心肺康复训练对脑卒中患者的康复效果及对血清BDNF、NT-3、MMP-9及心肺功能的影响

摘要 目的：探讨心肺康复训练对脑卒中患者的康复效果及对血清脑源性神经生长因子（BDNF）、神经营养因子-3（NT-3）、基质金属蛋白酶-9（MMP-9）及心肺功能的影响。方法：选择2020年01月-2021年01月在我院接受治疗的129例脑卒中患者，采用抽签法分为试验组（n=65）和对照组（n=64）。对照组给予常规康复治疗，试验组给予心肺康复训练治疗。比较两组患者的临床疗效、血清BDNF、NT-3、MMP-9、左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、最大心率、静息心率、峰值摄氧量（VO_2peak ）、无氧阈（AT）、峰值能量代谢当量（MET peak）、每分峰值通气量（VE _peak ）及Fugl-Meyer评定量表（FMA）、改良Barthel指数（MBI）评分变化情况。结果：治疗后，两组总有效率比较差异显著（P<0.05）；治疗前，试验组和对照组血清BDNF、NT-3、MMP-9比较无显著差异；治疗后，试验组和对照组血清BDNF随着时间的推移而升高，且试验组均高于对照组，NT-3、MMP-9随着时间的推移而降低，且试验组均低于对照组，差异显著（P<0.05）；治疗前，试验组和对照组LVEF、LVESD、最大心率及静息心率比较无显著差异；治疗后，试验组和对照组LVEF、最大心率随着时间的推移而升高，且试验组均高于对照组，LVESD、静息心率随着时间的推移而降低，且试验组均低于对照组，差异显著（P<0.05）；治疗前，试验组和对照组VO_2peak 、AT、MET peak及VE _peak 比较无显著差异；治疗后，试验组和对照组VO_2peak 、AT、MET _peak 及VE _peak 随着时间的推移而升高，且试验组均高于对照组，差异显著（P<0.05）；治疗前，试验组和对照组FMA、MBI评分比较无显著差异；治疗后，试验组和对照组FMA、MBI评分随着时间的推移而升高，且试验组均高于对照组，差异显著（P<0.05）。结论：在脑卒中患者中应用心肺康复训练临床效果更好，可有改善患者血清BDNF、NT-3、MMP-9及心肺功能。     

Synergic effects of exercise training and octopamine on peroxisome proliferator-activated receptor-gamma coactivator -1a and uncoupling protein 1 mRNA in heart tissue of rat treated with deep frying oil

Octopamine (OCT) have an adverse effect on heart function. One of the positive effects of exercise training is improving cardiac function and cardiomyocytes signaling, which along with herbal supplements can have better effects on the heart tissue. Therefore, the aim of this study was to evaluate the effects of exercise training and OCT on changes of PGC1α and UCP1 expression in heart tissue of rat treated with deep frying oil (DFO). In this study, 45 male wistar rats were divided into 5 groups (n = 9 in each): I) control (Co), II) DFO, III) DFO + exercise, IV) DFO + OCT, and V) DFO + OCT + exercise. The quantification of apoptotic effects of DFO in heart tissue was assessed by TUNEL assay. Masson's trichrome stain applied to study cardiomyocytic fibers. Moreover, PGC1α and UCP1 genes and proteins expression in all groups were investigated using quantitative real-time PCR and immunohistochemical method. A significant increase in apoptotic cells was observed in the DFO-treated group (p < 0.05). In Masson's Trichrome stain study, more cardiomyocytic fibers were observed and some lymphocytic cells were present in some fibers. Also, the expression of PGC1α and UCP1 was significantly increase in DFO + exercise group, DFO + OCT group, and DFO + OCT + exercise group compare to DFO group (p < 0.05). Based on these findings, exercise and octopamine can be considered as factors affecting the expression of PGC1α genes and UCP1 as well as drug poisoning.     

The effect of physical training on the N-methyl-N-nitrosourea-induced mammary carcinogenesis of Sprague–Dawley rats

The impact of physical activity on carcinogenesis has been demonstrated in many studies. Taking into account the discrepant results of physical exercise on the cell proliferation and apoptosis of breast cancer, we aimed to examine the impact of physical training on N-methyl-N-nitrosourea-(MNU)-induced mammary carcinogenesis. Fifty female rats were divided into four groups according to the intensity of physical activity they undertook. The number of developed tumors, tumor volume, and histopathological diagnoses were noted. Apoptosis and cell proliferation were studied by the number of TUNEL-positive and Ki-67-expressing cells. We demonstrated a statistically significant decrease in the tumor number between all trained groups and the control group. The results were most pronounced in the group with a moderate intensity of training. Moreover, we showed a decrease in tumor volume as training intensity increased, though the differences were not statistically significant. The mean number of TUNEL-positive cancer cells was significantly higher in the training groups than in the control group. These data suggest that physical training, especially of moderate intensity, may alleviate MNU-induced mammary carcinogenesis. The results could suggest that physical exercise-induced apoptosis may be a protective mechanism.     

Moderate walnut consumption improved lipid profile,steroid hormones and inflammation in trained elderly men: a pilot study with a randomized controlled trial

The present study aimed to investigate the effect of walnut consumption on lipid profile, steroid hormones and inflammation in trained elderly men performing concurrent (resistance and endurance) training. Twenty healthy elderly males were divided into two matched groups, in a randomized controlled trial, that trained three sessions per week: concurrent training + dietary walnut consumption (15 g/day for six weeks, CTW: n = 10); concurrent training + control diet (CT: n = 10). Fasting blood samples were taken 48 hours before and after intervention for biochemical assessments. levels of high-density lipoprotein (HDL) increased only in CTW compared to baseline (19.8%, p < 0.01). Total cholesterol (TC), low-density lipoprotein (LDL) and triglyceride (TG) levels significantly decreased only for CTW (i.e., 13%, 18%, and 18.5% at p < 0.01 for all). Testosterone (T) increased after the training compared to pre-training for CTW and CT (10.3%, p < 0.01, 4.27% p < 0.05, respectively), but the increase was significantly higher in CTW (p < 0.05). Serum cortisol (C) was lower for CTW compared to CT (p < 0.01). C-reactive protein (CRP) decreased in CTW in comparison with CT. The present study revealed that 6-week moderate walnut supplementation (15 g/day) improved lipid profile, steroid hormones and systematic inflammation in aged men performing concurrent training. These findings could be attributable to the potential effect of polyunsaturated fatty acids (PUFA) contained in walnut (linoleic acid, n-6; linolenic acid, n-3).     

The effect of repetitive ankle perturbations on muscle reaction time and muscle activity

The use of a tilt platform to simulate a lateral ankle sprain and record muscle reaction time is a well-established procedure. However, a potential caveat is that repetitive ankle perturbation may cause a natural attenuation of the reflex latency and amplitude. This is an important area to investigate as many researchers examine the effect of an intervention on muscle reaction time. Muscle reaction time, peak and average amplitude of the peroneus longus and tibialis anterior in response to a simulated lateral ankle sprain (combined inversion and plantar flexion movement) were calculated in twenty-two physically active participants. The 40 perturbations were divided into 4 even groups of 10 dominant limb perturbations. Within-participants repeated measures analysis of variance (ANOVA) tests were conducted to assess the effect of habituation over time for each variable. There was a significant reduction in the peroneus longus average amplitude between the aggregated first and last 10 consecutive ankle perturbations (F_2.15,45.09 = 3.90, P = 0.03, ɳ_p² = 0.16). Authors should implement no more than a maximum of 30 consecutive ankle perturbations (inclusive of practice perturbations) in future protocols simulating a lateral ankle sprain in an effort to avoid significant attenuation of muscle activity.     

Increased concentrations of interleukin 1-β in whole blood cultures supernatants after 12 weeks of moderate endurance exercise

The aim of the study was to investigate whether a regular moderate endurance exercise programme influenced the in vitro cytokine synthesis by stimulated whole blood cultures. To this end, eight healthy subjects exercised moderately by running for 3-5 h a week over a period of 12 weeks, whilst seven other healthy subjects served as the control group. The intensity of the exercise was determined by lactic acid concentrations in the blood which were maintained between 1.8 and 2.5 mmol x l(-1). Over the period of training the running velocity producing the 4 mmol x l(-1) lactic acid threshold increased from 2.86 (SD 0.83) m x s(-1) to 3.06+/-0.79 m x s(-1) (P < or = 0.008). Blood samples were taken at rest before and after the training programme. The following blood parameters were determined: leucocyte count, differential leucocyte count, lymphocyte subpopulations [CD14 positive (+)/CD45+, CD4+/ CD25+, CD8+, CD16+/CD122+]. Whole blood cultures were stimulated with lipopolysaccarides [interleukin (IL)-1 beta and IL-6] and staphylococcal enterotoxin B [IL-2, soluble interleukin 2 receptor (sIL2-R) and interferon (IFN)-gamma]. Cytokine concentrations in the supernatants were measured using an enzyme-linked immunosorbent assay. The white blood cell count, differential leucocyte count, lymphocyte subset distribution and the expression of the CD25 and CD122 antigen on lymphocytes were unchanged by training. After the training programme the IL-1 beta production changed significantly [1496 (SD 264) pg ml(-1) before, compared to 2127 (SD 672) pg ml(-1) after training, P < or = 0.008]. In the control group these parameters remained unchanged. With respect to changes in the values in both groups the syntheses of IL-1 beta (P < or = 0.023) and IL-6 (P < or = 0.021) were significantly higher after regular training. The syntheses of IL-2, sIL-2 and INF-gamma were not significantly influenced. Regular endurance exercise influenced the in vitro production of monocyte derived cytokines, while the effect of exercise on the cytokines synthesized by T-cells appeared to be of lesser importance.     

探究式课程设计在医学生临床决策能力培养中的探索

临床决策能力是一个医生的必备能力之一，是医学教育中必要且重要的培养目标之一。目前对医学生临床决策能力的培养没有形成完备的体系，一般安排在高年级阶段进行，为时较晚。如何把临床决策能力的培养融入低年级基础课中，以尽早开展能力训练值得探索研究。本研究以医学遗传学课程为例，结合探究式教学方式的特点，模拟临床决策思维过程的各细分模块，优化了课程设计，探索在低年级课程中融入临床决策能力的培养。结果提示：探究式课程设计能充分调动学生主动性，增加学生分析、思考的投入；在教师引导下，促使学生依循临床决策思维的过程得到有效地训练。最后，整理分析了探究式课程设计及实践的思路，总结了设计原则和要点，反思了教学中的经验得失。