运动肺康复干预对稳定期慢性阻塞性肺疾病患者遵医行为、肺功能及衰弱状况的影响研究

目的探讨肺康复干预对于稳定期慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)患者肺功能及衰弱状况、遵医行为的影响。方法对我院呼吸科门诊及住院的84例稳定期COPD患者进行居家或医院随访,实施运动肺康复健康行为干预。结果患者肺功能、6min步行距离及运动后Borg评分、COPD患者生活质量评分、MRC呼吸困难指数、CHS衰弱总分及衰弱指数及遵医行为干预前后比较差异均有统计学意义(P0.05),而日常生活活动能力,干预前后差异无统计学意义(P0.05)。结论运动肺康复健康干预方案有效可行,能改善患者的肺功能及运动耐力、降低衰弱状况,提高遵医行为及生活质量,并有效节约医疗资源。     

长期氧疗对老年慢性阻塞性肺疾病患者心理状况及活动耐力的影响

目的探讨长期家庭氧疗对老年慢性阻塞性肺疾病(COPD)患者心理状况及活动耐力的影响。方法对35例长期家庭氧疗的老年 COPD 稳定期患者,运用症状自评量表(SCL-90)、运动耐力时间进行评估。结果①氧疗后患者的运动耐力时间显著长于治疗前,差异有统计学意义(P＜0.05)；②治疗后患者 SCL-90总分及躯体化、抑郁、焦虑及恐怖因子评分较治疗前显著降低,差异有统计学意义(P＜0.05)。结论长期家庭氧疗可以显著改善老年 COPD 患者的情绪障碍。     

肺康复锻炼提高老年慢性阻塞性肺疾病Ⅱ级稳定期患者的睡眠质量

目的了解老年慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)Ⅱ级临床稳定期患者睡眠不良的发生情况,并给予肺康复锻炼干预措施,以期为改善老年COPDⅡ级患者的睡眠质量提供有效措施。方法便利抽样法选取2011年1月至2011年5月参加健康查体筛查出的老年COPDⅡ级临床稳定期患者60例为研究对象,给予肺康复锻炼指导。在干预前及干预3个月后采集患者匹兹堡睡眠质量自评量表(Pittsburgh Sleep Quality Index,PSQI)评分,并分析肺康复锻炼干预措施的有效性及实用性。结果坚持肺康复锻炼3个月的患者,PSQI各项评价指数明显优于护理干预前,差异有统计学意义(P<0.05)。结论肺康复锻炼能有效提高老年COPDⅡ级临床稳定期患者的睡眠质量。     

多组分运动护理干预在老年慢性心力衰竭合并衰弱患者中的应用

目的 构建多组分运动护理干预方案,并探讨其对改善老年慢性心力衰竭患者衰弱、日常生活活动能力及生活质量的效果。方法 基于文献分析、专家小组会议等形成多组分运动护理干预方案。2022年1月—9月,选取山东省某三级甲等医院心内科住院的71例老年慢性心力衰竭患者作为研究对象,采用抛硬币法随机分为试验组35例和对照组36例。试验组在常规护理的基础上实施多组分运动护理干预,对照组接受常规护理。于干预前及干预4、12周后,采用Tilburg衰弱量表、改良Barthel指数量表和简易生活质量量表对两组进行评估。结果 共有62例患者完成干预,其中试验组31例,对照组31例。广义估计方程结果显示,两组衰弱、日常生活活动能力和生活质量的组间效应、时间效应及交互效应均具有统计学意义（P<0.05）。干预4、12周后,试验组Tilburg衰弱量表得分低于对照组（P<0.05）,改良Barthel指数量表得分和简易生活质量量表得分均高于对照组（P<0.05）。结论 多组分运动护理干预可有效改善老年慢性心力衰竭患者的衰弱状态,提高其日常生活活动能力和生活质量。     

自我管理对慢性阻塞性肺疾病患者知信行的影响

目的 探讨自我管理项目对稳定期慢性阻塞性肺疾病(COPD)患者的知识、信念及行为结果的影响.方法 对68例稳定期COPD患者按随机对照原则分为干预组与对照组,对干预组实施以家庭为背景的自我管理项目,对照组进行常规教育.比较干预前后两组健康知识水平、自我效能及呼吸功能改善情况.结果 自我管理干预后2个月,干预组健康知识得分、自我效能及其各维度评分、呼吸困难症状评分均较对照组显著提高,干预组在干预前后各资料得分差异有统计学意义(P＜0.05);而对照组自身比较,差异无统计学意义(P0.05).结论 自我管理项目可提高COPD患者健康知识水平,提高患者对症状管理的自信心,改善患者的呼吸症状.     

居家体感互动游戏锻炼对稳定期慢性阻塞性肺疾病患者疲乏及负性情绪的影响

目的探讨居家体感互动游戏锻炼对稳定期慢性阻塞性肺疾病(COPD)患者疲乏及负性情绪的影响。方法选取2018年7月至2019年4月呼吸内科44例稳定期COPD患者为研究对象,随机等分为试验组和对照组,对照组给予常规健康指导,试验组在常规健康指导基础上接受为期8周的居家体感互动游戏锻炼。干预前后采用多维度疲乏量表(MFI-20)和医院焦虑抑郁量表(HADS)评价两组患者的效果。结果干预后,试验组疲乏总分及一般性疲乏、活动减少、动力下降3个维度得分均低于干预前及对照组(P 0. 05),体力疲乏得分低于干预前(P0. 05); HADS量表总分及焦虑、抑郁分量表得分明显低于对照组与干预前(P 0. 05)。结论居家体感互动游戏锻炼能改善稳定期COPD患者的疲乏及负性情绪,有助于提高其生活质量水平。     

肺康复护理对COPD稳定期患者肺功能及生活质量的影响

目的探讨肺康复护理对慢性阻塞性肺疾病(chronic obstructive pulmonary diseases,COPD)稳定期患者肺功能及生活质量的影响。方法对67例COPD稳定期患者实施肺康复护理6个月,比较肺康复护理前后患者肺功能及生活质量情况。结果肺康复护理后,患者肺功能指标及病变程度较护理前明显改善;欧洲五维健康量表(euroqol five-dimension questionnaire,EQ-5D)评分较护理前明显提高,前后比较,均P<0.05,差异具有统计学意义。结论肺康复护理能有效改善COPD稳定期患者肺功能,提高其生活质量。     

家庭肺康复锻炼对老年COPDⅡ级稳定期患者肺通气功能的影响

目的：探讨与评估家庭肺康复锻炼对老年慢性阻塞性肺疾病（ COPD）Ⅱ级临床稳定期患者肺通气功能的影响。方法筛选2013年1—5月参加某院健康查体中老年COPDⅡ级临床稳定期患者62例,给予量化的家庭肺康复锻炼指导,并监督实施,在干预前及干预后6,12个月分别测定患者呼吸肌力、肺功能、6 min行走距离（6MWD）,比较家庭肺康复锻炼的有效性及实用性。结果坚持家庭肺康复锻炼6个月后,患者最大吸气压（PImax）（69．9±3．7）cmH2O,最大呼气压（PEmax）（99．1±2．9）cmH2O,6MWD（276．2±25．6）m,均较锻炼前增加,差异有统计学意义（t值分别为2．02,1．04,3．43;P＜0．05）。肺康复锻炼12个月后,患者第1秒用力呼气容积实测值与预计值的比值（FEV1％）为（37．8±4．2）,第1秒用力呼气容积占用力肺活量比值（FEV1／FVC％）为（47．4±6．2）,均较锻炼前增加,差异有统计学意义（t值分别为2．27,2．01;P＜0．05）。结论家庭肺康复锻炼可有效改善老年COPDⅡ级稳定期患者肺通气功能。     

以适应性行为促进为目标的集成式健康教育项目在COPD老年患者家庭肺康复中的应用

目的:探讨以适应性行为促进目标的集成式健康教育项目在COPD老年患者家庭肺康复中的应用效果。方法:选择2015年1~12月自我院出院的COPD患者122例作为研究对象,随机将其分为对照组和试验组,对照组接受家庭肺康复常规健康教育,试验组接受以适应性行为促进为目标的集成式健康教育项目干预,对两组病例干预后的各观察指标进行比较。结果:干预后试验组老年COPD稳定期观察病例的家庭肺康复健康知识评分、家庭肺康复适应性行为依从性均明显高于对照组,生活质量评分则明显低于对照组(P0.05)。结论:采用以适应性行为促进为目标的集成式健康教育项目对COPD老年患者实施家庭肺康复健康教育干预,有利于提高该类患者的家庭肺康复健康知识水平和适应性行为依从性,并获得生活质量的提高。     

慢性阻塞性肺疾病患者早期简易肺康复方案的构建及应用

目的 构建COPD患者早期简易肺康复方案并评价其应用效果。方法 选取2018年5月—12月入院的COPD急性加重期患者97例作为研究对象,采用随机数字表法将其分为试验组49例和对照组48例。试验组在对照组方案基础上接受COPD患者早期简易肺康复方案的干预,即在入组后进行呼吸训练、腹肌抗阻训练、上下肢训练、床边起蹲运动、步行训练、爬楼梯训练;对照组接受常规治疗、健康教育和家庭肺康复指导,比较两组干预前和干预后3个月的改良英国医学研究委员会呼吸困难量表（modified medical British Research Council,mMRC）评分、6 min步行距离、COPD评估测试（COPD Assessment Test,CAT）评分、肺功能指标、焦虑自评量表（Self-rating Anxiety Scale,SAS）评分、家庭肺康复依从性。 结果 干预后3个月试验组mMRC评分、6 min步行距离、CAT评分、SAS评分均优于对照组,试验组家庭肺康复依从性良好者比例（51.02%）高于对照组（16.67%）,差异有统计学意义（P<0.05）。 结论 COPD患者早期简易肺康复方案安全、有效,可改善COPD患者的运动耐力、生活质量,缓解患者的呼吸困难、焦虑症状,提高患者家庭肺康复的依从性。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。