HR、%HRmax、RPP、RPE呈高度正相关,它们与ST呈高度负相关(P<0.01或P<0.05) ,建立了用HR和RPE推测VO2和RPP的回归方程。结论:(1)康复锻炼后利用改良Bruce跑台方案进行机能测试有效;(2)12周康复锻炼后,PMI患者进行运动时其强度不宜超过80 %HRmax或RPE不超过15 ;(3)利用本研究建立的预测方程,可在PMI患者康复活动中,根据其心率或RPE变化间接得知其呼吸循环机能的反应和心肌的耗氧状况。     

40～69岁中老年人递增负荷运动试验中心血管事件的发生风险及影响因素

目的:通过递增负荷运动试验观察中老年人群运动中心血管的异常反应,分析其特征及影响因素,为运动中心血管事件的防控提供参考。方法:筛选40~69岁无运动禁忌症的中老年人138名为研究对象,测试其安静时血液、形态、血压等指标,再进行递增负荷运动试验,以美国运动医学学会(ACSM)制定的运动终止标准作为运动中发生的心血管事件阳性反应的判定标准,分析运动中心血管事件的发生特征及影响因素。结果:(1)递增负荷运动试验中心血管事件阳性反应的发生率为12.3%。在各反应症状中,出现心电异常的比率最高,其后依次为血压与心率异常。(2)在阳性人群中,男性多于女性,中年人多于老年人,其中有76.5%的阳性人群年龄范围集中在40~54岁。(3)阳性组的超重、肥胖比率之和高于阴性组,但血脂指标和C反应蛋白(CRP)的异常率均低于阴性组。以上比较阴性组与阳性组之间均无显著性差异。(4)阳性组运动终止时主观体力感觉等级(RPE)均值高于阴性组,无显著性差异,但阳性组细分的心电异常组和心率异常组RPE分别显著高于阴性组(P<0.05)。结论:(1)经常参加体育锻炼的中老年人群发生心血管事件的风险不容忽视。在心电图异常表现中,不仅要关注ST段异常变化,更应重视不同早搏类型心律失常。(2)40~54岁可能是运动中心血管事件高发年龄段。(3)血脂正常、CRP正常、心肺耐力水平较高者依然出现心血管事件的风险不容忽视。(4)推荐中老年人采用RPE小于15的运动强度进行锻炼。     

运动性蛋白尿及其类型的强度依赖性

本文研究探讨了不同强度负荷(50%,70%,90% VO_(2max))跑台运动后尿总蛋白(TP)及其各组份白蛋白(Alb)、β_2—微球蛋白(β_2—mG)、溶菌酶(Lys)、淀粉酶(Amy)、乳酸脱氢酶(LDH)、磷酸肌酸激酶(CPK)排泄率变化及尿蛋白各组份排泄率与HR、LA.VO_2、%VO_(2max)的相关性;运动性蛋白尿类型与运动强度的依赖性;观察了运动强度对肾小球滤过选择性和肾小管重吸收功能某些指标的影响。结果表明不同强度运动后即刻尿蛋白排泄率不同;当LA≥5.4mmol.L~(-1)时上述各组份排泄率才有显著增加;其中β_2—mG和Lys排泄率是指示大强度运动灵敏的生化指示;TP、Alb、β_2—mG、Lys、LDH与各强度指标均呈指数函数相关;Alb/TP与HR、LA、VO_2呈直线相关。HPLC研究表明中大强度运动后SI有显著下降(P<0.05);大强度运动后β_2-mG/Alb排泄率显著增加。小到中等强度运动后尿蛋白呈肾小球型,大强度运动后呈肾小球—肾小管混合型。     

运动干预对40～49岁男性运动中心电风险指标的影响

目的:通过对40~49岁男性进行为期12周不同运动量的运动干预,探寻改善运动中心电风险指标的最佳运动干预方式。方法:24名40~49岁的城市健康男性,随机分为3组:对照组(n=9);小运动量组(n=7),运动量为1200 kcal/wk;大运动量组(n=8),运动量为2000 kcal/wk。运动组的运动强度均为65%~80%VO2max,在标准的400米跑道上进行持续12周的运动干预。运动过程中佩戴加速度计和心率表进行监控,运动量通过运动距离和时间控制,强度通过靶心率控制。干预前后对受试者进行递增负荷实验,实验中同时采用12导联心电测试仪记录受试者运动时心电图的ST段下压幅度、校正后的QT间期离散度(QTcd)指标。结果:(1)比较干预前后运动测试完成时心电图指标发现,干预前后各组ST段下压幅度没有产生显著变化,而小运动量组和大运动量组心电图指标QTcd干预后均显著低于干预前(P<0.05)。(2)通过对运动中心电图指标差值分析比较发现,小运动量组QTcd下降幅度显著高于对照组(P<0.05),而大运动量组QTcd下降幅度非常显著高于对照组(P<0.01),各组ST段下压幅度差值之间没有显著性差异。结论:12周强度为65%~80%VO2max、运动量为1200 kcal/wk和2000 kcal/wk的运动干预对运动中心电ST段下压幅度没有显著影响,两种运动量均可以使运动中心电图QTcd显著降低,进而降低运动诱导产生的心肌缺血的风险。     

评估非ST段抬高型急性冠脉综合征预后的生物标志物研究进展

急性冠脉综合征(acute coronary syndrome,ACS)的病理基础是冠脉内动脉粥样硬化斑块破裂,急性血栓形成,从而造成心肌缺血或心肌梗死,包括ST段抬高型心肌梗死(ST segment elevation acute myocardial infarction,STEAMID、非ST段抬高型心肌梗死(non-STsgment elevation acute myocardial infarction,NSTEAMID、不稳定型心绞痛(unstable angia,UA).NSTEAMI和UA统称非ST段抬高型急性冠脉综合征(non-ST segment elevation acute coronary syndrome,NSTEACS),其发病是血栓不完全堵塞血管所致.NSTEACS患者再发心血管事件(包括死亡或心肌缺血事件)的概率在不同患者中差别很大,因此,对其再发心血管事件的风险做出快速准确的预测,为患者提供更科学有效的治疗策略具有重要的临床意义[1-2].     

地尔硫加比索洛尔治疗老年稳定型心绞痛效果观察

目的:比较地尔硫加比索洛尔小剂量合用与比索洛尔单用,对老年稳定型心绞痛患者抗心绞痛和抗心肌缺血的中期疗效及耐受性。方法:选择老年稳定型心绞痛136例,随机分为地尔硫加比索洛尔组(合用组)74例,应用地尔硫加比索洛尔治疗;比索洛尔组(单用组)62例,单用比索洛尔治疗。均治疗100周,比较运动试验结果、血流动力学资料和严重不良事件。结果:两组运动开始至终止时间、运动开始至出现第一次胸痛的间隔时间、最大运动耐量时ST段下移、最大运动耐量时心率与血压乘积比较,差异显著(P<0.05,P<0.01)。两组运动前卧位血压及心率、运动开始至ST段下移1mm时间及每天胸痛发作次数比较,差异不显著(P>0.05)。常见严重不良事件为Ⅱ度以上房室传导阻滞、脑梗死、心力衰竭和心肌梗死,两组比较差异不显著(P>0.05)。结论:对于老年稳定型心绞痛患者,地尔硫加比索洛尔小剂量合用抗心绞痛和抗心肌缺血疗效优于比索洛尔单用。     

地尔硫(艹卓)加比索洛尔治疗老年稳定型心绞痛效果观察

目的:比较地尔硫(艹卓)加比索洛尔小剂量合用与比索洛尔单用,对老年稳定型心绞痛患者抗心绞痛和抗心肌缺血的中期疗效及耐受性.方法:选择老年稳定型心绞痛136例,随机分为地尔硫(艹卓)加比索洛尔组(合用组)74例,应用地尔硫(艹卓)加比索洛尔治疗;比索洛尔组(单用组)62例,单用比索洛尔治疗.均治疗100周,比较运动试验结果、血流动力学资料和严重不良事件.结果:两组运动开始至终止时间、运动开始至出现第一次胸痛的间隔时间、最大运动耐量时ST段下移、最大运动耐量时心率与血压乘积比较,差异显著(P<0.05,P<0.01).两组运动前卧位血压及心率、运动开始至ST段下移1 mm时间及每天胸痛发作次数比较,差异不显著(P>0.05).常见严重不良事件为Ⅱ度以上房室传导阻滞、脑梗死、心力衰竭和心肌梗死,两组比较差异不显著(P>0.05).结论:对于老年稳定型心绞痛患者,地尔硫(艹卓)加比索洛尔小剂量合用抗心绞痛和抗心肌缺血疗效优于比索洛尔单用.     

药物对高原人体运动时心率的影响

目的 探讨在高原低氧条件下药物对人体运动心率(HR)的影响。方法 对进驻海拔4 100 m20 d的50名健康青年随机分为服用复方红景天组、西氏胶囊组、乙酰唑胺组、吸入一氧化氮(NO)组和对照组,每组10人。在服(吸入)6 d前后的安静时、踏阶运动5min及恢复5 min时分别检测HR。结果 服药前运动5 min及恢复5 min时5组HR较安静时增高非常明显(P<0.01);服药后安静时较服药前安静时HR4组服药组降低非常显著(P<0.01);服药后运动5 min时较服药前运动5 min时HR4组服药组降低显著(P<0.05);服药后恢复5min较服药前恢复5min HR西氏胶囊组及乙酰唑胺组降低显著(P<0.05),红景天组及NO组降低非常显著(P<0.01);服药后安静时HR4组服药组较对照组降低显著(P<0.05)服药后恢复5 min时HR红景天组及NO组较对照组降低显著(P<0.05)。结论 服用红景天、西氏胶囊、乙酰唑胺及吸入NO均能有效地提高和改善低氧条件下人体运动耐力和降低HR;吸入NO和服用红景天效果更明显。     

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.