不同训练方式对武警战士血浆肌酸激酶和血浆游离DNA的影响

 目的 观察不同训练方式对武警战士血浆肌酸激酶(CK)和血浆游离DNA(cf-DNA)的影响,探寻军事训练过程中早期诊断运动性疲劳和运动性肌肉损伤的敏感标志物。方法 45名某部队武警战士随机分为3组,分别为有氧训练组(5 km跑)、向心力量训练组(俯卧撑和仰卧起坐)和离心力量训练组(原地蹲跳和蛙跳),每组各15人。于训练前、训练后即刻、训练后30 min、1 h、12 h和24 h测定血浆CK和cf-DNA。结果 有氧训练组各时间点血浆CK和cf-DNA均无显著性变化(P>0.05)。向心力量训练组血浆CK在训练后12 h显著升高[(315±95) vs (134±45) U/L,P<0.01],24 h即恢复至安静水平[(151±71) vs (134±45) U/L,P>0.05];cf-DNA在训练后即刻显著升高[(59.1±12.7) vs (43.4±8.0) pg/μl,P<0.05],30 min达峰值[(95.3±13.6) vs (43.4±8.0) pg/μl,P<0.01],12 h即恢复至安静水平[(47.7±10.9) vs (43.4±8.0) pg/μl,P>0.05]。离心力量训练组血浆CK与cf-DNA的变化与向心力量组基本一致,但各时间点升高幅度均高于向心力量组(P<0.01)。结论 cf-DNA对运动的反应具有训练方式依赖性,中等强度有氧训练对cf-DNA的影响不大,力量训练特别是离心力量训练对cf-DNA的影响最大;cf-DNA可能是军事训练中早期诊断运动性疲劳和运动性肌肉损伤的敏感标志物。
     

神经外科手术患者系统规范化护理模式对应激反应的影响

 目的 探讨神经外科手术患者系统规范化护理模式对应激反应的影响。方法 2012-03至2014-11期间我院进行的脑神经胶质瘤手术患者70例,随机分为实验组和对照组。对照组给予常规护理,实验组除接受常规护理外还进行系统规范化的护理干预,比较分析两组患者围手术期的应激反应。结果 实验组患者在手术前一天(T₁)血压和心率为[(125.43±19.32)mmHg、(78.98±10.94)次/分]、进入手术室后插气管时(T₂)血压和心率为[(128.45±18.35)mmHg、(78.94±11.47)次/min]、手术结束时(T₃)血压和心率为[(120.15±16.12)mmHg、(83.45±15.15)次/min]手术后的24 h(T₄)血压和心率为[(120.35±17.90)mmHg,(72.25±12.63)次/min]和手术后72 h(T₅)血压和心率为[(121.12±15.23)mmHg、(70.35±12.95)次/min],这几个时刻的心率和收缩压均明显低于对照组,差异有统计学意义(P<0.05)。实验组患者血清IL-6在手术前后的波动较对照组小,差异有统计学意义(P<0.05),术后实验组患者血清皮质醇含量变化较对照组小,差异有统计学意义(P<0.05),术后72 h对照组较实验组更焦虑(P<0.05)。结论 系统规范化护理模式可以调节患者手术中的应激反应,维持患者内环境的稳定,对患者的手术效果和术后康复有着重要的促进作用。     

高原低氧环境下军事训练对武警新兵微循环功能的影响

 目的 观察高原低氧环境下军事训练对武警新兵微循环功能的影响,为指导高原地区军事、体能训练提供科学依据。方法 试验在青海( 海拔约3000 m,大气压力60.49 kPa ) 和天津( 海拔约4 m,大气压力101.08 kPa ) 完成。受试者为武警某部新兵连战士,将受试者分为3组,分别为平原籍平原训练组(对照组,60人)、平原籍高原训练组(A组,62人)和高原籍高原训练组(B组,38人)。所有受试者进行12周训练,训练强度相同。训练前和训练后第4、8、12周用XXG-E3 型自动心血管功能诊断仪记录微循环功能指标,并对受试者甲襞微循环进行检测。结果 在高原低氧环境下军事训练新兵血容量明显减少,以A组减少最为显著(P<0.05);B组半更新率低于其他两组(P<0.05),平均滞留时间和半更新时间高于其他两组(P< 0.05);B组形态积分和流态积分高于对照组(P<0.05);A组襻周积分[(2.78±0.85)vs(0.93±0.34)]和流态积分[(1.33±0.34)vs(0.59±0.31)]显著高于对照组(P<0.05)。结论 高原籍战士的微循环功能对高原训练适应性较强,平原籍战士高原低氧军事训练应当逐步增加训练量,以减少高原反应和微循环障功能碍的发生。     

显微镜下精索静脉结扎术对青年原发性精索静脉曲张患者的安全性评价

 目的 探讨显微镜下精索静脉结扎术对青年原发性精索静脉曲张患者的安全性。方法 80例在我院确诊为原发性精索静脉曲张患者,随机分为观察组和对照组各40例,观察组接受显微镜下精索静脉结扎术,对照组接受经后腹膜精索静脉结扎术,比较两组的手术情况、精子质量、并发症情况及复发情况。结果 观察组和对照组相比,术后卧床时间[(1.05±0.45)d vs (5.36±0.72)d],差异有统计学意义(P<0.05)、住院总时间[(6.12±0.44)d vs (7.92±0.56)d]明显缩短,差异有统计学意义(P<0.05),NRS疼痛评分[(1.03±0.35) vs (2.75±0.48)]明显下降(P<0.05);术后3个月,观察组与对照组相比,精子密度[(68.25±7.72)×10⁶/ml vs (54.36±5.45)×10⁶/ml,P<0.05]、精子活动力a级[(25.36±3.12)％ vs (20.12±2.25)％],均明显升高(P<0.05);观察组术后静脉曲张复发率明显低于对照组(P<0.05)。结论 显微镜下精索静脉结扎术有助于减小手术创伤,促进术后恢复,提高精子质量,预防远期复发。     

有氧运动对自发性高血压大鼠肾脏纤维化的影响

 目的 探讨有氧运动对自发性高血压大鼠(SHR)肾脏纤维化的影响并探讨肾小管上皮－间质转化(EMT)在其间的作用机制。方法 将10只Wistar-Kyoto大鼠作为正常血压对照组(WKY),30只雄性SHR按照随机数字表法分为高血压安静组(SHR-S)和高血压运动组(SHR-E),每组15只。WKY和SHR-S组在鼠笼内安静饲养,SHR-E组进行8周跑台运动。实验后,利用无创血压仪检测尾动脉血压;测定24 h尿蛋白(UP)、血尿素氮(BUN)和血清肌酐(SCr)含量评价肾功能;Masson染色进行肾脏病理组织学观察并获取纤维化指数(FI);免疫印迹测定转化生长因子β₁(TGF-β₁)、磷酸化Smad2/3(p-Smad2/3)、α-平滑肌肌动蛋白(α-SMA)和E-钙黏蛋白(E-CA)表达量。结果 与WKY组比较,SHR-S组血压[SBP:(177.3±17.2) mmHg vs. (110.6±13.3)mmHg,P<0.05;DBP:(108.1±6.3) mmHg vs. (75.6±4.9) mmHg,P<0.05;MAP:(131.1±7.4) mmHg vs. (87.3±4.7) mmHg,P<0.05]、肾脏FI[(7.87±1.89)% vs. (0.43±0.05)%,P<0.05]、UP[(197.3±41.6) mg/24 h vs. (89.2±9.5) mg/24 h,P<0.05]、BUN[(14.3±2.9) mmol/L vs. (4.9±1.0) mmol/L,P<0.05]和SCr[(98.6±10.1) μmol/L vs. (35.8±4.3) μmol/L,P<0.05]升高,TGF-β₁、p-Smad2、p-Smad3和α-SMA蛋白表达上调(P<0.05),E-CA蛋白表达下调(P<0.05);与SHR-S组比较,SHR-E组血压[SBP:(152.3±14.2) mmHg vs. (177.3±17.2) mmHg,P<0.05;DBP:(93.1±9.7) mmHg vs. (108.1±6.3) mmHg,P<0.05;MAP:(112.8±7.9) mmHg vs. (131.1±7.4) mmHg,P<0.05]、肾脏FI[(3.02±0.91)% vs. (7.87±1.89)%,P<0.05]、UP[(127.9±25.7)mg/24 h vs. (197.3±41.6) mg/24 h,P<0.05]、BUN[(6.8±1.7) mmol/L vs. (14.3±2.9) mmol/L,P<0.05]和SCr[(50.3±6.0) μmol/L vs. (98.6±10.1) μmol/L,P<0.05]下降,TGF-β₁、p-Smad2、p-Smad3和α-SMA蛋白表达下调(P<0.05),E-CA蛋白表达上调(P<0.05)。结论 有氧运动可能通过调控TGF-β₁/Smad信号途径抑制高血压肾病大鼠肾小管EMT,进而改善肾脏纤维化并提高肾功能。     

心脏临时起搏器对颈内动脉支架置入术围术期并发症的影响

 目的 探讨心脏临时起搏器(temporary cardiac pacemaker,TCP)对颈内动脉支架置入术(carotid artery stenting,CAS)围术期并发症的影响。方法 采用回顾性分析方法,选取2014-01至2019-10于武警特色医学中心住院治疗行CAS患者84例,根据是否行临时心脏起搏器,分为起搏器组和对照组,分析两组患者术中的血压、心率变化及围术期并发症出现情况。结果 起搏器组患者术中的心率降低值[(16.57±5.65)次/min]低于对照组[(28.86±13.36)次/min],起搏器组的术中血压降低值[收缩压(49.81±16.86)mmHg、舒张压(22.4±12.49)mmHg]也低于对照组[(57.81±17.79)mmHg 、(30.19±12.26)mmHg],差异均有统计学意义(P<0.05)。 起搏器组围术期总体并发症发生率为9.52%(4例),低于对照组的33.33%(14例),差异有统计学意义(P<0.05)。结论 CAS联合心脏起搏器能够明显降低其围术期并发症的发生率,可保证手术安全性。     

小儿发育性髋脱位矫正术超声引导下骶管阻滞麻醉效果

 目的 探讨小儿发育性髋脱位矫正术超声引导下骶管阻滞效果。方法 选取2016-06至2018-06在北京积水潭医院进行小儿发育性髋脱位矫正术患者70例,随机分为试验组和对照组,每组35例。试验组予以超声引导定位骶管阻滞麻醉,对照组常规使用0.2％罗哌卡因硬膜外阻滞。记录两组患儿的穿刺情况;记录两组患儿的罗哌卡因用量、切皮前后血压(BP)及心率(HR)变化;记录术中芬太尼用量;记录术后2、4、6、12、24 h及48 h的患儿疼痛FLACC评分及患儿首次使用乙酰氨基酚时间;记录患儿睡眠障碍镇静评分(Ramsay评分),评价患儿术后12 h的镇静情况;记录患儿术后并发症情况。结果 试验组的穿针调整次数显著少于对照组(P<0.05);而试验组的穿刺时间[(13.42±2.50)min]长于对照组[(5.73±2.12)min],差异有统计学意义(P<0.05);试验组患儿的罗哌卡因用量高于对照组(P<0.05);试验组患儿术后首次觅求对乙酰氨基酚时间[(19.6±3.2)h]明显晚于对照组[(11.4±4.1)h],差异有统计学意义(P<0.05)。术后12 h,试验组的FLACC评分(1.6±0.9)明显低于对照组(4.3±1.5),差异有统计学意义(P<0.05)。但试验组术后12 h的Ramsay评分要高于对照组(P<0.05)。结论 在小儿DDH矫正术采用超声引导下骶管阻滞可提供术后24 h有效镇痛,值得临床推广。     

冠心病不同分支病变对血清新喋呤、同型半胱氨酸及基质金属蛋白酶的影响

 目的 探讨冠状动脉粥样硬化性心脏病(简称冠心病)不同分支病变对血清新喋呤(neopterin, Np)、同型半胱氨酸及基质金属蛋白酶的影响。方法 选择冠心病148例,根据病变分支数量分为单支组、双支组、多支组,分别有58例、53例、37例。检测血清Np、Hcy及MMP-2、MMP-9、TIMP-2水平,并比较各组中的差别及分析它们之间的相关性。结果 多支组Np[(12.45±3.09)nmol/L] 和Hcy[(23.71±4.57) μmol/L]均高于单支、双支组,双支组Hcy还高于单支组,差异均有统计学意义(P<0.05)。双支组MMP-2[(49.83±7.64)ng/L]、MMP-9[(194.81±17.58)ng/L]较单支组均高,而TIMP-2[(283.70±23.45)ng/L]较单支组则低,差异有统计学意义(P<0.05)。多支组MMP-2[(63.42±8.59)ng/L]、MMP-9[(249.73±24.16)ng/L]、TIMP-2[(205.61±17.32)ng/L]较单支、双支组变化更加明显,差异有统计学意义(P<0.05)。Np与MMP-9呈正相关(P<0.05),而与TIMP-2呈负相关 (P<0.05);Hcy与MMP-2、MMP-9呈正相关(P<0.05),而与TIMP-2呈负相关(P<0.05)。结论 Hcy与Np是反映冠状动脉粥样硬化范围增加的重要因素,且与反映冠状动脉重构相关的MMPs家族密切相关。     

地特胰岛素治疗妊娠糖尿病的疗效

 目的 观察地特胰岛素治疗妊娠糖尿病的临床疗效。方法 选取2016-06至2017-06武警内蒙古总队医院收治的88例妊娠糖尿病患者,随机分为2组,每组44例。对照组皮下注射优泌林N治疗,观察组皮下注射地特胰岛素,比较两组临床相关指标情况。结果 治疗2周后,观察组血糖达标率为79.55%(35/44),高于对照组59.09%(26/44),差异有统计学意义(P<0.05);观察组血糖达标时间[(9.33±1.74)d]比对照组短[(11.25±2.05)d],且胰岛素用量[(16.25±3.24)U]少于对照组[(26.35±7.54)U],差异均有统计学意义(P<0.05)。观察组治疗3个月后的FPG、HbA₁c水平均比对照组低,差异均有统计学意义(P<0.05)。观察组妊娠结局明显优于对照组(P<0.05)。结论 妊娠糖尿病应用地特胰岛素治疗后,能有效控制血糖水平,并改善母婴结局,且低血糖发生率低,安全、有效。     

某部士兵高温高强度军事训练对血清生化指标的影响及其意义

 目的 分析某部士兵高温高强度军事训练对血清生化指标的影响及其意义。方法 随机选取某部参加10 km长跑训练士兵52例,于训练前后进行生化指标检测,比较训练前后生化指标的变化。结果 (1)训练后电解质Ca⁺、Na⁺较训练前升高[(2.6±0.07)mmol/L vs. (2.5±0.06)mmol/L,(145.2±1.6)mmol/L vs. (141.9±5.5)mmol/L,P<0.01],Mg⁺、K⁺较训练前降低[(0.9±0.06)mmol/L vs. (1.0±0.07)mmol/L,(4.4±0.4)mmol/L vs. (5.0±0.4)mmol/L,P<0.01];(2)训练后AST较训练前升高[(20.7±6.6)μmol/L vs. (18.7±4.2)μmol/L,P<0.01],ALT、GGT、ALP、TBIL、DBIL训练前后差异无统计学意义;(3)训练后Cr、UA、LAC较训练前升高[(74.1±11.2)μmol/L vs. (67.4±14.6)μmol/L,(426.4±77.3)μmol/L vs. (411.2±78.3)μmol/L,(7.4±0.6)μmol/L vs. (4.4±0.7)μmol/L,P<0.01],Urea、β₂-MG训练前后差异无统计学意义;(4)训练后LDH、CK较训练前升高[(229.9±24.1)U/L vs. (188.3±31.2)U/L,(188.3±57.2)U/L vs. (149.6±58.8)U/L,P<0.01],CHE、CK-MB训练前后的改变差异无统计学意义。结论 高温高强度训练可对机体造成影响,但未发生器官损伤,在训练后及时补充电解质,是尽快恢复体力的有效措施。     

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.