中药膳食配合运动干预对肥胖性脂肪肝的影响

目的探讨中药膳食配合运动干预对肥胖性脂肪肝的影响.方法将68例脂肪肝患者随机分为对照组和观察组各34例.对照组常规给予低脂饮食和易善复、大黄庶虫丸等降酶保肝治疗;观察组按常规方法治疗外,采用中医辨证施食予以活血化淤、健脾利湿的中药膳食疗法配合运动干预,疗程均为1年.结果治疗后观察组体重、甘油三酯、总胆固醇、谷丙转氨酶等显著低于对照组(均P<0.01).结论中药膳食配合运动干预对肥胖性脂肪肝疗效显著.     

生活方式干预对单纯肥胖性脂肪肝预后的影响

目的探讨生活方式干预对单纯肥胖性脂肪肝患者预后的影响。方法将124例单纯肥胖性脂肪肝患者随机分为观察组（66例）和对照组（58例）。对照组予常规降脂治疗，观察组在此基础上进行生活方式干预，包括健康教育、饮食与运动行为干预、记生活日记等，干预3个月后进行效果评价。结果观察组干预后减重效果、脂肪肝程度、肝功能恢复及血脂下降程度显著优于对照组（均P〈0．01）。结论生活方式干预能使患者建立良好的饮食与运动行为习惯，全面降低对患者预后不利的影响。     

生活方式干预对单纯肥胖性脂肪肝预后的影响

目的探讨生活方式干预对单纯肥胖性脂肪肝患者预后的影响.方法将124例单纯肥胖性脂肪肝患者随机分为观察组(66例)和对照组(58例).对照组予常规降脂治疗,观察组在此基础上进行生活方式干预,包括健康教育、饮食与运动行为干预、记生活日记等,干预3个月后进行效果评价.结果观察组干预后减重效果、脂肪肝程度、肝功能恢复及血脂下降程度显著优于对照组(均P<0.01).结论生活方式干预能使患者建立良好的饮食与运动行为习惯,全面降低对患者预后不利的影响.     

中药治疗单纯性肥胖患儿的家庭护理干预

目的探讨中药治疗单纯性肥胖患儿的家庭护理干预方法及效果。方法将50例服用自制中药减肥口服液的单纯性肥胖患儿随机分为干预组和对照组各25例。对照组予常规护理；干预组在此基础上，从饮食、运动、睡眠、心理行为方面给予3个月的家庭护理干预。结果干预组治疗效果显著优于对照组，干预3个月后BMI显著低于对照组（均P〈0．01）。结论家庭护理干预在中药治疗儿童单纯性肥胖中起到重要的强化作用，有利于患儿康复。     

中药治疗单纯性肥胖患儿的家庭护理干预

目的 探讨中药治疗单纯性肥胖患儿的家庭护理干预方法及效果.方法 将50例服用自制中药减肥口服液的单纯性肥胖患儿随机分为干预组和对照组各25例.对照组予常规护理;干预组在此基础上,从饮食、运动、睡眠、心理行为方面给予3个月的家庭护理干预.结果 干预组治疗效果显著优于对照组,干预3个月后BMI显著低于对照组(均P＜0.01).结论 家庭护理干预在中药治疗儿童单纯性肥胖中起到重要的强化作用,有利于患儿康复.     

肥胖与中青年舒张期高血压关系

目的:肥胖与中青年舒张期高血压的发生、发展及转归呈正相关。方法:80例单纯舒张期增高的中青年患者随机分为两组,对照组常规药物治疗,治疗组在常规治疗的基础上配合辅助运动,科学膳食减肥治疗。观察两组治疗前后体重指数(BMI)及血压达标情况。结果:治疗组总有效率95%,对照组总有效率47.5%。结论:肥胖与中青年舒张期高血压的发生、发展及转归呈正相关。     

中西结合治疗配合护理干预反复发作性上呼吸道感染

目的:观察中西医结合治疗配合护理干预反复发作性上呼吸道感染的疗效.方法:将患者随机分为观察组和对照组,观察组在采用阿奇霉素注射液治疗的基础上联合应用中药治疗并配合护理干预,对照组采用阿奇霉素注射液治疗和常规护理,7d后对比两组疗效.结果:观察组起效时间和症状消失时间明显少于对照组(P＜0.05)两组治疗费用相当.结论:在西药治疗的基础上加用中药口服治疗配合护理干预反复发作性上呼吸道感染效果良好,治疗费用未明显升高.     

循经刮痧与微信运动用于痰湿体质单纯性肥胖人群的干预效果

目的分析循经刮痧结合微信运动对痰湿体质单纯性肥胖人群的干预效果,为临床单纯性肥胖患者的健康管理提供思路。方法将80例痰湿体质单纯性肥胖患者随机分为两组各40例。对照组采用微信运动配合饮食调整及常规健康宣教进行干预,观察组在此基础上施以循经刮痧。分别在干预前,干预12周后比较两组的体质量、腰围、体重指数、中医痰湿体质评分、总胆固醇、甘油三酯、低密度脂蛋白。结果干预12周后,观察组体质量、腰围、体重指数、总胆固醇、中医痰湿体质评分显著优于对照组(P 0. 05,P 0. 01)。结论循经刮痧结合微信运动更能降低痰湿体质单纯性肥胖患者的体质量、腰围、体重指数、中医痰湿体质评分。     

综合护理干预对颈动脉型颈椎病患者的影响

目的探讨综合护理干预对职业人员颈动脉型颈椎病患者的影响。方法将102例患者随机分为观察组和对照组各51例。对照组采用常规治疗护理，观察组在此基础上加用认知干预、心理干预、日常生活行为干预及运动疗法干预等，6个月后行效果评价。结果观察组干预后颈性眩晕症状与功能评分显著优于对照组（均P〈0．01）；椎基底动脉血流调节效果显著优于对照组（均P〈0．01），总有效率显著高于对照组（P〈0．01）。结论日常生活行为干预、颈椎操等综合护理干预措施能有效改善职业人员颈动脉型颈椎病患者症状，达到提高疗效的目的。     

手术配合中药坐浴治疗陈旧性肛裂80例临床观察

为寻求治疗陈旧性肛裂可靠、效果满意的方法,将80例Ⅱ、Ⅲ期陈旧性肛裂患者随机分为两组,治疗组42例采用手术配合中药坐浴、缩肛运动治疗,对照组38例采用手术配合1：5000PP液坐浴治疗,观察两组疗效。结果显示,两组创口愈合时间差异有统计学意义（P〈0．05）,治愈率均为100％（P〉0．05）。均未出现肛门失禁及肛门功能障碍。结果表明,肛裂切除并扩肛术,配合中药冰朴散坐浴、缩肛运动治疗,减轻了患者术后痛苦,加快了创口愈合。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

Intraoperative autotransfusion is associated with modest reduction of allogeneic transfusion in prosthetic hip surgery

Background: The efficacy of intraoperative salvage and washing of wound blood and the predictors of allogeneic red cell transfusions in prosthetic hip surgery are insufficiently known.
Methods: In 96 patients, undergoing primary or revision surgery, salvaged and washed red cells and, if necessary, allogeneic blood were used to keep haematocrit not lower than 33%. The bleeding of red cells during hospital stay was calculated from the red cell balance. The preoperative red cell reserve (millilitres of red cells in excess of a haematocrit of 33%) was estimated and the difference between this volume and the total bleeding of red cells was retrospectively used to classify patients with regard to the need for red cells. Stepwise regression analysis was used to define patient-related variables associated with allogeneic blood transfusion.
Results: Preoperative knowledge of the type of operation (primary, revision), the preoperative red cell reserve, and the body mass could predict roughly half of the need for banked blood (r²=0.45). Only one-third of the total bleeding of red cells was retransfused. For complete avoidance of allogeneic blood, autotransfusion was most effective in patients with a moderate need (0–4 u). However, 32% of such patients required allogeneic blood.
Conclusions: Autotransfusion has a limited efficacy to decrease the need for allogeneic blood, and other blood-saving methods should be added for this purpose. It is difficult to predict the need for allogeneic blood preoperatively.     

缺氧对肾小管上皮细胞分泌外泌体的影响

目的    观察缺氧对肾小管上皮细胞分泌外泌体的影响,探讨外泌体在缺氧致肾脏损伤中的作用及机制。 方法    （1）常氧（21% O₂）及缺氧（1% O₂）分别处理大鼠肾小管上皮细胞（NRK-52E）48 h,收集细胞上清液并使用高速梯度离心法分离外泌体。采用透射电镜、纳米示踪分析、Western印迹、蛋白浓度定量鉴定并比较两组外泌体的基本特性。（2）在共培养实验中,以不同浓度（1、10、50、100、300 mg/L）的常氧外泌体、缺氧外泌体分别干预脂多糖（LPS）诱导的大鼠原代腹腔巨噬细胞,使用实时荧光定量PCR与酶联免疫吸附试验（ELISA）法分别检测巨噬细胞白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、诱导型氮氧化物合酶（iNOS）水平;使用Western印迹法检测巨噬细胞磷酸化（p）STAT/STAT及细胞因子信号传导抑制蛋白1（SOCS1）的蛋白表达;最后,使用实时荧光定量PCR法检测常氧外泌体与缺氧外泌体中炎性反应相关微RNA（microRNA,miR）的表达差异。 结果    （1）离心得到的囊泡具有外泌体典型的结构,粒径小于150 nm,表达外泌体标志蛋白CD63,说明分离得到外泌体。缺氧对肾小管上皮细胞分泌的外泌体形态、粒径分布比例无明显影响,但提高了外泌体的分泌量。（2）缺氧外泌体相比于常氧外泌体促进了LPS诱导的M1型巨噬细胞IL-6、TNF-α、iNOS 的表达和分泌（均P＜0.01）,同时提高STAT的磷酸化水平并减少SOCS1的蛋白表达（均P＜0.01）;对炎性反应相关microRNA检测发现缺氧外泌体中miR-155、miR-27a表达量较常氧外泌体明显升高（P＜0.05）。 结论    缺氧可改变外泌体的生物学功能,表现为协同促进LPS诱导的M1型巨噬细胞的表型转化,这可能是慢性肾脏病微炎性反应状态持续的原因之一。     

In Vitro Function and Durability Assessment of a Novel Polyurethane Heart Valve Prosthesis

Abstract While flexible-leaflet, central-flow prosthetic heart valves promise relief from anticoagulation therapy, they continue to be restricted by inadequate durability. In consequence, a novel trileaflet valve, made entirely from polyurethane, has been developed. A batch of 6 consecutively manufactured polyurethane valves was subjected to hydrodynamic function and accelerated fatigue testing. Computerized data acquisition and control systems have been introduced to improve valve testing methodologies. In terms of hydrodynamic function, the polyurethane valve demonstrates transvalvular pressure gradients similar to those for a bioprosthetic valve (Carpentier-Edwards) and levels of retrograde flow significantly less than those for either the bioprosthetic valve or a bileaflet mechanical valve (St Jude Medical). The equivalent of 10 years of cycling without failure has been exceeded by all 6 polyurethane valves in accelerated fatigue tests with 2 valves remaining intact after 674 million cycles (equivalent to approximately 17 years) in continuing tests. Highspeed photography revealed considerable differences in leaflet motion between valves cycled at accelerated and physiological rates.     

Negative pressure ventilation vs. spontaneous assisted ventilation during rigid bronchoscopy: A controlled randomised trial

Background: Ventilation during interventional rigid bronchoscopy (IRB) under general anaesthesia (jet ventilation, positive pressure ventilation and spontaneous assisted ventilation) may offer some difficulties. This study compares the effectiveness during IRB of intermittent negative pressure ventilation (INPV) and spontaneous assisted ventilation (SAV). Methods: Thirty-eight patients submitted to IRB were randomised into two groups: SAV or INPV. All patients received a total intravenous anaesthesia; INPV patients were paralysed. Pre-and intra-operative arterial blood gases and O₂ flow through a rigid bronchoscope were assessed. The endoscopist applying a subjective score evaluated the operating conditions. Results: Patients of the INPV group, as compared to the SAV group, required a lower dosage of fentanyl (2.6 ± 1.8 (μg · kg^?1· h^?1 vs. 6.6 ± 4.8 μg · kg^?1· h^?1), a lower O₂ supply (3.3 ± 2.8 1/min vs. 11.6 ± 3.4 1/min), a shorter recovery time (5.4 ± 2.9 min vs. 9.8 ± 7.1 min) and no manually assisted ventilation (0 ± 0 vs. 1 ± 1.1 nd?/procedure). Intraoperative PaCO₂ was higher in the SAV (8.1 ± 1.3 kPa) than in the INPV group (5.0 ± 1.6 kPa) and intraoperative pH differed in the two groups (7.26 ± 0.05, SAV vs. 7.47 ± 0.08, INPV). Operating conditions, as assessed by a subjective score, were considered better with INPV than with SAV (4.9 vs. 4.3). Conclusions: As compared to SAV, INPV in paralysed patients during IRB reduces administration of opioids, shortens recovery time, prevents respiratory acidosis, excludes the need for manually assisted ventilation, reduces 02 need and affords optimal surgical conditions. INPV appears a safe, non-invasive and effective ventilatory management during IRB.