目的 探讨基于智能手环的呼吸功能训练对阻塞性睡眠呼吸暂停综合征（OSAS）的影响。方法 选 取2020年8月至2022年8月在南通大学附属海安市人民医院诊治的100例OSAS患者作为研究对象。采用随机数字表法将 患者分为试验组与对照组，每组50例。对照组患者行常规药物治疗及常规指导，试验组患者在对照组治疗基础上进行 基于智能手环的呼吸功能训练，具体干预过程包括组建干预团队、制定呼吸功能训练流程、实施基于智能手环的呼吸 功能训练及质控措施。两组均干预8周。比较两组干预前后肺通气功能指标〔用力肺活量（FVC）和第1秒用力呼气容 积（FEV1）/FVC比值〕、呼吸肌力指标〔最大吸气压（MIP）和最大呼气压（MEP）〕、运动耐力指标〔6 min步行 距离和“起立-行走”测试（TUGT）〕、睡眠质量指标〔匹兹堡睡眠质量指数（PSQI）〕、血清炎症因子〔白介素6 （IL-6）和肿瘤坏死因子α（TNF-α）〕及总抗氧化能力（TAOC）。结果 干预后，对照组和试验组FVC分别大于 本组干预前，FEV1/FVC比值、MIP、MEP分别高于本组干预前，且试验组FVC大于对照组，FEV1/FVC比值、MIP、 MEP高于对照组（P＜0.05）。干预后，对照组和试验组6 min步行距离分别长于本组干预前，TUGT结果分别短于本组 干预前，PSQI评分分别低于本组干预前，且试验组6 min步行距离长于对照组，TUGT结果短于对照组，PSQI评分低于 对照组（P＜0.05）。干预后，对照组和试验组血清IL-6、TNF-α分别低于本组干预前，TAOC分别高于本组干预前， 且试验组血清IL-6、TNF-α低于对照组，TAOC高于对照组（P＜0.05）。结论 基于智能手环的呼吸功能训练可有效 改善OSAS患者肺通气功能和呼吸肌力，提高患者运动耐力和睡眠质量，减轻患者炎症反应和氧化应激。

目的:使用血氨等实验室指标,筛选出对肝豆状核变性(Wilson's Disease,WD)肝硬化并发肝性脑病辅助诊断效能较高的指标组合.方法:选取2017年1月～2020年3月在安徽中医药大学神经病学研究所附属医院住院的WD肝硬化135例为研究对象,其中63例肝性脑病为病例组,72例非肝性脑病为对照组;检测并比较两组的血氨、血清学指标[总胆红素(TBIL)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)、铜蓝蛋白(CP)及肌酐(Cr)];血小板(PLT)计数;凝血酶原时间(PT);计算国际标准化比值(INR)、凝血酶原活动度(PTA)、白蛋白-胆红素指数(ALBI)、AST-PLT比率指数(APRI)、MELD评分及Child-Pugh分级.根据Spearman相关系数分析观察指标与MELD评分的相关性、受试者工作特征(ROC)曲线下面积(AUC)值筛选出敏感指标;分析血氨联合其他敏感指标对辅助诊断WD肝硬化并发肝性脑病的价值.结果:病例组血氨、APRI、ALBI及MELD均高于对照组,PTA低于对照组,差异具有统计学意义(P<0.05);Child分级可见病例组以C级为主(57.2％),对照组则为A级(69.5％).病例组PTA、ALBI、APRI及血氨与MELD的相关系数分别为-0.794、0.701、0.564及0.350(P<0.01).病例组血氨、ALBI、PTA及APRI的AUC面积分别为0.915、0.827、0.804及0.736;血氨、ALBI、PTA及APRI对病例组的诊断比值比分别为49.2、11.9、8.8及6.9;血氨在辅助诊断病例组时最佳诊断界值是45μmol/L;血氨联合APRI辅助诊断的灵敏度最高(96.8％);血氨联合PTA的特异度(91.7％)、诊断准确度(89.6％)最高.结论:血氨联合PTA或APRI在辅助诊断肝豆状核变性肝硬化并发肝性脑病诊断效能高,具有临床应用价值.

目的 研究肝豆状核变性(WD)患者血清超氧化物歧化酶(SOD)活性变化与肝功能、铜生化指标的相关性.方法 选择2017年7月—2019年2月本院收治的267例肝豆状核变性(WD)患者(病例组)和117名同期门诊健康体检正常者(对照组)作为研究对象.病例(WD)组又分为肝型129例,脑型138例.检测并比较两组SOD活性、肝功能及铜生化指标;将病例组按照性别、临床分型进行分组,比较组间SOD水平;用spearman相关分析病例组SOD活性与年龄、血清肝功能、铜生化指标的相关性.结果 病例(WD)组的SOD、CHE、Alb、CP及Cu低于对照组,ALT、AST高于对照组,差异具有统计学意义(P<0.05);病例(WD)组男、女性间SOD活性水平比较,差异无统计学意义(P>0.05);病例肝型组的SOD活性低于病例脑型组,而CP与Cu水平高于病例脑型组,差异有统计学意义(P<0.05);病例组SOD活性与ALB、CHE成正相关,与年龄、Cu、CP及AST成负相关,与ALT没有相关性.结论 肝豆状核变性患者SOD活性减低,其水平与肝功能及铜生化指标密切相关,检测其活性能为抗氧化物治疗提供依据.

Objective To investigate the levels of serum copper biochemical examination [copper ion(Cu2+),copper oxidase(SCO) and ceruloplasmin(CP)] in patients with hepato-lenticular degeneration(HLD)and their significance for the diagnosis of HLD.Methods By atomic absorption spectrophotometry,hydrochloric acid-p-phenylenediamine colorimetric method and immune turbidimetric method,288 patients with HLD and 90 healthy controls were measured for serum Cu2+,SCO and CP levels.The 285 patients with decreasing serum copper biochemical examination levels were classified according to clinical types(42 cases of pseudo-sclerosis type,49 cases of brain-visceral hybrid type,138 cases of liver type and 59 cases of Wilson type) and the age(under 10 years old group,11 to 20 years old group,21 to 30 years old group and ≥31 years old group),and the results of serum copper biochemical examination were compared.Results In the 288 HLD patients,the results of serum copper biochemical examination of 3 cases were normal,and the abnormality rate was 98.96%.In 285 HLD patients with decreasing levels of serum copper biochemical examination,the serum level of Cu2+ was(2.46±1.73)μmol/L,the serum level of SCO was 0.027(0.005-0.248) U/L,and the level of CP was(55.07±31.87)mg/L,which were significantly lower than those in controls [(15.09±2.42) μmol/L,0.492(0.269-0.798) U/L and(306.37±46.84)mg/L ](P<0.01).The SCO level in Wilson type group was significantly lower than those in the liver type and pseudo-sclerosis type groups(P<0.01),and the CP level was significantly lower than those in the liver type and brain-visceral hybrid type groups(P<0.05,P<0.01).The serum Cu2+ level in pseudo-sclerosis type group was higher than those in the other clinical type groups(P<0.05,P<0.01).The serum Cu2+ level was the lowest in under 10 years old group,and the results of serum copper biochemical examination in ≥31 years old group were higher than those in the other age groups.The areas under the receiver operating characteristic(ROC) curve(AUC) were 0.995,0.994 and 0.996,respectively.The optimal cut-off values were 6.34 μmol/L,0.121 U/L and 123.1 mg/L,respectively.The sensitivity,specificity and false identification rate were 95%,100% and 0%.Conclusions Serum copper biochemical examination is the most convenient screening program for diagnosing HLD.For patients with HLD,the best diagnostic cut-off values are as follows: Cu2+ ≤ 6.34 μmol/L,SCO ≤0.121 U/L and CP ≤123.1 mg/L.

In order to study miners'unsafe behavior influencing factors,28 miners'unsafe behavior influencing factors were summed up according to the intrinsic and extrinsic factors with the literature review method.On the basis of this theory,a miners' unsafe behavior influencing factors questionnaire was prepared,the statistical analysis of the questionnaire data was made with factor analysis method,and a index system of miners'unsafe behavior influencing factors was established.In addition,the index weight value of all levels were determined and the miners'unsafe behavior influencing factors were importantly analyzed.This study provided a theoretical basis for controlling miners'unsafe behaviors.

In this paper, the behavior observation and behavior sampling methods were applied to collect the miners' unsafe behaviors and a database of the miners' unsafe behaviors was built;the quantitative analysis was made on the correlation degree between the working environmental factors of the miners and the influence factors of unsafe behaviors on the basis of the stratified correlation analyzing method and the database of the unsafe behaviors. The research results showed that the external factors were closely correlated with the miners' behaviors, the correlation degree between them is 81. 3%;in the external factors, there is a greatest correlation degree between the environmental factors and the miners' unsafe behaviors, it is 33. 4%.

Objective: To survey diagnostic value of urinary micro-albumin(mALB),retinol binding protein(RBP),urinary N-acetyl β-d-glucosaminidase(NAG) detection on renal surgery in early times of hepatolenticular degeneration(HLD) and whether the difference existed in index of different HLD.Method: Levels of urinary mALB and RBP were detected with immunoturbidimetry and level of urinary NAG was tested with the continuous monitoring method.Result: Urinary mALB,RBP,NAG of TCM pattern and western medicine pattern groups were higher than normal control group(P0.01);comparison among groups had no statistical meaning in mALB,RBP and NAG(P0.05).Positive rates of HLD were respectively: RBP(94.74%),mALB(78.07%) and MAG(35.09%).mALB is positively associated to NAG(r=0.26,P0.01) and RBP(r=0.232,P0.01),NAG is positively related to RBP(r=0.180,P0.01).Conclusion: Urinary mALB,RBP and NAG show diagnostic value to renal injury in early time of HLD,among them,positive rate of RBP can reach to 94.74%.There is no significant difference among mALB,RBP and NAG in different patterns of HLD.

Objective To explore the changes and their significance of the levels of urine renal tubule damage associated markers in patients with hepatolenticular degeneration(HLD).Methods The urine routine was examined in 196 HLD patients(HLD group,including false sclerosis type in 45 cases,brain-visceral mixed type in 41 cases,hepatic type in 58 cases and Wilson type in 52 cases) and 47 normal controls(normal control group).The levels of urine renal tubule damage associated markers[including N-acetyl-β-D-glucosaminidase(NAG),retinol-binding protein(RBP),α1-microglobulin(α1-MG) and β2-microglobulin(β2-MG)]were detected by immunoturbidimetric assay.Results In HLD group,urine routine was normal in 54 cases,abnormal in 142 cases.The levels of urine NAG,RBP,α1-MG and β2-MG in HLD group were significantly higher than those in the normal control group(P0.05-0.01),but those index among each HLD type were no statistical different.The levels of urine NAG,RBP and α1-MG in HLD patients with abnormal urine routine were significantly higher than those in HLD patients with normal urine routine patients(all P0.01),bur the level of urine β2-MGand between the two groups was no statistical different.Conclusions The levels of urine renal tubule damage associated markers in all types HLD patients are significantly increased.The levels of urine NAG,RBP and α1-MG can be more sensitive reflects renal dysfunction in HLD patients.

Objective To detect serum Cystatin C(SCys C) and urine albumin(mAlb) in patients with hepato-lenticular degeneration(HLD),and to evaluate the significance in the diagnosis of HLD patients with glomerular injury.Methods The levels of SCys C and mAlb of 211 HLD patients and 47 normal controls were detected with particle enhanced turbidimetric immunoassay.All 150 HLD patients were divided into normal urine routine examination group and abnormalities urine routine examination group according to their urine routine examination results.The levels of SCys C and mAlb of each group were compared.Results The levels of SCys C and mAlb in HLD patients were significantly higher than those in the normal controls(P<0.01 orP<0.05).The levels of mAlb of the abnormalities urine routine examination group were significantly higher than those of the normal urine routine examination group,and the levels of SCys C showed no statistically significant differences for them.Conclusion Glomerular filtration rate was damaged for HLD patients.The level of mAlb was more sensitive than that of SCys C for HLD patients with glomerular injury.

Aim To investigate the changes of levels of serum liver enzyme in patients with hepato-lenticular degeneration(HLD).Methods Serum ALT,AST,GGT,ADA,5'-NT,TBA,TBIL,DBIL and CHE levels were measured by HITACHI 7020 automatic analyzer in 477 patients with HLD and 60 controls.Results The patients with HLD,the serum levels of ALT,AST,GGT,TBA,TBIL,DBIL,ADA and CHE were significantly different from those in controls.Conclusion Combined determination of serum liver enzyme in patients of HLD is of clinical usefulness.

Objective:To investigate the possibility,treatment effectiveness and complications of bronchoscopic lung volume reduction by airway membrana tectoria cochleae stents made in China in goat model of heterogeneous emphysema.Methods:4 female goats were used for localized papain instillations to generate heterogeneous emphysema.1～2 airway membrana tectoria cochleae stentses were embedded in the different segmental bronchus of emphysema regions(anterior segment or posterior segment of superior lobe of right lung)by bronchofibroscope.1 day before and 6 weeks after the surgery,lung function,blood gas analysis and CT scans were detected.The pulmonary infection and other complication were deteceted.Results:7 valves were successfully sent out,while 1 was expectorated.TLC,FRC,RV decreased after 6 weekst(P0.05).RV/TLC(%) was decreased from 42.55 % to 20.37 %.PaO2 increased from(70.50±1.85)mmHg to(81.25±1.11)mmHg(P0.05).PaCO2 decreased slightly,which has no significant(P0.05).Atelectasis was confirmed by CT scan and the specimen of lung tissue.Only 1 goat has the early symptoms of lung infection.no pneumothorax and pulmonary abscess happened in all animals.Conclusion:Bronchoscopic lung volume reduction by one-way valve made in China to treat sheep model of heterogeneous emphysema is effectiveness.Minor trauma.safety and easy operation.

本文基于进化博弈理论，构建了"矿工--安全监管者"和"矿工--矿工"之间的博弈模型，通过对模型的求解和分析，探寻矿工不安全行为的演化规律，研究发现：①安全监管者和工友的安全力度和矿工的不安全行为负相关；②不安全行为的成本和矿工的不安全行为负相关；③矿工群体中安全行为矿工的比例和不安全行为负相关。为煤矿企业控制矿工的不安全行为，减少人因事故提供了一定的方法指导和理论依据。