军校医学生主动性人格对成就动机的影响：条件过程模型

目的　探讨军校医学生主动性人格、心理弹性与成就动机之间的关系,考察心理弹性在主动性人格与成就动机之间的中介作用,以及骨干身份对这一中介作用的调节效应。方法　采用主动性人格量表、Connor-Davidson心理弹性量表（Connor-Davidson resilience scale,CD-RISC）以及成就动机量表对109名军校医学生进行测量。采用SPSS 26.0进行描述性统计分析和相关分析。结果　①军校医学生主动性人格、心理弹性与成就动机三者总得分之间显著相关（均P<0.01）;②主动性人格能显著预测成就动机水平（a=0.454,P<0.001）,心理弹性能显著预测成就动机水平（b=0.231,P=0.019）;③心理弹性在主动性人格与成就动机之间的中介作用显著（c’=0.300,P=0.003）;④骨干身份调节了心理弹性对成就动机的作用（index=0.338,95%CI为0.057~0.881）。心理弹性在主动性人格与成就动机之间的中介效应对于骨干学员影响显著（Effect=0.381,95%CI为0.085~1.005）,而对非骨干学员影响不显著（Effect=0.043,95%CI为-0.069~0.252）。结论　军校医学生主动性人格部分可以通过心理弹性影响成就动机水平,这一影响还受到骨干身份的调节,提示军校教育要从多方面提高学员的成就动机水平。     

压力对军校医学生社交焦虑的影响：心理弹性的中介作用

目的考察军校医学生压力、心理弹性与社交焦虑的关系,并探究其机制。方法应用社交焦虑量表（IAS）、大学生压力量表（SSCS）及Connor-Davidson心理弹性量表（CD-RISC）对211名军校医学生进行测量,采用Pearson相关分析和结构方程模型分析变量关系。结果回收有效问卷198份,有效率为93.8%。社交焦虑和压力各维度之间及心理弹性各维度之间均存在相关关系（P均<0.01）。结构方程模型分析表明,心理弹性对压力和社交焦虑之间的关系起部分中介作用（χ²/df=2.08,P<0.05;渐进残差均方和平方根=0.074,比较适配指数=0.98,规准适配指数=0.97,增值适配指数=0.98）。军医院校男生较女生压力更大[（24.67±15.01）分vs（20.17±13.07）分,t=2.17,P<0.05]。结论心理弹性在压力与社交焦虑之间起部分中介作用,应加强对军校医学生心理弹性的培养。     

大学生自杀意念与社会支持和生命质量的相关性

目的 探讨大学生自杀意念与社会支持和生命质量之间的相关性。 方法 采用分层整群随机抽样方法对重庆市9 808名在校大学生进行问卷调查,了解重庆市在校大学生自杀意念的发生情况,并通过多元相关分析探讨大学生自杀意念与社会支持和生命质量之间的关系。 结果 重庆市大学生自杀意念的报告率为13.04%,女生、文科学生、有宗教信仰和有自杀未遂史的大学生自杀意念的发生率较高（分别为16.39%、15.09%、15.05%和68.64%）;有自杀意念的大学生在社会支持总分、客观支持、主观支持、对支持的利用度以及生命质量总分、躯体健康状况、心理健康状况、经济状况、工作状况、与家人关系、与他人关系方面均低于无自杀意念大学生（P<0.01）;大学生自杀意念与社会支持因子的主观支持（r=-0.100,P<0.01）、对支持的利用度呈负相关（r=-0.094,P<0.01）,与生命质量因子的躯体健康状况（r=-0.127,P<0.01）、心理健康状况（r=-0.067,P<0.01）和经济状况（r=-0.081,P<0.01）呈负相关。 结论 重庆市大学生自杀意念的发生率较高。社会、家庭、学校应重视大学生心理健康,完善大学生的社会支持系统,并采取综合干预措施,预防大学生自杀意念和自杀行为的发生。     

应对方式与急性脑卒中患者心理弹性的相关性及其作用

目的 探索应对方式与急性脑卒中患者心理弹性的相关性及其作用。方法 采用便利抽样法选择2016年3月至2017年4月在南京鼓楼医院神经内科住院的急性脑卒中患者192例为研究对象,采用一般资料调查表、中文版心理弹性量表（CD-RISC）、医学应对问卷（MCMQ）对患者进行调查,采用Pearson相关性检验分析患者应对方式与心理弹性的相关性,采用分层回归分析应对方式对急性脑卒中患者心理弹性的作用。结果 面对与回避应对方式与心理弹性总分呈正相关（r=0.491、0.313,P<0.05）,屈服应对方式与心理弹性总分呈负相关（r=-0.418,P<0.05）。进一步分层回归分析显示,应对方式中的面对、屈服维度是急性脑卒中患者心理弹性水平的影响因素。结论 急性脑卒中患者应对方式与心理弹性水平显著相关,应对方式是影响患者心理弹性的重要因素。     

军医院校研究生情绪调节自我效能感在心理素质和抑郁间的中介效应

目的 探讨军医院校研究生情绪调节自我效能感在心理素质和抑郁之间的中介作用。方法 采用医学硕士研究生心理素质问卷（PQQMM）、情绪调节自我效能感量表（RESES）、抑郁自评量表（SDS）对485名军医院校研究生进行整群抽样调查,采用SPSS 19.0软件进行数据分析。结果 心理素质总得分和各维度（认知、适应性与个性）得分均与情绪调节自我效能感得分呈正相关（表达积极情绪自我效能感得分r=0.74、0.57、0.41、0.67,P均<0.01;管理消极情绪自我效能感得分r=0.78、0.65、0.37、0.64,P均<0.01）,两者均与抑郁得分呈负相关（心理素质总得分及各维度得分r=-0.78、-0.54、-0.50、-0.62,P均<0.01;表达积极情绪自我效能感得分r=-0.60,P<0.01;管理消极情绪自我效能感得分r=-0.65,P<0.01）。高情绪调节自我效能感个体的心理素质得分高于低情绪调节自我效能感个体（t=14.71,P<0.01）、抑郁得分低于低情绪调节自我效能感个体（t=-9.43,P<0.01）。表达积极情绪自我效能感在心理素质3个维度（认知、个性、适应性）与抑郁之间存在部分中介效应,分别占总效应的22.38%、6.25%、24.75%;管理消极情绪自我效能感在心理素质3个维度与抑郁之间存在部分中介效应,分别占总效应的24.80%、13.50%、24.54%。结论 情绪调节自我效能感在军医院校研究生心理素质与抑郁之间具有部分中介作用。     

气郁质得分与健康相关生命质量:运动的中介效应

[目的]探讨运动在气郁质得分与健康相关生命质量（HRQOL）间的中介效应。[方法]采用横断面现场调查法,于2015年3月-2016年12月在北京、河北获得2 113例有效样本数据。运动水平由自我报告获得;气郁质得分采用中医体质量表气郁质亚量表计算;HRQOL评价采用简明健康状况调查问卷SF-36,获得生理领域（PCS）、心理领域（MCS）及其总体HRQOL得分。在相关分析的基础上,进一步应用分层多元线性回归模型探讨运动的中介效应。[结果]1）气郁质得分与PCS（r=-0.461,P<0.01）、MCS（r=-0.564,P<0.01）以及总体HRQOL（r=-0.573,P<0.01）呈负相关;运动水平与气郁质得分（r=-0.108,P<0.01）呈负相关,与PCS（r=0.115,P<0.01）、MCS（r=0.100,P<0.01）以及总体HRQOL（r=0.111,P<0.01）呈正相关。2）运动在气郁质得分与PCS、MCS和总体HRQOL间的中介效应分析具有统计学意义,中介效应量分别为0.93%、0.53%和0.69%。[结论]运动在气郁质对健康相关生命质量的负向影响中具有中介效应,但中介效应量较小,仅占不到1%。     

军人焦虑敏感性和心理健康关系:心理弹性的中介效应

目的 探讨军人焦虑敏感性（anxiety sensitivity,AS）、心理弹性（resilience,RS）和心理健康之间的关系。方法 抽取某部260名现役军人,采用AS指数量表Ⅲ（ASI-3）、Conner-Davidson心理弹性量表（CD-RISC）、症状自评量表进行调查,运用结构方程模型分析变量间关系。结果 收回有效问卷240份,有效率为92.3%。军人AS和心理健康水平在服役年限、是否独生子女、职别、文化程度、入伍前户籍等人口学变量方面的差异均无统计学意义（P>0.05）;高AS军人症状自评量表总分和各因子得分均高于低AS军人（P<0.01）。相关分析结果显示,军人症状自评量表总分与ASI-3总分（r=0.487,P<0.001）和各因子得分呈正相关（r_躯体关注=0.435,r_社会关注=0.455,r_认知关注=0.445;P<0.001）,与CD-RISC各因子得分呈负相关（r_坚韧=-0.315,r_力量=-0.321,r_乐观=-0.227;P<0.001）。结构方程模型和Sobel检验结果显示,AS能通过RS间接影响军人心理健康：χ²/df=20.222/12=1.685 2,P=0.063,拟合优度指数（GFI）=0.977,调整拟合优度指数（AGFI）=0.946,规范拟合指数（NFI）=0.977,相对拟合指数（RFI）=0.960,增值拟合指数（IFI）=0.991,Tucker-Lewis系数（TLI）=0.983,比较拟合指数（CFI）=0.990,近似误差均方根（RMSEA）=0.054。结论 RS在军人AS与心理健康之间起部分中介效应,应重点关注高AS军人心理健康问题,提高RS,以改善其心理健康状况。     

中青年慢性病住院患者自杀意念的危险因素分析

目的 探讨中青年慢性病住院患者自杀意念的危险因素。方法 采用横断面研究设计和方便抽样法选取2019年8月1~31日安徽医科大学第一附属医院收治的住院号末尾数为偶数的中青年慢性病住院患者270例为研究对象。通过问题"最近一周内，你是否曾有过自杀的念头"来测定患者自杀意念发生情况，回答"是"则判定为有自杀意念，反之则无。根据有无自杀意念，将患者分成有自杀信念组（23例）和无自杀信念组（247例）。通过logistic回归分析导致患者有自杀意念的危险因素。结果 logistic回归分析结果显示，婚姻状况（OR=0.182，95% CI：0.065~0.504，P=0.001）、主观支持（OR=0.703，95% CI：0.588~0.841，P=0.000）和家庭功能（OR=0.793，95% CI：0.658~0.956，P=0.015）是中青年慢性病住院患者自杀意念的危险因素。结论 单身、获得社会支持少和家庭功能欠佳是中青年慢性病住院患者产生自杀意念的危险因素，临床对此类患者在治疗过程中应予密切关注并及时干预。     

海军某部官兵睡眠与自杀意念的关系

目的 调查海军某部官兵的睡眠与自杀意念的关系。方法 采用集体测验方法，应用自编人口学问卷、匹兹堡睡眠质量指数（PSQI）量表、抑郁自评量表（SDS）、焦虑自评量表（SAS）和自杀意念自评量表（SIOSS）对海军某部459名官兵的睡眠状况与自杀意念情况进行调查。结果 共发放问卷459份，回收有效问卷434份，有效率为94.6%。海军某部军官的PSQI总分为（5.85±3.37）分，SIOSS总分为（7.05±3.98）分，SDS总分为（35.29±9.52）分，SAS总分为（31.80±7.36）分。海军某部官兵的自杀意念与睡眠质量、入睡困难、夜间易醒或早醒、噩梦呈正相关，与睡眠时长呈负相关（P均<0.01）。控制一般人口学因素（性别、年龄、文化程度）、物质使用情况（吸烟、饮酒、喝茶、喝咖啡）、焦虑症状及抑郁症状后，发现睡眠质量越差（β=0.289，P<0.01）、入睡困难症状越严重（β=0.110，P=0.019）、文化程度越高（β=0.080，P=0.013）者自杀意念越强。结论 睡眠质量、入睡困难症状是海军某部官兵自杀意念的独立预测因子。     

疫情常态化防控期间军校医学生的心理状况及影响因素

目的　探讨疫情常态化防控背景下军校医学生的心理压力、焦虑及创伤后应激障碍（posttraumatic stress disorder,PTSD）水平,并探究其影响因素。方法　采取随机抽样法选取某军校医学生225名,采用知觉心理压力量表（Chinese perceived stress scale,CPSS）、领悟社会支持量表（Perceived social support scale,PSSS）、焦虑自评量表（Self-rating anxiety scale,SAS）和创伤后应激障碍检查表第五版（PTSD Checklist-5,PCL-5）测量被试的心理健康情况和影响因素。采用SPSS 26.0进行独立样本t检验和ANOVA分析,相关分析采用Pearson相关分析法,并采用多元回归方程对心理测量因素之间的关系进行进一步分析。结果　22.2%（50/225）的被试SAS分数达到阳性标准,30.7%（69/225）的被试PCL-5分数达到阳性标准。相关分析结果显示,PSSS总分与CPSS（r=-0.315,P<0.01）、SAS（r=-0.336,P<0.01）、PCL-5（r=-0.137,P<0.05）得分之间均呈负相关。家庭支持得分显著负性预测军校医学生的心理压力（B=-0.595,P<0.001）、焦虑（B=-0.635,P<0.001）、PTSD水平（B=-0.769,P=0.006）。结论　疫情常态化防控期间,社会支持尤其是家庭支持对军校医学生的心理压力、焦虑、PTSD有明显的保护作用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.