芪黄益气汤煎剂治疗慢性前列腺炎的研究

目的探讨芪黄益气汤煎剂治疗慢性前列腺炎(CP)临床疗效。方法CP患者84例分为芪黄组42例予芪黄益气汤煎剂治疗,清化组42例予清热化瘀煎剂治疗。观察2组CP患者的前列腺液卵磷脂小体、白细胞数、pH值及临床症状的改善情况。结果临床观察芪黄组疗效优于清化组,有显著性差异(P<0.01)。结论以具有益气功效的中药组成的芪黄益气汤煎剂是治疗CP的有效方剂。     

ITERATIVE DYNAMIC PROGRAMMING FOR MINIMUM ENERGY CONTROL PROBLEMS WITH TIME DELAY

This paper presents the use of iterative dynamic programming employing exact penalty functions for minimum energy control problems. We show that exact continuously non-differentiable penalty functions are superior to continuously differentiable penalty functions in terms of satisfying final state constraints. We also demonstrate that the choice of an appropriate penalty function factor depends on the relative size of the time delay with respect to the final time and on the expected value of the energy consumption. A quadratic approximation (QA) of the delayed variables is much better than a linear approximation (LA) of the same for relatively large time delays. The QA improves the rate of convergence and avoids the formation of ‘kinks‘. A more general way of selecting appropriate penalty function factors is given and the results obtained using four illustrative examples of varying complexity corroborate the efficacy of the method.     

Significance of the hepatic mitochondrial redox state in the development of posttraumatic jaundice

The effect of the hepatic energy status on the development of posttraumatic jaundice (PTJ) was studied to clarify the mechanism of PTJ. Fifty-four patients with severe torso injury who were expected to develop PTJ on admission with an average Injury Severity Score of 27 were selected for this study. They were retrospectively divided into three groups according to their maximum bilirubin concentration by day 10: group H, 12 patients with marked elevation of serum bilirubin (>8 g/dl); group L, 23 with mild bilirubinemia (2–8 g/dl); and group N, 19 with no bilirubinemia (<2 g/dl). Group H patients, in whom trauma-related shock was severe and prolonged, developed severe hyperbilirubinemia, and their arterial ketone body ratio (AKBR), which reflects the hepatic mitochondrial redox state and is closely correlated to its energy production, was significantly lower throughout the first week. In contrast, the AKBR increased to an above normal level, indicating enhanced energy production in groups N and L. The serum direct/total bilirubin was also higher in group H. The abnormal hepatic energy metabolism is considered to have reduced the excretion of conjugated bilirubin from the hepatocytes into the bile canaliculi, which is a process that has to proceed against the bilirubin concentration gradient. The subsequent diffusion of the accumulated water-soluble conjugated bilirubin in hepatocytes into the blood is thus considered to be one of the causes of PTJ.     

The poor pay more: Health-related inequality in Thailand

This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care are discussed.     

The Prospective Assessment of Autonomic Nerve Function by Pupillometry in Adolescents with Type 1 Diabetes Mellitus

The study aimed to compare the longitudinal assessment of autonomic nerve function by computerized infrared pupillometry and standard cardiovascular tests in adolescents with diabetes. Adolescents (n = 150) were assessed at two time points (T1 and T2). The median time interval between assessments was 1.5 (range 0.9–3) years. At T1 the median age was 14.5 (range 8.3–19.5) years and the median duration was 6.5 (range 1.1–16) years. The pupillary variables assessed included the resting pupil diameter, the maximum constriction velocity, and the reflex amplitude of constriction. Heart rate reflexes were assessed in response to deep breathing, the Valsalva manoeuvre, and on standing from a lying position (30/15 ratio). Between visits there was a significant decrease in maximum constriction velocity (6.0 mm s^?1 vs 6.3 mm s^?1, p = 0.0001) and resting pupil diameter (6.2 mm vs 6.3 mm, p = 0.001). At reassessment pupillary abnormalities increased from 32 (21 %) to 45 (30%), with 17 (54 %) of the initial abnormalities persisting. Adolescents with abnormally slow maximum constriction velocity compared to those with normal maximum constriction velocity had a higher glycated haemoglobin (HbA_1c%) at T2 (p = 0.02) and between assessments (p = 0.01). Cardiovascular test abnormalities did not increase between visits and the persistence of initial abnormalities was low (21 %). In summary, pupillometry appears a more sensitive test of autonomic nerve dysfunction in adolescents with diabetes than assessment of cardiovascular reflexes.     

眼镜蛇人蛰前、蛰眠期和出蛰后血清激素与能量物质代谢的关系

本文研究眼镜蛇入蛰前、蛰眠期及出蛰后血清 T_3,T_4和皮质醇水平与体内能量物质的含量变化关系,探讨其与蛰眠行为的关系。结果表明入蛰前眼镜蛇大量摄食储能过冬,由于血清激素水平降低,控制了体内组织器官的氧化代谢系统,使新陈代谢逐渐下降。蛰眠期血糖血脂明显下降,耗氧量显著减少,呈节能低代谢状态。此期血清激素水平已升高,但低温抑制了体内代谢。出蛰后血清激素水平明显升高且在春暖升温季节使眼镜蛇代谢率升高。     

Daily nutrient intake represents a modifiable determinant of nutritional status in chronic haemodialysis patients.

BACKGROUND: In maintenance haemodialysis patients, daily food intake is changeable; however, its relationship with nutritional status is unexplored. This study aimed to evaluate the isolated, long-term effect of daily nutrient intake on nutritional status in haemodialysis patients. METHODS: We performed a prospective 1-year controlled study in 27 chronic haemodialysis patients, without recognized risk factors for malnutrition. Each day for 1 week, four times in the year, we measured protein nitrogen appearance, and assessed dietary protein (DPI) and energy (DEI) intake from dietary diaries. We compared the nutritional outcome of patients spontaneously reducing nutrient intake below the threshold of 0.8 g/kg body weight/day for DPI and 25 kcal/kg body weight/day for DEI during the week (LOW, n = 8), with controls at adequate nutrient intake (CON, n = 19). An interventional 6-month study was then carried out in LOW to verify the cause-effect relationship. RESULTS: All patients showed a day-by-day reduction of whole nutrient intake during interdialytic period, which was mostly relevant in the third interdialytic day (L3). During the 1-year study, even in the presence of adequate dialysis dose and normal inflammatory indexes, body weight (68.0 +/- 5.5 to 65.8 +/- 5.9 kg), serum albumin (3.96 +/- 0.07 to 3.66 +/- 0.06 g/dl) and creatinine (9.2 +/- 1.1 to 8.1 +/- 0.7 mg/dl) significantly decreased in LOW but not in CON. Diaries evidenced in LOW a reduced number of meals at L3 that was explained by the fear of excessive interdialytic weight gain. During the interventional study, daily DPI and DEI increased at L3; this was associated with a significant increment of body weight, and serum albumin and creatinine levels. CONCLUSIONS: In maintenance haemodialysis patients the persistent, marked reduction of daily nutrient intake, even if limited to a single day of the week, is an independent determinant of reversible impairment of nutritional status.     

医院建筑的电气节能设计探讨

阐述了节能建筑的特点,分析了建筑节能设计规程及标准的特点,并结合中国的资源状况和北京的能耗现状,论述了医院建筑电气专业的具体设计做法。     

Influence of stretch-shortening cycle on mechanical behaviour of triceps surae during hopping

Belli , A. & Bosco, A. 1992. Influence of stretch-shortening cycle on mechanical behaviour of triceps surae during hopping. Acta Physiol Scand 144 , 401408. Received 20 March 1 991 , accepted 3 December 1991. ISSN 0001–6772. Laboratories of Physiology, Universities of St Etienne and Lyon, France and Departments of Biology and Physical Activity, University of Jyväskylä, Finland. Six subjects performed a first series of vertical plantar flexions and a second series of vertical rebounds, both involving muscle triceps surae exclusively. Vertical displacements, vertical forces and ankle angles were recorded during the entire work period of 60 seconds per series. In addition, expired gases were collected during the test and recovery for determination of the energy expenditure. Triceps surae was mechanically modelled with a contractile component and with an elastic component. Mechanical behaviour and work of the different muscle components were determined in both series. The net muscular efficiency calculated from the work performed by the centre of gravity was 17.5±3.0% (mean ± SD) in plantar flexions and 29.9 ± 4.8% in vertical rebounds. The net muscle efficiency calculated from the work performed by the contractile component was 17.4 %% 2.9% in plantar flexions and 16.1 ± 1.47; in vertical rebounds. These results suggest that the muscular efficiency differences do not reflect muscle contractile component efficiency but essentially the storage and recoil of elastic energy. This is supported by the relationship (P < 0.01) found in vertical rebounds between the extra work and the elastic component work. A detailed observation of the mechanical behaviour of muscle mechanical components showed that the strategy to maximize the elastic work depends also on the force-velocity characteristics of the movement and that the eccentric-concentric work of the contractile component does not always correspond respectively to the ankle extension-flexion.     

Prevention of ischemia-reperfusion injury by metabolic substrate—Mechanisms and surgical implications

Summary Background Despite new insights into mechanisms contributing to ischemia-reperfusion injury, new therapeutic interventions to reduce ischemia-reperfusion injury have thus far not been available for routine clinical use. In order to restore sufficient postischemic contractile function, such a therapy would be of great value in conjunction with reperfusion therapy for acute myocardial infarction and after cardiac surgery. This paper examines whether metabolic disturbances and energy depletion contribute to ischemia-reperfusion injury and whether metabolic interventions could alleviate ischemia-reperfusion injury. Methods Experimental and clinical studies are reviewed for evidence of a beneficial effect of metabolic interventions, in particular of increased glycolytic substrate, on ischemia-reperfusion injury. Results During ischemia, metabolism of the myocardium shifts to a preferential use of carbohydrates. Increased glycolytic substrate i.e. glucose-insulin-potassium infusion as metabolic support for ischemic myocardium is beneficial in reducing ischemia-reperfusion injury by increasing energy production via anaerobic glycolysis, decreasing circulating free fatty acids and intracellular free fatty acid accumulation, maintaining ion homeostasis, reducing cellular edema, and scavenging free radicals. During reperfusion, glucose-insulin-potassium, apart from increasing glycolysis and decreasing free fatty acid metabolism, provides substrate for replenishment of the citric acid cycle, which is important for optimal energy transfer. Conclusions During ischemia, glucose-insulin-potassium preserves energy reserves and maintains cell viability. During reperfusion, glucose-insulin-potassium improves energy transfer and increases contractile function. Experimental and clinical studies have proven glucose-insulin-potassium to be a safe and effective intervention to reduce ischemia-reperfusion injury.