Female Athlete Triad and Its Components: Toward Improved Screening and Management

As female athletic participation has increased, the positive effects of exercise on health have become evident. However, with this growth in sports activity, a set of health problems unique to the female athlete has emerged. The female athlete triad as first described in 1992 by the American College of Sports Medicine consisted of disordered eating, amenorrhea, and osteoporosis; the definition was updated in 2007 to include a spectrum of dysfunction related to energy availability, menstrual function, and bone mineral density. For this review, a comprehensive search of databases—MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Scopus, from earliest inclusive dates to January 2013—was conducted by an experienced librarian with input from the authors. Controlled vocabulary supplemented with keywords such as female athlete triad, amenorrhea, oligomenorrhea, fracture, osteopenia, osteoporosis, bone disease, anorexia, bulimia, disordered eating, low energy availability was used to search for articles on female athlete triad. Articles addressing the prevalence, screening, and management of the female athlete triad were selected for inclusion in the review. This article reviews the current definitions of the triad components, epidemiology, pathophysiology, and recommended screening and management guidelines. The lack of efficacy of current screening of athletes is highlighted. Low energy availablity, from either dietary restriction or increased expenditure, plays a pivotal role in development of the triad. Athletes involved in “lean sports” (those that emphasize weight categories or aesthetics, such as ballet, gymnastics, or endurance running) are at highest risk. Treatment is centered on restoring energy availability to reverse adverse changes in the metabolic milieu. Prevention and early recognition of triad disorders are crucial to ensure timely intervention. Caregivers and physicians of female athletes must remain vigilant in education, recognition, and treatment of athletes at risk.     

Motor inhibition and cognitive flexibility in eating disorder subtypes

Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are complex Eating Disorders (EDs). Even if are considered two different diagnostic categories, they share clinical relevant characteristics. The evaluation of neurocognitive functions, using standardized neuropsychological assessment, could be a interesting approach to better understand differences and similarities between diagnostic categories and clinical subtypes in EDs thus improving our knowledge of the pathophisiology of EDs spectrum. This study explored cognitive flexibility and motor inhibition in patients with AN considering both Restricter and Binge/Purge subtypes, patients with BN and healthy comparisons subjects (HC). Intra-Extra Dimentional Set shifting Test and Stop Signal Task, selected from CANTAB battery, were administered to analyzed set-shifting and motor inhibition respectively. AN patients showed a deficient motor inhibition compared to HC, while no evidence for impaired motor inhibition was found in BN patients; a significant relationship between commission errors in the Stop Signal Task and attentional impulsiveness was found. Moreover, no difference in set-shifting abilities was found comparing all clinician groups and HC. So our results indicated no cognitive impairment in these two cognitive functions in BN patients, while AN and BN showed different performances in motor inhibition. A similar cognitive profile was found in other obsessive compulsive spectrum disorders. Finally, the paper suggests a new interactive approach for the study of cognitive profile in psychiatric disorders; it might be more useful since it is more closely related to the executive functions complexity.     

脊柱推拿对腰椎间盘突出症患者脑功能活动的影响

目的观察脊柱推拿治疗对腰椎间盘突出症患者脑功能活动的影响。方法招募11例腰椎间盘突出症患者，8例受试者完成了研究。所有患者接受6次腰部脊柱推拿治疗，并在脊柱推拿治疗前、后对患者进行颅脑功能核磁共振成像检测，评估患者脑功能活动的改变及与疗效关系。结果4例腰椎间盘突出症患者脊柱推拿治疗有效，4例无效。脊柱推拿有效患者治疗前、后产生视觉模拟评分（VAS）为50分时的疼痛压力值分别为（7.43±1.47）kg和（10.53±0.55）kg（ P < 0.05），而无效患者的则无明显差异（ P＞0.05）。颅脑功能核磁共振成像检测结果提示，脊柱推拿治疗有效患者的脑功能活动以抑制为主，抑制区域主要位于右侧前额叶及小脑区域；而脊柱推拿治疗无效患者的脑功能活动以增强为主。 结论脊柱推拿能够影响腰椎间盘突出症患者的脑功能活动，其治疗有效患者的抑制区域主要在额叶及小脑。     

安军明主任医师治疗小儿周围性面瘫临床经验撷要

安军明主任医师认为小儿脏腑娇嫩,易被邪侵,风邪中络则易导致周围性面瘫,且感冒为其主要诱发因素。该病急性期邪气表浅,变化迅速,治疗以祛浅表之风邪为主,予远端针刺配合耳部贴压揿针治疗;恢复期邪气始衰,正气始复,为治疗关键时期,治宜调和营卫、活血通络、祛邪扶正,予局部浅刺与远端针刺相结合,辅以方氏头针进行头部穴位刺激;后遗症期治宜益气通络、活血补血,治疗仍以针刺为主,配合中药及小儿推拿,疗效显著。附案例1则,以资验证。     

急性胰腺炎早期患者IL-6,TNF,CD_4~ /CD_8~ 的变化及意义

目的揭示重型胰腺炎发病机制和早期监测指标。方法对 12例重型胰腺炎 (SAP) ,15例轻型胰腺炎 (MAP)病人和 13例正常人 (N )的外周血用ELISA法测定IL -6及TNF ;用间接免疫荧光法测定CD4 、CD8 细胞。结果SAP组IL-6水平明显高于MAP组及N组 (P <0 .0 1) ,但MAP组与N组比较无差异 (P >0 .0 5 )。IL -6大于 10 0 pg/ml时预测SAP的敏感性为83 .33 % ,特异性 93 .33 % ;三组间TNF检出率无差异 ;CD4 百分率在SAP组明显下降 (P <0 .0 1)。SAP组IL -6与CD4 百分率呈明显负相关 (r =-0 .6 196 ,P <0 .0 5 )。结论SAP早期IL -6升高和细胞免疫功能抑制可能属其早期反应 ,测定IL -6有助于轻、重型胰腺炎的鉴别     

C-erbB-2癌基因蛋白、EGFR、TGF-β1在胰腺癌组织中的表达及意义

目的了解C-erbB-2癌基因蛋白、表皮生长因子受体(EGFR)、转化生长因子-β1(TGF-β1)在人胰腺癌中的表达情况,探讨其与胰腺癌进展、转移的关系.方法应用SABC染色法对10例正常胰腺(NP)、13例慢性胰腺炎(CP)和36例胰腺导管腺癌(PC)石蜡组织切片进行C-erbB-2蛋白、EGFR,TGF-β1免疫组化染色.结果C-erbB-2蛋白、EGFR在NP中无表达,仅在一例CP中二者均阳性,在PC中阳性率分别为41.7%,50.0%;明显高于NP组和CP组(均P<0.05);TGF-β1在NP组、CP组、PC组阳性率分别为0.0%,7.7%和44.4%,PC组与前两组比较差异有显著性(P<0.05).三种蛋白单独表达与PC者的年龄、性别和肿瘤大小、部位及组织学分级无关(均P>0.05),与临床分期有关(P<0.01);三种蛋白共同阳性率为27.8%,其共同表达与肿瘤组织学分级、临床分期有关.结论检测C-erbB-2蛋白、EGFR和TGF-β1在胰腺组织标本中的表达,对判断胰腺癌的恶性程度、病程进展及转移趋势有参考价值.     

类肝素聚乙烯醇复合材料抗凝血性能的研究

本文报道了聚乙烯醇羧甲醚（ＰＣ）、聚乙烯醇硫酸酯（ＰＳ）及聚乙烯醇接枝甲基丙烯酸β羟乙酯、丙烯腈（ＰＶＡｇＨＥＭＡＡＮ）的合成制备方法。通过红外光谱和元素分析定性、定量证实了合成方法的可行性。研究了将ＰＣ、ＰＳ以不同重量比加入ＰＶＡｇＨＥＭＡＡＮ后形成的聚乙烯醇衍生物复合材料（ＣＤＰＶＡ）对抗凝血性能的影响。（ＣＤＰＶＡ）对人血的溶血度仅为３２％,人血复钙时间比空白对照延长２０２ｓ,凝血时间延长１８５７ｓ。ＳＥＭ观察表明ＣＤＰＶＡ接触血液一定时间后表面没有形成血液蛋白纤维网络,具有微相分离结构。     

肝硬化患者血、尿β2-微球蛋白检测的临床意义

[目的]探讨肝硬化患者血、尿β2-微球蛋白(β2-MG)变化的特点及与肝脏功能的关系.[方法]143例肝硬化患者中按①肝炎后肝硬化、酒精性肝硬化分成两组;②按Child-Pugh分级标准分成三组.用放射免疫法检测143例肝硬化患者及126例正常人血、尿β2-MG浓度,并加以对比分析.[结果]肝硬化患者血清β2-MG较正常对照组明显升高(P<0.01),且与肝脏功能损害程度有相关关系;肝炎后肝硬化组血β2-MG明显高于酒精性肝硬化组(P<0.05).肝硬化患者尿β2-MG较正常对照组明显升高(P<0.01),且与肝脏功能损害程度有相关关系;但肝炎后肝硬化组尿β2-MG与酒精性肝硬化组比较,差异无显著性(P>0.05).[结论]检测血、尿β2-MG有助于肝硬化诊断,可间接反映肝病的活动程度.     

安效先治疗小儿支气管哮喘经验撷萃

安效先教授从事中医临床工作40余年,尤其擅长治疗小儿呼吸系统疾病,在小儿支气管哮喘的中医治疗方面有其独特的疗效。依据小儿生理病理特点,他提出"痰瘀伏肺"是哮喘的夙根,风邪为其发作诱因,哮喘发作期以"祛风、豁痰、化瘀"为大法。小儿"脾常不足"、"肺常虚"在哮喘缓解期表现尤为突出,也是小儿哮喘与成人哮喘最大不同所在,所以小儿哮喘缓解期以肺脾气虚为主要证型,自拟"益肺健脾汤",健脾补肺,益气固表为治疗大法。