针刺对急性肺系感染临床退热初探

针刺合谷、肺俞、大椎、膻中等穴，对１４２例急性肺系感染之发热患者的临床退热观察。结果表明，针刺后２０分钟内体温下降至正常或＞１．５℃者８４例，下降＞０．５～１．４℃者４６例；针刺后１０分钟内体温下降者１３０例，１０～２０分钟下降者１２例，体温下降幅度在１０分钟已达高峰；卫气证候体温下降幅度优于营血证候体温下降幅度（Ｐ＜０．０５）。证明针刺有肯定的退热效果。     

Electrogastrography in Healthy Children Evaluation of Normal Values, Influence of Age, Gender, and Obesity

Electrogastrography (EGG) is a reliabletechnique to record gastric electrical activity.However, the normal values of electrical activity inchildren and the effects of age, gender, and body massindex (BMI) are not well defined. To evaluate theseitems, EGG signal was picked up before and after a mealin 114 healthy children (age range: 6-12 years) by meansof a pair of cutaneous electrodes sonographically placed on the abdominal surface. The dominantfrequency was prevalently found in the 2.0-4.0 cpm range(P < 0.001). A significant difference was foundcomparing the pre- and postprandial instability coefficient of dominant frequency (P <0.05). The EGG power increased postprandially (powerratio = 3.6), and the power ratio was not correlated tothe approach of the wall of the gastric antrum to the abdominal surface (Spearman r = 0.0045,NS). In obese children, the postprandial pattern inresponse to a mixed test meal containing carbohydrate asthe major caloric source was similar to that recorded in normal-weight children. EGG parameters werenot affected by age and gender apart from a significantdifference in the postprandial instability coefficientobtained from the girls 9 years groupcompared to the girls <9 years andboys 9 years groups (P < 0.05). Inconclusion, in children 6-12 years old, EGG parametersare not affected by BMI in response to a mixed testmeal. Gastric electrical rhythm and rate, and gastric power are notinfluenced by age and gender, whereas the instabilitycoefficient seems to be influenced by these factors. Thenormal values of the EGG parameters evaluated in this study should be introduced in the analysisof gastric electrical activity for an effectiveinterpretation of the EGG signal from children withfunctional or organic diseases.     

Leptin and HDL-Cholesterol in Non-Diabetic Normotensive Subjects

Background: We investigated the relationships between body mass index (BMI), serum leptin and serum HDL-cholesterol. Material and Methods: A retrospective study was carried out in 80 patients who did not have type 2 diabetes mellitus and/or high blood pressure. Results: Both serum leptin and HDL-cholesterol serum levels correlated with BMI (r = 0.616 and r = -0.269, respectively), but when the BMI values were kept constant no correlation was found between serum leptin and HDL-cholesterol both in simple and in multiple regression. Conclusion: The findings suggest that serum leptin concentration is completely independent of lipid metabolism.     

Appearance Self-Esteem in Systemic Sclerosis

Although disease- and/or treatment-relatedchanges in physical appearance accompany many illnesses,the relationship of these physical changes to appearanceselfesteem and overall psychological adjustment has received little attention in the literature. Inthis study, subjects were 93 persons with diagnoses ofsystemic sclerosis, a chronic and progressive rheumaticdisease characterized by physical changes, especially skin thickening. Subjects receivedclinical examinations of skin thickening and providedself-reports via questionnaires of theirappearance-related self-esteem and overall psychologicaldistress. Results showed that disease-related physicalchanges were related to appearance self-esteem. Stepwisemultiple regression analysis found skin thickening ofthe righthand and fingers to be the strongest predictors of appearance self-esteem. Appearanceself-esteem was examined as a possible moderator ormediator of the relationship between skin thickening andpsychological distress. Results did not support amoderator role for appearance self-esteem; however,appearance self-esteem met statistical criteria as amediator of the relationship between skin thickening anddistress. Interestingly, results differed for thediffuse and limited subtypes ofsystemicsclerosis,suggesting that physical changes associatedwith disease may have stronger relationships withself-esteem and overall adjustment in the context ofless serious illnesses.     

Changes in Body Composition, Metabolic Profile and Nutritional Status 24 Months after Gastric Banding

Background: Laparoscopic adjustable gastric banding (LAGB) causes significant weight loss in morbidly obese adults. However, its consequences on nutritional status still remain unclear. This study aimed to investigate the effects of LAGB on body composition, metabolic profile and nutritional status in obese, premenopausal women. Methods: 36 obese, premenopausal women (age 24-52 years; mean BMI 43.8 kg/m²) who underwent LAGB were included. Body composition was measured using dual-X-ray absorptiometry at baseline, 6, 12 and 24 months after surgery. Blood pressure, total cholesterol, HDL-cholesterol, triglycerides, glucose, uric acid, total proteins, iron, ferritin, vitamin B₁₂, folic acid, hemoglobin and mean corpuscular volume were measured at baseline, 6, 12, 18 and 24 months after surgery. Results: All patients lost weight over 24 months (range 16.0-71.9 kg): there was a significant loss of fat mass (−51.4%; P<0.0001) as well as of fat-free mass (−13.1%; P<0.0001). There was a significant improvement in blood pressure, glucose, total cholesterol, HDL-cholesterol, triglycerides and urates during the first year; during the second year, a further significant decline was noted only in glucose and urates. According to ATP III criteria, 21 of our patients (58%) had a metabolic syndrome before surgery, but only 9 of them (25%) after 12 months and 1 of them (3%) after 24 months. No nutritional deficiency was noted, except for a significant decrease in serum folate (44.1%; P<0.0001 between baseline and month 24). Conclusion: LAGB allows significant improvements in metabolic profile, especially during the first postoperative year, without causing major nutritional deficiencies, except for folates.     

One-Year Changes in Energy Expenditure and Serum Leptin Following Adjustable Gastric Banding in Obese Women

Background: Weight loss is associated with a decrease in both energy expenditure and circulating leptin levels. Whether this holds true when the influence of body composition on energy expenditure and leptin is taken into account remains controversial. The aim of the study was to assess changes in resting metabolic rate (RMR) and serum leptin adjusted for body composition during surgically induced weight loss. Methods: In 36 women (age 42.7±8.7 years; BMI 47.2±8.5 kg/m²; mean±SD) undergoing laparoscopic adjustable gastric banding (LAGB) for morbid obesity, we measured RMR (by indirect calorimetry), body composition (by dual-energy X-ray absorptiometry) and serum leptin (by immunoradiometry), immediately before and 1 year after surgery. Results: 1 year after LAGB, there were significant decreases in body weight (−23.7±11.6 kg, P<0.001), fat mass (FM: −20.9±11.3 kg, P<0.0001), lean body mass (LBM: −3±5.3 kg, P=0.005), RMR (−298±309 kcal/day, P<0.0001), serum leptin (−24.0±18.4 ng/ml, P<0.0001), RMR/LBM ratio (−3.9±5.8 kcal/kg LBM/day, P<0.01) and leptin/FM ratio (−0.21±0.29 ng/kg FM/ml, P<0.001). RMR values after surgery were correctly predicted by the regression equation relating RMR to LBM and FM at baseline, whereas this was not the case for serum leptin (in relation to FM). Conclusions: Changes in RMR 1 year after LAGB were explained by changes in body composition whereas changes in serum leptin were not. The data provide no evidence for a metabolic adaptation of RMR with weight loss, but suggest that serum leptin is decreased beyond expected values based on body composition, a factor that may favor weight regain after surgically induced weight loss.     

Weight Loss Composition: The Effects of Exercise following Obesity Surgery as Measured by Bioelectrical Impedance Analysis

Background: Sudden weight loss following bariatric operations for morbid obesity, such as the duodenal switch (DS), can result in a concurrent decrease in lean body mass. Several methods for tracking body composition, such as bioelectrical impedance analysis (BIA), are available to monitor these changes. One method to offset the negative effects of sudden weight loss on body mass composition may be exercise. Methods: 100 patients who had undergone the DS operation for morbid obesity were classified as exercisers and non-exercisers based on self-reporting. Their body mass compositions were measured using BIA preoperatively and at 0.75, 1.5, 3, 6, 9, 12, and 18 months postoperatively. Results: At no study interval did postoperative percent changes in weight loss differ between the exercise and non-exercise groups. At 18 months postoperatively, the exercise group showed a 28% higher loss of fat mass and an 8% higher gain in lean body mass than the non-exercise group. Conclusion: Exercise positively influences body mass composition following the DS. BIA can be successfully employed to monitor changes, diagnose deficiencies, and formulate treatment recommendations.     

The Early Effects of Weight Loss Surgery on Regional Adiposity

Background: Weight loss beyond 6 months following laparoscopic adjustable gastric banding (LAGB) is associated with a preferential mobilization of visceral adipose tissue and an improvement in insulin sensitivity in insulin resistant subjects. Because the rate of weight loss is greatest in the first 3 months after LAGB, we investigated the impact of LAGB on changes in regional lipid deposition and insulin sensitivity over this period. Methods: 10 female obese non-diabetic subjects underwent magnetic resonance (MR) imaging and spectroscopy before and 12 weeks after LAGB (using the Swedish band), for the quantification of abdominal subcutaneous and visceral adipose tissue areas and intrahepatic lipid. Fasting blood free fatty acids were analyzed. Insulin sensitivity was monitored by fasting insulin and homeostasis model assessment (HOMA). Results: Median weight loss 12 weeks after gastric banding was 9.5 kg [interquartile range (IQR): −16.5 to −6]. There were significant reductions in median abdominal subcutaneous (−20% [IQR: −24 to −13]) and visceral (−15% [IQR: −49 to −8]) adipose tissue depots as well as plasma free fatty acids (−34% [IQR: −79 to −8]). The amount of weight lost was directly proportional to the initial BMI (r=0.778; P=0.008). Visceral fat loss was proportional to initial visceral adiposity (r=0.80, P=0.01). There was no significant improvement in insulin sensitivity. Conclusion: Significant fat loss occurs 3 months after LAGB. The absence of a concurrent improvement in insulin sensitivity may reflect the relatively small reduction in visceral adipose tissue at this stage. Improvement in insulin sensitivity beyond 3 months after LAGB may be due to the continued loss of visceral adipose tissue.     

Estimating Ideal Body Weight – A New Formula

A simple formula for estimating ideal body weight (IBW) in kilograms for both men and women is presented. The equation IBW = 22 × H², where H is equal to patient height in meters, yields weight values midway within the range of weights obtained using published IBW formulae.     

Improvement of Vertical Banded Gastroplasty by Strict Dietary Management

Background: Vertical banded gastroplasty (VBG) has been found to reduce BMI significantly during the first postoperative year. However, the same trend in weight loss has not been established thereafter.The purpose of this study was to evaluate the effects of our dietary program on morbidly obese patients treated with VBG. Methods: A prospective evaluation of 40 obese patients (25 female, 15 male) undergoing VBG over a 3-year period was undertaken. Results: The age range was 24-57 (median 38) years, mean weight 133±2 SD kg, and mean BMI 45±6.4 SD kg/m2. After VBG, a special follow-up program was applied to patients. All patients (100%) were available for follow-up. Operative mortality was zero. 4 patients developed an early postoperative complication, and 1 patient was re-operated because of staple-line disruption 8 months after VBG. BMI decreased to 34±3.2 after 12 months, 27±1.3 after 24 months, and 28±1.4 after 36 months. All patients showed weight loss after VBG, and the weight loss continued with the strict follow-up program during a 3-year period, except in 1 patient who regained the weight lost despite an intact staple-line and stoma. Conclusion: Our policy for patients after VBG appears to be effective.