慢性阻塞性肺疾病患者营养状态对运动心肺功能的影响

目的：探讨营养状态对慢性阻塞性肺疾病（COPD）患运动心肺功能的影响。方法：43例COPD患分为营养不良组（15例），营养正常组（28例）和健康志愿（20名）进行负荷连续递增的运动心肺功能试验。运动行营养评价和常规肺功能检查，结果：（1）COPD营养不良组最大氧耗量（VO2max）、最大运动负荷（Wmax）、最大氧脉搏（O2pulsemax)和无氧阈（AT）低于营养正常组，两组比较差异有显性（P＜0．05）。通气氧耗（VO2／W／VE)和最大运动时的气急指数（DImax)与营养正常组比较，差异有显性（P＜0．05）。（2）COPD患理想体重百分比（IBW％）与VO2max占预计值百分比、Wmax占预计值百分比、O2pulsemax占预计值百分比，AT呈正相关（r=0.696,0.432,0.717,0.822,P均＜0．01）、与DImax,VO2/W/VE呈负相关（r=-0.450,-0.640,P均＜0．01）。结论：营养不良可以导致COPD患肌肉有氧代谢能力和运动耐力降低。     

静息肺功能状态对肺癌患者运动心肺功能的影响

目的：探讨静息肺功能状态对肺癌患者运动心肺功能的影响。方法：对20例健康者和140例肺癌患者和行静息肺功能，心电图和运动心肺功能测定。结果：（1）与健康组相比，肺癌患者的VO2％P、VO2／kg,,AT,VO2/HR%,VE,SpO2％降低（P＜0．05或0．01），VD／VT增加（P＜0．05），肺通气功能障碍的类型及弥散功能对其无明显影响；（2）与通气功能正常者相比，通气功能减负功能减退的肺癌患者存在W％，VO2％P，BP，SpO2%降低（P＜0．05或0．01），以通气功能显著减退的肺癌患者为著；（3）低氧血症组和氧合状态正常组的运动心肺功能指标间无显著差异。结论：静息肺功能正常的肺癌患者，就存在着运动通气受限，并成为运动中氧摄取量减少的主要原因，肺通气功能不同程度减退是肺癌患者运动心肺功能进一步减退的重要原因。     

有氧运动联合抗阻运动对急性心肌梗死患者微循环及梗死面积的影响

目的：探讨急性心肌梗死（AMI）患者应用有氧运动联合抗阻运动对心肌微循环及梗死面积的影响,为临床上治疗AMI提供更广泛的治疗手段。方法选择2013年1月至2014年12月首发入住哈尔滨市第一医院的AMI患者86例,随机分为治疗组（n＝43）及对照组（n＝43）。两组患者均给予药物治疗,治疗组在药物治疗的基础上进行为期12周的有氧运动?抗阻运动治疗。于治疗前和治疗12周后对两组患者的峰值氧耗量（VO2max）、相对最大摄氧量（VO2max/kg）、峰值氧脉搏（VO2max/HR）、最大心率（HRmax）、最大通气量（VEmax）、心肌声学造影（MCE）结果进行评价和比较。结果治疗前,两组间VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax各项指标比较,差异均无统计学意义（P＞0.05）。治疗12周后,两组的VO2max、VO2max/kg、VO2max/HR、HRmax、VEmax比较,差异均有统计学意义（P＜0.05）。治疗前,心肌声学造影显示两组间的A（平台期强度）、κ（再充盈平均速度）、及A·κ值无明显差异（P＞0.05）。12周后,治疗组的3项指标较对照组明显增加（P＜0.05）。结论在急性心肌梗死患者的心脏康复方案中采用有氧运动与抗阻训练相结合的训练方法,可以使患者心肌微循环及梗死面积得到不同程度的改善,该方法为临床上治疗AMI提供一种新的思路及更广泛的治疗手段。     

肺通气功能障碍对肺癌患者运动心肺功能的影响

目的：探讨肺癌患者在不同肺通气功能障碍的肺癌患者行静息肺功能和运动心肺功能测定。方法;对20例肺通气功能正常和56例肺通气功能障碍的肺癌患者行静息肺功能和运动心肺功能测定。结果：（1）25％以上的肺通气功能正常的肺癌患者VO2％P、VO2/kg,VO2/HR降低,DY增高和AT提前出现。（2）肺通气功能障碍的肺癌患者上述指标进一步异常,且BR和VTex降低,以混合型通气功能障碍组为著。（3）肺癌患者的VE与VO2／HR相关,通气障碍组运动肺通气指标和VO2／HR（除限制型组）与VO2％P相关,限制型组的VC％、阻塞型和混合型组的MVV％等均与运动肺通气指标相关（P均＜0．05）。结论：肺癌患者存在着运动心肺功能减退,肺功能障碍加重其运动心肺功能的异常,VC％、MVV％降低是通气功能障碍的肺癌患者通气功能受限的主要原因,运动通气功能减退是导致运动心功能异常的主要原因。     

综合康复医疗对慢性心衰患者心肺功能的影响

目的:评价综合康复医疗对慢性心衰患者心肺功能的影响。方法:采用逐级负荷踏车试验检测79例慢性心衰患者的心肺功能,对比观察综合康复医疗组(观察组)与传统疗养组(对照组)治疗前、后心率、血压、心肌耗氧量及6 min步行距离的变化。结果:观察组较对照组6 min步行试验后心率、血压增加值减少,步行距离延长,心肌耗氧量降低(P<0.05).VO2max,VO2max/kg,VO2max/HR,VEmax均值均高于对照组(P<0.05)。结论:综合康复医疗对改善慢性心衰患者心肺功能,提高生存率有益。     

慢性充血性心力衰竭患血清心肌肌钙蛋白Ⅰ测定

目的：探讨血清心肌肌钙蛋白Ⅰ（CTnⅠ）定量检测对慢性充血性心力衰竭（心衰）患的诊断价值。方法：采用微粒子酶免分析法定量检测血清CTnⅠ。结果：冠心病中重度心衰且的CTnⅠ比对照组、冠心病轻度心衰组，非冠心病中重度心衰组CTnⅠ明显升高（P＜0．05）。非事重度心衰组与对照组CTnⅠ比较无差异（P＞0．05）。四组CK－MB比较均无差异（P＞0．05）。结论：血清CTnⅠ定量检测对冠心病心衰患心衰程度及中重度心衰患的病因诊断有一定的价值。     

急性心肌梗塞运动试验的临床价值

目的：研究急性心肌梗塞（AMI）患者平板运动试验的评定心功能、指导康复作用。方法：16例AMI病人（平均56．5岁）在发病4周后按照Bruce方案进行症状限止平板运动试验。结果：VO2max3～12（平均7．3±3．8）METs；HRmax106～186（平均152．7±29．7）次／分；运动试验阳性12例．其中ST段下移、VO2max＜4METs者6例（50％）；ST段抬高、VO2max＜4METs者5例（31．2％）；没有1例发生意外。结论：AMI病人的运动试验对评定心功能、指导康复有较大临床意义；只要掌握适应证、禁忌证，运动中严密监护．AMI病人运动试验是安全的。     

健康成人最大运动负荷下的摄氧量和心率的测定

我们测定了94例健康国人在递增运动至症状自限的运动下的摄氧量（VO2）、心率（HR）和HR－VO2的关系。方法：94例健康成人（男性48例，女性46例）踏功率自行车进行运动测试，每分钟递增功率直至受试者最大耐受量，同步记录VO2和HR。结果：VO2max与年龄（AGE）和体表面积（BSA）有关，预计方程为：女性VO2max（ml／min）＝917．75×BSA－8．99×AGE＋176．20（SEE＝171．7，r2＝0.36）；男性VO2max（ml／min）＝660．61×BSA－18．92×AGE＋1510．23（SEE＝271．5，r2＝0．49）。HRmax＝174－0．562×年龄。HR－VO2的关系为：HR（女性）＝70．32＋0．058×VO2（ml／min）±12；HR（男性）＝75．01＋0.037×VO2（ml／min）±12。结论：VO2max受性别、年龄和体表面积的影响，但HR－VO2的关系变异较小。     

心肺运动试验预测肺癌侵及血管的患者术后呼吸衰竭的探讨

目的探讨心肺运动试验预测肺癌侵及血管的患者术后呼吸衰竭的探讨。方法术前采用运动负荷递增的方案对172例原发性肺癌患者行心肺运动试验,测定终止负荷运动时的功率（W％）、最大摄氧量（VO2％P）、公斤氧耗量（VO2/kg）、无氧闽（AT）、代谢当量（MET）、氧脉搏（VO2/HR）、呼吸频率（BF）、通气量（VE）。结果 ①运动心肺功能试验各项指标在肺叶切除术后呼衰和非呼衰组间均无显著性差异（乃0．05）。垒肺切除术而言,w％、vo：％P、寸O2／kg、MET、VE、BF在术后呼衰组均较非呼衰组降低（P〈0．05或0．01）。②W％、VO2％P、VO2／kg、MET在行左垒肺切除术术后呼衰组较非呼衰组降低（P〈0．05或0．01）。右全肺切除组仅BF在组间差异有显著性意义（P〈0．05）。③X^2检验显示,六项指标不同程度异常与全肺切除术后呼衰的发生率有关,logistic回归分析显示MET〈4和BF〈30次／分与全肺切除术后呼衰的发生密切相关,VO2／kg〈14．6ml／min／kg与左全肺切除术后呼衰的发生关系密切。④术后全肺切除组VO2％P〈60％、BF〈30次,分、VE〈35L／min的敏感性和特异性均〉60％,阴性预测值均大干90％。左全肺切除组W％、VO2％P〈60％的敏感性和特异性均〉80％,阴性预测值100％,均高于审。扯g。结论运动心肺功能试验对于有血管侵及的肺癌患者行全肺切除术,特别是行左全肺切除术,预测术后的呼吸衰竭,为全肺切除术的适应症评估提供依据,均具有重要意义。选择VO2％P作为预测术后呼衰、评估手术适应症的指标。因MET〈4、VO2/kg〈14．6ml／min／kg与肺切除术后呼衰关系密切,应结合临床情况适当考虑。     

稳定期COPD患者静息肺功能测定及与最大摄氧量的相关性分析

目的探讨慢性阻塞性肺疾病（COPD）患者静息肺功能、运动耐力变化及两者的关系。方法选择32例稳定期COPD患者（COPD组）和20例健康体检者（对照组）,分别行静息肺功能测定和症状自限最大运动负荷递增试验,记录用力肺活量（FVC）、第1秒用力肺活量（FEV1．0）、FEV1．0占预计值百分比（FEV1．0％）、最大通气量（MVV）、静息状态下一氧化碳弥散量（DLCO）和最大摄氧量（VO2 max）;对COPD静息肺功能指标与VO2 max的关系行直线相关分析。结果COPD组FVC、FEV1．0、FEV1．O％、FEV1．0／FVC、MVV、DLCO和VO2 max均显著低于对照组（P均〈0．05）;COPD组FVC、FEV1．0、FEV1．0％、FEV1．0／FVC、MVV和DLCO与VO2 max均呈显著正相关（P均〈0．05）。结论稳定期COPD患者静息肺功能及运动耐力均有所减退,且两者呈正相关;联合检测此两项指标可综合评价COPD病情进展、预后及指导康复治疗。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.