女性压力性尿失禁风险预测的研究进展

综述女性压力性尿失禁(stress urinary incontinence,SUI)风险预测的研究进展。指出女性SUI风险预测相关文献普遍存在风险预测工具和指标缺乏临床大样本验证,指标、纳入人群不统一的现象,风险预测模型存在构建过程未按报告规范进行,未进行完整的模型验证以及模型性能评价指标不规范的情况。未来研究可以在现有风险预测工具或模型的基础上进行改进、完善,以期为女性SUI风险预测提供参考。     

江苏省专科护士工作投入现状及影响因素调查分析

目的 了解江苏省省级专科护士工作投入现状及影响因素，为针对性管理提供参考。方法 采用一般资料调查问卷与专科护士工作投入量表对2 472名省级专科护士进行调查分析。结果 专科护士工作投入总均分为4.06±0.46;多元线性回归分析显示，性别、聘任方式、专科类别、工作类型、出任专科护理门诊、论文发表是专科护士工作投入的影响因素(P<0.05,P<0.01)。结论 专科护士工作投入水平较高，其影响因素较多，护理管理者应关注专科护士专业开展现况，采取针对性措施支持专科护理的有效开展，从而进一步提高专科护士的工作投入水平。     

Impact of repaired aortic coarctation in left ventricular myocardial work

AimsMyocardial strain analysis enables more precise assessment of cardiac performance but is relatively load dependent. New tools have been developed with afterload adjustment. Our objective was to assess myocardial work (MW) in patients with repaired aortic coarctation (rACo).MethodsProspective study of consecutive patients with rACo who underwent a routine transthoracic echocardiogram in 2018 and 2019 at our center. Patients with significant aortic valve disease, pacemaker, or other congenital heart diseases (except for mild bicuspid aortic valve disease) were excluded. Global longitudinal strain with two dimensional speckle tracking analysis and MW were obtained (GWI:Global Work Index; GCW: Global Constructive Work; GWW: Global Wasted Work; GWE: Global Work Efficiency). Blood pressure was measured in the patient's right arm.ResultsWe included 42 patients in the analysis, mean age of 37±10 years, 38% males. In this group, 52% had hypertension and 64% had a concomitant bicuspid aortic valve. In comparison to previously published reference values, patients with rACo had significantly lower GWI (1807 vs. 1896 mmHg%) and GCW (2173 vs. 2232 mmHg%) (p<0.001), particularly in males. Systolic blood pressure is an independent predictor for GWI (β=0.432) and for GCW (β=0.534) and GLS an independent predictor of all MW parameters (β>0.594). Neither age nor gender were independent predictors.ConclusionsIn patients with rACo, there are some signs of left ventricular dysfunction with a reduction in GCW and GWI and with preserved GWE, despite normal ejection fraction and strain.     

七叶一枝花甾体皂苷种类及含量差异研究进展＊

重楼是我国传统的名贵中药，七叶一枝花为历版《中国药典》收载的重楼药材两个基原植物之一，具有清热解毒、消肿止痛、活血化瘀等功效，其主要活性成分为甾体皂苷类物质。由于重楼市场需求量剧增和七叶一枝花成药时间较长，导致大量依靠人工种植。然而，人工种植过程中产地、采收年限和采收月份都会影响七叶一枝花的甾体皂苷含量。本文系统地总结了七叶一枝花中主要活性成分甾体皂苷的种类，以及不同产地、不同生长年限及不同采收月份的七叶一枝花根茎中甾体皂苷含量差异的研究现状，以期为进一步研究七叶一枝花品质差异、野生资源驯化及规范化种植提供参考。     

Shift work disorder and related influential factors among shift workers in China

BackgroundShift work may cause insomnia and sleepiness in individuals. The present study aimed to exam shift work disorder (SWD), and to investigate their associations with individual characteristics.MethodsA total of 1833 shift workers were assessed using the Pittsburg Sleep Quality Index, Epworth Sleepiness Scale (ESS), Composite Scale of Morningness (CSM), Circadian Type Inventory (CTI), Center for Epidemiologic Studies–Depression Scale (CES-D), Beck Anxiety Inventory (BAI) and other self-compiled socio-demographic questionnaires.ResultsIn the current sample, 17.1% shift workers have experienced insomnia symptoms, 20.9% were tested for daytime sleepiness, and 19.9% were categorized as having SWD. Logistics regressions revealed that history of mental disorders (OR = 2.04, 95% CI = 1.30–3.21), chronic physical illness (OR = 1.53, 95% CI = 1.17–1.99), CES-D scores (OR = 1.03, 95% CI = 1.02–1.05), BAI scores (OR = 1.04, 95% CI = 1.03–1.06), languid/vigorous tendencies (OR = 1.06, 95% CI = 1.03–1.10) were positively associated with the onset of SWD, while morningness (OR = 0.97, 95% CI = 0.94–0.99) decreased the odds of SWD onset.ConclusionsThese findings suggested that attention should be drawn to individuals with mental and chronic diseases in when scheduling work shifts. While SWD and its associates should be considered when providing psychological services to shift workers.     

中药对癫痫相关信号通路调控作用的研究进展

癫痫是一种常见的神经系统疾病，其反复发作，迁延难愈，对患者的身心造成极大危害。抗癫痫药带来良好的治疗作用的同时也伴发着诸多身心损伤的不良反应。中医药治疗癫痫由来已久，目前除不断丰富传统中医理论治疗癫痫的认知理论外，从分子生物学角度研究中医药治疗癫痫的细胞信号传导机制发展迅速。通过对国内外文献检索发现，癫痫发生与细胞增殖、凋亡、自噬、炎症反应、免疫应答等病理生理过程密切相关；同时中西药的现代医学研究表明，无论是中药单体、单味中药甚至中药复方治疗癫痫的机制的研究均与文中所述信号通路有着直接或间接的关系，其可以通过调控相应信号通路的关键分子表达，达到抑制癫痫发生，控制癫痫发作，保护癫痫脑损伤的作用。该文通过对国内外研究现状进行总结，具体如下：①桔皮素，银杏内酯B等能通过激活磷脂酰肌醇3-激酶/蛋白激酶B（PI3K/Akt）信号通路，抑制凋亡及氧化应激反应。②黄芩苷，蛇床子素等能通过抑制哺乳动物-雷帕霉素靶蛋白（mTOR）信号通路，抑制自噬。③灵芝多糖，黄芪甲苷等能通过抑制丝裂原活化蛋白激酶（MAPK）信号通路，减少细胞凋亡。④红景天苷，白藜芦醇等能通过激活核因子E2相关因子2/抗氧化反应元件/血红素加氧酶1（Nrf2/ARE/HO-1）信号通路，抗氧化应激反应及抑制凋亡。⑤姜黄素，黄芩苷等能通过抑制核转录因子-κB（NF-κB）信号通路，降低炎症反应及减少凋亡。以上总结旨在为中药治疗癫痫的深入研究提供参考依据，也为临床中药治疗癫痫提供新的思路。     

基于十二指肠异常探讨功能性消化不良的中医研究进展＊

功能性消化不良（functional dyspepsia， FD）是一种常见的功能性胃肠病（functional gastrointestinal disorder， FGID），属于中医“痞满”“胃脘痛”范畴，多因“气机升降失常”所致。目前，FD发病机制主要涉及脑肠互动异常、胃容受性受损、内脏敏感性增高、胃动力不足、幽门螺杆菌感染、十二指肠异常、心理精神因素等。随着罗马Ⅳ标准的颁布，十二指肠的作用在FD的发病中日益凸显。十二指肠高敏性、十二指肠黏膜屏障受损及十二指肠黏膜低度炎症等在FD病理生理过程中起着非常重要的作用，十二指肠可能是治疗FD的新靶点。本文综述FD发病中十二指肠的作用及中医药研究，为FD的基础研究及临床治疗提供理论依据。     

青年人群近距离工作后眼部参数的变化及恢复时间

目的：观察青年人群近距离用眼后眼部生理及功能性参数的变化及恢复时间。

方法：前瞻性研究。随机选取2019-12/2020-06在我院进行医学验光的患者69例138眼，根据主觉验光结果分为正视组(+0.75D≤等效球镜度≤-0.50D，18例36眼)、低度近视组(-0.75D≤等效球镜度≤-3.00D，25例50眼)和中度近视组(-3.25D≤等效球镜度≤-6.00D，26例52眼)。所有受试者近距离阅读20min后远眺放松20min，分别于近距离用眼前、近距离用眼20min后、远眺5、10、15、20min时测量受试者眼部生理性参数\〖前房深度(ACD)、眼轴长度(AL)\〗和功能性参数\〖正相对调节(PRA)、调节反应(BCC)\〗，分析各参数的达极时间和恢复时间。

结果：近距离用眼后眼轴变长，前房变浅，PRA绝对值变大，BCC无明显变化，75%(52/69)的受试者AL在近距离用眼20min后达极，87%(60/69)的受试者ACD在远眺5min时达极，96%(66/69)的受试者PRA在近距离用眼20min后达极，且以上参数均在远眺10min后逐渐恢复至初始状态。

结论：近距离用眼后眼部参数发生改变，眼轴变长，前房变浅，PRA绝对值增大，但均在远眺放松过程中逐渐回退，且均需要10min以上才能恢复至初始状态。     

Valuing height: diagnosis,valuation and the case of idiopathic short stature

This paper proposes a ‘valuographic’ approach to diagnosis, exploring how values and valuation practices are implicated in the contested diagnostic category of idiopathic short stature (ISS). ISS describes children who are ‘abnormally’ short but do not have any other detectable pathology. In the USA growth‐promoting hormone therapy has been approved for ISS children, since 2003. However, no other jurisdiction has approved this treatment and the value of ISS as a diagnostic category remains disputed among healthcare professionals. Drawing on qualitative interviews with paediatric endocrinologists in the UK and the US, this study presents a historical snapshot illustrating how the problematisation of ISS as a diagnosis involved multiple registers of value including epistemic, economic and moral calculations of worth. Contestation of the diagnosis was not just about what counts but about what ought to be counted, as respondents’ accounts of ISS gave differential weight to a range of types of evidence and methods of assessment. Ultimately what was at stake was not just the value of increased height for short patients, but what it meant to properly practice paediatric endocrinology. Consideration is then given to how a valuographic approach can be applied to sociological studies of diagnosis more broadly.