心力衰竭的心脏康复运动

心力衰竭(HF)为临床病理综合征,以往认为应限制HF患者的活动以减少循环负荷,近年来,研究认为HF患者进行适量运动训练有益康复[1]。1心脏康复运动的目的心脏康复运动的目的是提高心脏的功能水平,改变疾病的自然进程,减少心衰发生率和病死率,提高生活质量。研究证实,通过降低危险     

急性心肌梗死患者早期进行运动康复效果临床研究

正冠心病尤其是心肌梗死可造成活动能力下降,影响性生活,健康相关性生活质量下降(HRQL)。运动训练作为心肌梗死后心脏康复的一部分在国外已经进行了广泛开展,在减少死亡率,提高运动能力和生活质量方面有良好的效果,尤其有益于保持心肌梗死后早期的身体机能[1]。遵循目前的运动训练指南,康复训练分为3个不同的阶段[2]。第一阶段通常开始于入院24 h内,并继续到患者出院。这一阶段的目标是通过健康宣教减少患者焦虑,及与卧床     

左室收缩功能障碍所致的心衰病人运动试验及训练

以往认为心衰病人运动耐量下降，运动会加重心脏负担。但一些随机试验证实，有心衰症状的病人经过正规训练，运动耐力改善，自主神经系统功能、局部血流、骨骼肌功能均有好转，现从三方面进行综述。心衰的病理生理与治疗多数心衰是左室收缩功能障碍所致，射血分数降低＜35％-40     

慢性心力衰竭康复治疗的研究进展

心力衰竭(心衰)是各种心脏疾病的最终结局。过去20多年,随着心脏康复的蓬勃发展,心衰康复治疗也得到快速的发展,告别了"绝对卧床"的时代。现代心衰康复包括教育、咨询、生活方式干预、心衰危险因素纠正和运动的综合的二级预防计划,其中运动治疗是核心。大量研究证实,心     

慢性心力衰竭的有氧运动康复

通过在心肺运动试验基础上制定的有氧运动心脏康复，对慢性心衰患者是安全有效的二级预防措施。有氧运动心脏康复可以改善慢性心衰患者运动耐力和心力储备，改善生活质量，提高寿命，且可以节约医疗开支。本文重点对慢性心衰患者有氧运动方案的制定、实施及作用效应作一综述。     

心脏Ⅰ期、Ⅱ期运动康复对冠心病PCI术后患者心功能、生活质量及血清和肽素水平的影响

目的:探讨心脏Ⅰ期、Ⅱ期运动康复对冠心病(CHD) PCI术后患者心功能、生活质量及血清和肽素水平的影响.方法:在我院行PCI治疗出院的120例CHD患者,被随机均分为常规治疗组(接受常规护理、术后12周的健康宣教以及6个月的常规随访)和运动康复组(在常规治疗组基础上接受6个月的心脏康复Ⅰ期、Ⅱ期运动训练).观察比较两...     

运动训练与心力衰竭

慢性心衰是一种以运动能力下降、疲劳和劳力性呼吸困难为特点的综合征。以往运动训练是心衰患者的绝对禁忌症,强调心衰病人需要限制体力活动、严格卧床休息,然而长期安静休息可引起骨骼肌萎缩、运动耐力下降甚至静脉血栓形成,导致发生肺栓塞等严重并发症。近年来,对运动训练在心衰康复中的作用有了新的认识,有许多试验研究、确定了运动训练的临床效果和安全性,认为运动训练是心衰综合治疗方案的一部分。运动训练早已成为心肌梗塞、冠脉搭桥和心脏移植病人恢复的常规程序,目前它应用于心衰病人,也取得一定效果。本文就运动训练对心衰患者的运…     

慢性心衰居家康复护理的远期效果研究

目的 探讨居家心脏康复护理模式在慢性心衰患者中的应用效果.方法 将156例心衰患者随机分为干预组78例和对照组78例.对照组接受常规住院康复指导;干预组按家庭心脏康复模式进行健康指导,以身体康复锻炼和心理放松训练为主要内容.出院后随访1年,比较两组患者心功能状况、心血管危险因素改善情况及再入院率.结果 干预组心功能状况及部分心血管危险因素改善情况与对照组比较差异有统计学意义（P＜0.05）,再入院率低（P＜0.01）.结论 将家庭心脏康复模式应用于心衰出院患者,可促进其康复,降低再入院率.     

异体原位性心脏移植术后康复护理要点(附3例报告)

目的：观察康复治疗促使异体心脏移植术后患恢复的情况。方法：对异体心脏移植术后患早期运用康复治疗方法：(1)早期做床上主动和被动运动，根据术后病情逐步增加运动量；(2)严格消毒隔离，预防并发症；(3)出院前进行康复指导．结果：换心术后患康复过程无并发症，经半年、1年随访，生活质量提高并参加工作．结论：对换心术后患采取康复护理措施，能促使病人早期恢复，返回社会。     

家庭心脏康复对经皮冠状动脉介入术后患者康复效果的研究

目的 探讨家庭心脏康复对PCI术后患者康复疗效的影响。方法 将106例PCI术后患者随机分为观察组（家庭心脏康复组）和对照组（常规康复组）各53例。分别于出院时、干预后3个月测定两组患者左心室射血分数、血压、血糖、低密度脂蛋白；同时给予SF-12量表、HADS量表评分。结果 干预3个月后，观察组患者SF-12量表评分显著高于对照组，危险因素控制方面明显优于对照组，HADS量表得分显著低于对照组，（p<0.05）；干预后两组左心室射血分数无显著差异（p＞0.05）。结论 家庭心脏康复可提高PCI术后患者生存质量，改善患者心理状态，进一步控制疾病危险因素。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.