OBJECTIVESince 1987, professor Wasserman displayed cardiopulmonary exercise test starting (CPET) data as 3 rows and 3 columns 9 panels plots. Although many changes and additions, there still are some important functional parameters were not shown in 9 panels. We want to display more.

METHODSThe 100 Hz sampling data of symptom-limited maximal limit CPET was used to calculate breath-by-breath data after per second cutting technique, and then to calculate the average value of 10 s data for graphic display.

RESULTSIn new 9 plots, panels (1) - (7) use time for the "X" axis, oxygen uptake, carbon dioxide elimination, loaded power, heart rate, systolic blood pressure, diastolic blood pressure, heart rate pressure product, minute ventilation, respiratory exchange ratio, CO2 elimination ventilatory efficiency, oxygen uptake ventilatory efficiency, oxygen pulse, ST segment level and ST segment slope at V5 lead, tidal volume, respiratory rate, end tidal oxygen partial pressure, end tidal carbon dioxide partial pressure and oxygen saturation of 18 noninvasive parameters, and arterial oxygen partial pressure, arterial oxygen saturation, arterial partial pressure of carbon dioxide 3 blood gas parameters for the "Y" axis respectively. There are 3 vertical dashed lines represent dividing lines of the resting, warm-up, incremental power loading exercise and recovery period respectively. In addition, panels (1) and (4) have the horizontal dashed line represents the maximal oxygen uptake (red), oxygen uptake efficiency plateau (red) and the lowest value of carbon dioxide elimation ventilatory efficiency (blue) expected value respectively. Panel ( used heart rate and carbon dioxide elimination (as Y) against to oxygen uptake (as X); the "+" indicates intersection of the predicted maximum values of oxygen uptake and heart rate. Panel (9) used tidal volume (as Y) against over minute ventilation (as X), vertical dashed line is the measured maximum ventilatory volume, the horizontal dashed lines were the inspiratory capacity and vital capacity respectively.

CONCLUSIONNew CPET 9 plots emphasizes on the integration of all circulatory, respiratory and metabolic etc functional parameters in human, and is conductive to optimization of clinical medical service and health management.

Arteries ; Blood Gas Analysis ; Blood Pressure ; Carbon Dioxide ; Exercise ; Exercise Test ; standards ; Heart ; Heart Rate ; Holistic Health ; Humans ; Integrative Medicine ; Oximetry ; Oxygen ; Oxygen Consumption ; Partial Pressure ; Pulmonary Gas Exchange ; Tidal Volume

The cardiopulmonary exercise testing (CPET) is one important clinical functional testing method, which linked to all functions of respiratory, circulatory, metabolic and neurohumoral etc. The most important parameter of CPET is oxygen uptake which can reflect the core oxygen metabolic information of the human being's holistic integrative physiology. We explain why the CPET interpretation needs new philosophy of holistic integrative physiology and medicine. CPET is a unique holistic, objective, quantitative scientific evaluation skill of human function to distinguish health, sub-health and dieases, It can help us to make optimal recommendations for prevention, diagnosis and differential diagnosis, treatment evaluation, exercise rehabilitation and prognosis of many clinical diseases. However, in order to so, we needs pre-qualified and calibrated stable system, standardized clinical practice, data analysis, display illustration and interpretation principle for CPET.
Exercise Test ; standards ; Humans

OBJECTIVEFrom the point of holistic integrative medicine, the D(L)CO depends on not only normal respiratory and circulatory functions, but also an optional matching between them. However, due to the limitation of traditional systemic physiology, the D(L)CO always be classified as lung functional parameter to be analyzed and interpreted. Because ignoring the circulatory system function, so it will certainly have some misunderstandings.

METHODSBased on the Holistic Integrative Medicine, under the control of neurohumoral, respiratory, circulatory and metabolic systems work together, we discussed the diffusion function. We analyzed the change of D(L)CO in the patients with cardiac dysfunction, especially the heart failure.

RESULTSThe D(L)CO, CO gas,diffusion from lung circulating blood, depends on the normality of respiratory and circulatory systems and their matching. We analyzed the reasons of D(L)CO for characteristic pathophysiological changes of patients with heart failure.

CONCLUSIONThe normal D(L)CO depends on a good matching of normal respiratory and circulatory systems. For heart failure, the respiratory and circulatory systems matching is poor. Due to dominant limitation of left ventricle pump function, pulmonary blood volume may slightly increased, but combination of all reduced pulmonary blood flow rate, thicked diffuse member and increased diffusion distance etc. suggest that patients with heart failure should have a decreased, rather than increased, D(L)CO.

Blood Gas Analysis ; Blood Volume ; Heart Failure ; Humans ; Lung ; physiology ; Pulmonary Circulation ; Pulmonary Diffusing Capacity ; Respiratory Function Tests ; Ventricular Function, Left

OBJECTIVESystemic mechanism of neurohumoral control and regulation for human is limited.

METHODSWe used the new theory of holistic integrative physiology and medicine to approach the mechanism and pattern of neurohumoral control and regulation for life.

RESULTSAs the core of human life, there are two core axes of functions. The first one is the common goal of respiration and circulation to transport oxygen and carbon dioxide for cells, and the second one is the goal of gastrointestinal tract and circulation to transport energy material and metabolic product for cells. These two core axes maintain the metabolism. The neurohumoral regulation is holistically integrated and unified for all functions in human body. We simplified explain the mechanism of neurohumoral control and regulation life (respiration and circulation) as the example pattern of sound system.

CONCLUSIONBased upon integrated regulation of life, we described the neurohumoral pattern to control respiration and circulation.

Blood Circulation ; physiology ; Holistic Health ; Humans ; Integrative Medicine ; Metabolism ; physiology ; Neurotransmitter Agents ; physiology ; Respiration ; Respiratory Physiological Phenomena

OBJECTIVEThe interpretation of control and regulation of circulatory parameters in traditional physiology has some limitations. Human being is an organic, circulatory control and regulation should involve all the systems.

METHODSBased upon the theory of holistic integrative physiology and medicine, we approach to explain the circulatory control and regulation from its purpose.

RESULTSThe main purpose of circulation is to maintain a stable metabolism of cells, i.e. transport oxygen (from lung) and nutrients (from gastrointestinal tract) to cells, and return carbon dioxide and metabolic products back for elimination. Based on this goal, all respiration and gastrointestinal digestion, absorption, urinary excretion, etc. are integrative together for regulation to maintain the supply-demand balance at any metabolic status of resting, exercise and sleep. So that, we can explain many existing problems and questions, for example: why and how the foramen ovale closed after birth; mechanism of Cheyne-Stokes respiration; blood flow redistribution during exercise; variabilities of systolic blood pressure, heart rate and autonomic tone.

CONCLUSIONThe circulatory control and regulation is the integration of all systems of the body.

Blood Circulation ; physiology ; Holistic Health ; Humans ; Integrative Medicine

OBJECTIVEThe modern systemic physiology, based on limit-understand functional classification, has significant limitation and one-sidedness. Human being is organic; we should approach the mechanism of control and regulation of breathing integrating all the systems.

METHODSWe use new theory of holistic integrative physiology and medicine to explain the mechanism of control and regulation of breathing.

RESULTSExcept the mean level information, the up-down "W" waveform information of arterial blood gas (ABG) is core signal to control and regulate breathing. In order to do so, we must integrate all systems together. New theory will help to explain some unanswered questions in physiology and medicine, for example: fetal does not breathing; how first breath generate; how respiratory rhythm and frequency generate, etc.

CONCLUSIONBreathing is the sign of life. Mechanism of control and regulation of breathing has to integrate respiration, circulation, nerves, metabolism, exercise, sleep and digestion, absorption and elimination and etc altogether.

Holistic Health ; Humans ; Integrative Medicine ; Respiration ; Respiratory Physiological Phenomena

Under background of reductionism in the modern science, physiology and medicine are stepwise refined into system, organ, disease, cell and gene etc. Although clinical medicine, only service in whole human object, obviously brought tremendous progress, it also appeared obvious defects and limits at the same time. Professionalized and specialized medicine not only needs to be integrated from basics to clinical fields, but also from prevention, health management, clinical treatment and functional rehabilitation medicine. People are indivisible organic whole. Professionalization, translation and integration must be combined. In order to provide the best quality and optimized medical service for the Chinese people and to lead in the world, we have to strengthen professional and technical knowledge, and have to establish the holistic integrative medical philosophy for physiology and medicine too.
Holistic Health ; Humans ; Integrative Medicine ; Quality of Health Care

Ischemic cerebrovascular disease is one of the major reasons of mortality and disability in adult populations.Ultra-early recanalization is by far the most positive treatment.Relative to intravenous thrombolysis,various endovascular treatment modalities can extend therapeutic time window and increase the recanalization rate.Furthermore,interventional therapy can also improve the clinical outcomes of patients by increasing the perfusion of colhteral circulation.This article reviews various endovascular treatment modalities and their application validated in previous clinical studies in China.

Objective To investigate the influence of sevoflurane and total intravenous anesthesia with propofol on hepatic and renal function in elder patients under gastrectomy .Methods 55 patients between the ages of 60-75 ,ASA physical status class Ⅰor Ⅱ ,scheduled for an elective gastrectomy were randomly divided into two groups .Anesthesia was maintained with sevoflurane 1% -1 .2% and remifentanil (0 .1-0 .2)μg · kg -1 · min-1 in the group S and propofol (1 -2)mg · kg -1 · h-1 and remifentanil (0 .1-0 .2)μg · kg -1 · min-1 in the group T .The hepatic and renal function ,aspartate aminotransferase (AST ) ,alanine amin-otransferase(ALT),bloodureanitrogen(BUN)andcreatinineweretestedatpreoperation(baseline),postoperative1dayand3 days .Results AST was increased at postoperative 1 day and 3 day ,compared with that of the preoperation in the group S and group T .Serum BUN at 3 day and creatinine at 1 day and 3 day were significantly higher from the preoperative values in group S (P<0 .05) ,but the values were within its normal limit .ALT was not changed after anesthesia in the both groups .And Serum BUN and creatinine were not changed after anesthesia in the T groups (P>0 .05) .There were no significant difference in the AST ,ALT , BUN and creatinine between the groups(P>0 .05) .Conclusion The changes of hepatic and renal effect after inhalation anesthesia with sevoflurane and remifentanil and TIVA with propofol and remifentanil for gastrectomy are clinically insignficant ,and there is no difference between the two methods .

BACKGROUND:Extracorporeal cardiac shock wave therapy (CSWT) can up-regulate angiogenic factors and its receptors,promote angiogenesis and collateral circulation establishment by introducing shock waves to myocardium,however,the specific mechanisms remain unclearly.OBJECTIVE:To observe the influence of CSWT on the content of serum endothelial nitric oxide synthase (eNOS) in pigs following acute myocardial infarction (AMI).METHODS:Pig AMI model was established by embolizing the distal of left anterior coronary artery.Following model preparation,pigs were randomly divided into 2 groups.In the experimental group received three CSWT at days 1,3 and 5,200 hits per point,totally 12 points,with 0.09 mJ/mm~2 energy.Pigs with simple AMI were served as the control group.The serum eNOS level was detected by ELISA method before,immediate postoperative,and at days,1,3,5,and weeks 1,2,3,and 4 after operation.RESULTS AND CONCLUSION:The eNOS level of both groups were obvious decreased at immediate postoperative than that before operation.At day 1 after CSWT,eNOS level was increased in the experimental group,which was still decreased in the control group.It revealed that CSWT play a positive effect on ischemia rnyocardium.The eNOS level reached a peak in the experimental group after 3 times of CSWT,lasted for 2-3 weeks,and began to decrease at week 4.The difference between the experimental group and control group had significance (P＜0.01).The results demonstrated that CSWT can treat AMI effectively by promoting eNOS expression.