医生的探索与发现

临床工作中有着许多未知、疑难问题,这就是医生们探索与发现的起点。通过对桂希恩等多位医学专家临床探索发现事例的分析,得到许多启示,指出临床探索发现是一个系统的科学活动过程,也是临床决策的重要组成部分;找到客观存在的事物或规律,有利于疾病的诊治,充满了大医精诚精神;有利于人才培养,医学创新和进步,应予大力提倡和鼓励。     

平板运动试验结合颈动脉斑块检测诊断冠心病

探讨平板运动试验(TET)结合颈动脉斑块检测在诊断冠心病的临床意义。对166例疑诊冠心病患者进行冠状动脉造影(CAG),TET,颈动脉斑块检查,以CAG的诊断结果为金标准,分析TET,颈动脉斑块检查,TET结合颈动脉斑块检查诊断冠心病的敏感度、特异度。比较三者诊断冠心病的敏感度、特异度。三者敏感度分别为71.4%、64.3%、96.0%。特异度分别为65%、60.0%、82.4%。后者较前两者敏感度、特异度P<0.05。TET结合颈动脉斑块检查可显著提高冠心病的诊断率,不失为CAG前的筛选方法。     

The time course effect of moderate intensity exercise on response execution and response inhibition

This research aimed to investigate the time course effect of a moderate steady-state exercise session on response execution and response inhibition using a stop-task paradigm. Ten participants performed a stop-signal task whilst cycling at a carefully controlled workload intensity (40% of maximal aerobic power), immediately following exercise and 30 min after exercise cessation. Results showed that moderate exercise enhances a subjects’ ability to execute responses under time pressure (shorter Go reaction time, RT without a change in accuracy) but also enhances a subjects’ ability to withhold ongoing motor responses (shorter stop-signal RT). The present outcomes reveal that the beneficial effect of exercise is neither limited to motor response tasks, nor to cognitive tasks performed during exercise. Beneficial effects of exercise remain present on both response execution and response inhibition performance for up to 52 min after exercise cessation.     

民航飞行员冠状动脉粥样硬化情况调查及特点分析

心血管事件成为威胁民航飞行安全的主要因素之一.为更及时地发现飞行员冠状动脉病变,提高用无创性常规辅助检查预测飞行员冠状动脉粥样硬化的准确性,对105例飞行员进行血脂、血压、血糖、体重指数、颈动脉彩色多普勒超声检查、运动负荷心电图试验以及64排双源CT冠状动脉造影检查.比较颈动脉粥样硬化与运动负荷心电图试验阳性、高危因素对冠状动脉预测的敏感性和特异性.飞行员的职业特点可能使其冠状动脉粥样硬化早于其他血管床,危险因素较其他辅助检查可能更具意义,必须综合分析各项检查才可能更准确地预测飞行员冠状动脉病变.     

EFFECTS OF A VARIABLE-RATIO REINFORCEMENT SCHEDULE WITH CHANGING CRITERIA ON EXERCISE IN OBESE AND NONOBESE BOYS

The effects of a variable-ratio schedule of reinforcement on pedaling a stationary exercise bicycle were examined. Three obese and three nonobese 11-year-old boys were individually tested five times weekly for approximately 12 weeks. A changing-criterion design was used in which each successive criterion was increased over mean performance rate in the previous phase by approximately 15%. The contingencies of the successive criteria resulted in systematic increases in rate of exercise for all children. Final variable-ratio rates were higher than those under fixed ratios found in previous research, with rates for 2 of the 3 obese boys approximating those of the nonobese.     

The Use of a Personal Trainer to Enhance Participation of Older Adults with Severe Disabilities in a Community Water Exercise Class

Inclusive instruction was provided for three older adults with profound mental retardation in a water exercise class at a local YMCA. The older adults were taught to exercise through the use of systematic prompting. A multiple baseline design across participants with an embedded reversal was used to evaluate the impact of a personal trainer. The three participants performed the exercise, but regressed without the assistance of the trainer, as demonstrated by the reversal. Data collected during peer prompting and maintenance conditions indicated that the participants continued to exercise at levels higher than baseline but lower than with a personal trainer.     

CONTINGENT EXERCISE: A MILD BUT POWERFUL PROCEDURE FOR SUPPRESSING INAPPROPRIATE VERBAL AND AGGRESSIVE BEHAVIOR

Two single-subject experiments were conducted in public school classrooms for severely emotionally disturbed children. Both experiments investigated the effects of a treatment requiring a child to exhibit a simple exercise task after a verbal or aggressive response, using reversal and multiple-baseline designs. The independent variable, contingent exercise, required standing up and sitting on the floor five to ten times contingent on an inappropriate behavior. It was found that contingent exercise was easy to carry out, and following it, the child quickly returned to the learning task that had been interrupted by the inappropriate behavior. The contingent exercise procedure required a minimum of prompting or manual guidance. Although contingent exercise was not topographically related to the inappropriate response, it decreased those responses dramatically. The results suggested that contingent exercise was not only more powerful than DRO but also could be administered independently. It was concluded that contingent exercise may constitute an alternative procedure that can be used by therapists confronted with severely abnormal behaviors. It would appear to be particularly relevant in settings where procedures such as timeout and painful consequences find restricted use. Finally, a number of guidelines have been proposed as a safeguard against the misuse of this mild but powerful procedure.     

Motivos de los ciudadanos para realizar ejercicio físico: un estudio desde la teoría de la autodeterminación

Based on self-determination theory, the objective of this study was to analyze the relationship between the reasons for exercise and its reported weekly frequency in a representative sample of an adult urban population. A total of 918 inhabitants, aged between 16 and 89, participated in this study answering the Spanish version of the Exercise Motivations Inventory-2 (EMI-2) and reporting on their exercise frequency. Controlling for the influence of age and gender, multivariate analysis of covariance (MANCOVA) showed that participants who reported the highest exercise frequency had the highest score on both self-determined and controlling exercise motives, except the ill-health avoidance motive. The results support propositions of self-determination theory, and suggest that citizens may internalize exercise behaviour as they become more physically active. However, the results also suggest that some controlling motives are pertinent to exercise. Decision makers of the local sport policy should look into suitable ways of combining both controlling motives and more internalized motives in order to produce long lasting exercise adherence in citizens.     

Influence of Accelerometer Placement and/or Heart Rate on Energy Expenditure Prediction during Uphill Exercise

Studies using a triaxial accelerometer and heart rate (HR) simultaneously for estimating energy expenditure (EE) during uphill exercise are rare. Exploring the optimal location for placing the accelerometer for predicting EE during uphill exercise is essential. Sixteen healthy male participants (M ± SEM; age 25.00 ± 0.61 years; body weight 74.13 ± 2.51 kg; body height 1.74 ± 0.01 m; body mass index 24.30 ± 0.63 kg/m²) exercised on a treadmill under 12 conditions (4 speeds and 3 gradients) on 3 days. Triaxial accelerometers, an HR recorder, and a metabolic measurement system were simultaneously used. Accelerometer outputs from various anatomical locations (upper arm, chest, lower back, waist, thigh, and instep) showed significant positive correlations with EE (0.819, 0.846, 0.816, 0.820, 0.672, and 0.669, respectively; p < .05). The linear regression equation for changes in HR showed the highest coefficient of determination (r²) of .837 with 87.9% reliability. When the HR signal was included, the r² value (> .842) and reliability (87.9%) between the accelerometer outputs and EE improved. Accelerometer outputs from the waist position alone provide highly accurate EE values. Using both accelerometer outputs and HR for EE estimation during uphill exercise is feasible and improves the accuracy of EE prediction.     

Predictors of adherence to aerobic exercise in rectal cancer patients during and after neoadjuvant chemoradiotherapy

This pilot study explored predictors of adherence to exercise during and after neoadjuvant chemoradiotherapy (NACRT) in rectal cancer patients. Eighteen rectal cancer patients were prescribed three supervised aerobic exercise sessions/week during NACRT followed by ≥150 min/week of unsupervised aerobic exercise after NACRT. Although not statistically significant, adherence to supervised exercise during NACRT was meaningfully better for patients who were women (d = .82; P = .12), younger (d = ?.62; P = .30), married (d = .62; P = .42), with better mental health (r = .32; P = .21), fewer diarrhea symptoms (r = .48; P = .052), and higher anticipated enjoyment (r = .31; P = .23), support (r = .32; P = .22), and motivation (r = .31; P = .23). After NACRT, adherence was significantly better for patients who reported worse mental health (r = ?.56; P = .046) and meaningfully better for patients who were women (d = .54; P = .38), better educated (d = .77; P = .22), had no comorbidities (d = ?.63; P = .17), and exercised at baseline (d = 1.05; P = .12). Demographics, tumor side effects, and motivational variables may predict adherence to exercise during and after NACRT.