对血脂异常人群实施生活方式干预后的观察

目的：探讨生活方式治疗在血脂异常人群中的作用，观察其效果。方法：100例在体检中发现的血脂异常者，随机分为实验组和对照组，对实验组进行生活方式治疗，对照组未进行生活方式治疗，两组均未使用药物降脂，随访6—9个月，平均7．6个月，复查血脂，以检测血脂结果是否达到目标值进行对比。结果：经统计学处理，两组血脂在达到目标值方面存在显著性差异（p〈0．01）。结论：生活方式治疗对血脂异常人群具有明显的防治作用。     

The aging process and potential interventions to extend life expectancy

Aging is commonly defined as the accumulation of diverse deleterious changes occurring in cells and tissues with advancing age that are responsible for the increased risk of disease and death. The major theories of aging are all specific of a particular cause of aging, providing useful and important insights for the understanding of age-related physiological changes. However, a global view of them is needed when debating of a process which is still obscure in some of its aspects. In this context, the search for a single cause of aging has recently been replaced by the view of aging as an extremely complex, multifactorial process. Therefore, the different theories of aging should not be considered as mutually exclusive, but complementary of others in the explanation of some or all the features of the normal aging process. To date, no convincing evidence showing the administration of existing “anti-aging” remedies can slow aging or increase longevity in humans is available. Nevertheless, several studies on animal models have shown that aging rates and life expectancy can be modified. The present review provides an overlook of the most commonly accepted theories of aging, providing current evidence of those interventions aimed at modifying the aging process.     

Extacorporeal shock wave therapy unsuccessful for chronic medial epicondylitis

Medial epicondylitis is a chronic noninflammatory condition resulting from mechanical injury. Despite many treatment options, including rest, medications, physiotherapy and operative interventions, the results are too often poor; thus new treatment options are sought. We treated 4 men with chronic epicondylitis (5 affected joints) with extracorporeal shock wave therapy after failed attempts of other treatments. The patients’ complaints were graded with the Nirschl scoring system prior to and six months after therapy. The treatment consisted of three sessions, at 20-day intervals, of 3000 pulses of ultrasonic shock waves from a Piezolith 3000 unit (energy dosage was gradually increased to reach step 10 equaling 0.9 mJ/mm²). At the 6-month follow-up, no patient was pain free. Three cases had slightly lower Nirschl scores than prior to the procedure but the patients rated this difference as insignificant; two cases were unchanged. No complications were observed but all patients rated the procedure as very unpleasant. The well recognized biologic effects of ultrasonographic waves (heat generation, oscillations, cavitation, etc.) that result in functional and structural changes of cellular membranes with sonochemical reactions (acceleration of normal metabolism, oxygenation and reduction in water solutions, polymer degradation, etc.), even if present in our cases, did not result in a noticeable decrease of symptoms, even though we used high energy and more impulses per session. Significant variations in methodology make inconclusive the results of numerous reports on the use of extracorporeal shock waves in epicondylar degenerative problems, although ineffectiveness of such therapy is the conclusion of a review by Haake and colleagues.     

冠状动脉搭桥术193例经验总结

目的:探讨冠状动脉搭桥术的病例选择、手术方法和治疗效果。方法:回顾性分析1997年1月～至2003年12月齐鲁医院施行的体外循环下冠状动脉搭桥术穴CPBCABG雪99例,非体外循环冠状动脉搭桥术穴OPCABG雪74例,冠状动脉搭桥加瓣膜置换术穴CABG VP雪20例的临床资料。结果:手术死亡6例,死亡率3.1%。体外循环下单纯冠状动脉搭桥术死亡率为2%,非体外循环冠状动脉搭桥术死亡率为2.7%,冠状动脉搭桥加瓣膜置换术死亡率为10%。短期随访3～6个月,症状消失占93.0%,症状明显减轻占5.4%。结论:患者近期随访效果良好,3组的手术死亡率差异无统计学意义穴P>0.05雪。     

低能级体外冲击波碎石治疗肾鹿角形结石

目的探讨低能级体外冲击波碎石(extracorporeal shock wave lithortripsy,ESWL)治疗肾鹿角形结石的效果. 方法对18例鹿角形结石进行体外冲击波治疗.碎石能级1～3级,冲击次数1 800～3 000次,脉冲间隔60 ～80次/min,工作电压10～12.75 kV. 若结石直径>3 cm,在碎石前预先插入双J管,防止石街形成.对直径>4 mm的残余结石,再次行ESWL,直至结石完全消失. 结果所有病人耐受良好,治疗结束能自行回家.除1例碎石失败外,余17例经ESWL治疗成功.治疗3～9次,至完全排除结石.66例次(66/77,85.7%)术后有1～2次肉眼血尿.5例出现石街,长1.9～5.2 cm,4例石街经再次碎石成功,1例输尿管镜取石. 结论低能级ESWL治疗肾鹿角形结石是一种安全、有效的方法.     

Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stonestreet formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm

The incidence of stonestreet formation after extracorporeal shock wave lithotripsy (ESWL) rises with increasing stone burden. However, stonestreet after ESWL is often experienced even in stones smaller than 20 mm. To examine whether the non-contrast helical computed tomography (CT) data could predict stonestreet formation in these stones, 53 radiopaque stones of 5-20 mm treated with ESWL were evaluated. Maximal dimension was measured on plain radiograph. From an attenuation value histogram graphed from the CT data, total stone volume and mean attenuation value were calculated. Seven stonestreets longer than 25 mm developed. There was no significant difference in maximal dimension and total stone volume between stones that did and stones that did not develop stonestreet. Mean attenuation value was the sole significant predictive factor. Application of mean attenuation value with cut-off level of 650 HU would anticipate stonestreet formation with a sensitivity of 85.7% and a specificity of 71.7%. The estimated risk of stonestreet formation is high in the treatment of stones with higher mean attenuation value.     

士兵体能训练卫生规范

以部队装备和士兵体质现状为基础，制定了士兵体能训练卫生规范。《规范》主要规定了以下三部分内容：①部队士兵进行基本体能训练应遵循循序渐进、超负荷训练及适宜恢复等生理卫生要求；耐力、力量和柔韧性训练的方式、强度和时间；体能训练的组织实施等，以使体能训练负荷与机体的生理状态相适应；②体能训练的卫生监督，针对体能训练中可能遇到的医学问题进行监督，能够防止训练伤、过度疲劳及其它医学事故的出现，保障体能训练的顺利进行；③体能训练的医学效果评价。本标准适用于陆军部队士兵基本体能训练。海、空军地勤部队士兵的体能训练亦可参照执行。     

How Can and Do Australian Doctors Promote Physical Activity?

Background.Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice.Methods.A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia.Results.We received a 71% response (n= 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience. Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems.Conclusions.There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors. Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored.     

长期居住海平面后藏族经受急性减压低氧时的体力活动能力

本研究从急性低氧对移居海平面后藏族的体力活动能力的影响来探索藏族的高原低氧适应机制。结果揭示藏族的最大体力负荷强度没有显著下降，最大氧耗和氧脉搏也没有明显变化，动脉血氧饱和度明显高于汉族，这更显示藏族对高原低氧适应机制有独特之处。推测可能是藏族在氧的摄取、传递和释放过程比汉族更有利于对高原低氧环境的适应。