高原某部官兵负性认知加工偏向特征与抑郁情绪间关系分析

目的 从高原官兵负性认知加工特征着手,探讨高原官兵心理健康状况,以及负性认知加工偏向与抑郁情绪间关系.方法 选择负性认知加工偏向问卷和流行抑郁量表,采用整群抽样,对4 635名高原某部留驻官兵进行心理测评.结果 ①在注意偏向方面,年龄(F=10.38,P＜0.01)、军龄(F=7.66,P＜0.01)、文化程度(F =4.17,P＜0.05)和职别(F=11.49,P＜0.01)差异存在统计学意义;②在记忆偏向方面,年龄(F=3.72,P＜0.01)、军龄(F=4.11,P＜0.01)、文化程度(F=13.27,P＜0.01)和职别(F=9.57,P＜0.01)差异存在统计学意义;③在解释偏向方面,年龄(F=15.05,P＜0.01)、军龄(F=11.20,P＜0.01)、文化程度(F=19.31,P＜0.01)和职别(F=24.76,P＜0.01)差异均存在统计学意义;④在沉思偏向方面,只有年龄(F=5.98,P＜0.01)、军龄(F=6.93,P＜0.01)和职别(F =6.96,P＜0.01)方面差异存在统计学意义;⑤负性认知加工偏向的4个因子与抑郁检出之间均存在相关性(r注意=0.43,r记忆=0.47,r解释=0.46,r沉思=0.58,P＜0.01).结论 负性认知加工偏向是抑郁易感者和抑郁患者的重要特征.     

医学生英语学习中认知加工技能的使用研究

目的:了解医学生英语学习中认知加工技能的使用现状,为提高英语教学质量提供理论基础.方法:116名医学新生随机分为实验组58人和对照组58人,进行噪音条件(无干扰/低干扰/高干扰)×单词发音规则类型(完全符合/部分符合/完全不符合发音规则)×音标(有/无)混合设计的单词再认实验.结果:单词发音规则类型和语音条件对单词再认率的交互效应有统计学意义(F=2.550,P=0.038＜0.05);实验组在音标提示下,不同发音规则单词类型的再认率的差异有统计学意义(F=4.656,P=0.010＜0.05),而蜂鸣音与类似语音条件下单词再认率的差异有统计学意义(F=0.094,P=0.017＜0.05).结论:医学生在英语学习中同时使用了迁移语音加工技能和迁移字形加工技能,但对语音加工技能的使用依赖度不高.     

不同年龄儿童不同时段尿碘水平代替晨尿的可行性研究

目的:探讨不同时段尿碘水平代替晨尿的可行性.方法:收集重庆市区1所小学60名8～10岁儿童的晨尿及同日10am、12:30、4pm时段的尿样,分析比较其尿碘水平.结果:重复测量方差分析提示不同时段尿碘间有显著性差异(F=12.98,P＜0.01),不同时段、不同年龄组尿碘水平有显著性差异(F=4.48,P＜0.0001),不同时段、不同性别对尿碘水平无共同作用(F=0.10,P=0.96),晨尿与10 am尿碘值差异无统计学意义(P＜0.05).结论:不同年龄段、不同时段之间尿碘值存在差异,运用10 am之前尿样代替晨尿具有代表性和可行性.     

南昌市基层医务人员职业认知现状及影响因素分析

目的了解南昌市基层医务人员的职业认知现状,并对其影响因素进行分析,为基层卫生综合改革提供政策依据。方法以南昌市新建县、青云谱区2个国家级基层综合改革示范点为样本县区,采用单纯随机方法,抽取6家基层卫生机构的基层医务人员,对其进行职业认知调查,并对影响职业认知的因素进行线性回归分析。结果完成调查的181名基层医务人员总体职业认知为(3.29±0.64)分。不同地区、性别、年龄、职称和每天工作时间的医务人员之间总体职业认知及各维度水平皆没有差异,不同工作类别医务人员的收入与绩效满意度差异有统计学意义(F=2.550,P<0.05),社区卫生服务中心医务人员的工作环境满意度(F=4.960,P<0.05)及职业认同水平(F=3.237,P<0.05)皆高于乡镇卫生院,医务人员月平均收入不同,其总体职业认知(F=3.556,P<0.05)及收入与绩效满意度(F=3.898,P<0.05)、职业规划水平(F=3.632,P<0.05)差异有统计学意义。低职称、月平均收入高、护士总体职业认知高(模型F=7.256,P<0.001)。结论合理提高基层医务人员的收入,建立不同工作类别人群的绩效考核与薪酬管理机制,增加绩效分配的弹性,拓宽绩效来源范畴,建立与其职业期望相适应的相关优惠政策,对稳定基层卫生服务队伍、增强职业认知具有重要意义     

肝细胞癌多普勒超声影像与微血管密度、血管内皮生长因子表达的相关性分析

目的:探讨肝细胞癌的多普勒血流特点与微血管密度(MVD)及血管内皮生长因子(VEGF)的相关性.方法:采用多普勒超声记录32例肝细胞癌患者肝脏肿块的大小和血流分级,并测定血流阻力指数(RI).取术后或穿刺的肿瘤组织进行MVD及VEGF免疫组化检测.结果:随血流分级的增高,MVD的表达逐渐增多(F=20.425,P＜0.05),不同血流分级的VEGF阳性率间差异无统计学意义(X2=0.793,P＞0.05).MVD、RI随肿块的增大而增高(F值分别为22.443和11.983,P均＜0.05),RI与MVD呈正相关(r=0.812,P＜0.05).不同大小肿块间VEGF阳性率差异无统计学意义(λ2=0.154,P＞0.05).VEGF表达阳性组与VEGF表达阴性组之间MVD、RI值差异有统计学意义(t值分别为-3.056和-2.961,P均＜0.05).结论:多普勒超声是一种无创评价肝细胞癌血管生成活性的方法,可以为临床各种治疗和预后判定提供客观依据.     

社会支持对赴川救灾医护人员替代性创伤的影响

目的 探讨社会支持对赴川救灾医护人员替代性创伤的影响.方法 采用社会支持评定量表和灾难救助者替代性创伤问卷对160名赴川救灾医护人员进行问卷调查.结果 (1)不同性别的医护人员在主观支持(t=2.685,P＜0.01)、社会支持总分(t=2.602,P＜0.01)、替代性创伤总分(t=-2.380,P＜0.01)、情绪反应(t=-2.660,P＜0.01)和行为反应(t=-2.310,P＜0.01)因子间差异均有统计学意义;(2)赴受灾程度不同地区的医护人员在客观支持(F=4.179,P＜0.01)和生活信念(F=6.349,P＜0.001)因子间差异有统计学意义;(3)不同年龄阶段的医护人员在认知反应因子(F=8.809,P＜0.001)和主观支持(F=4.659,P＜0.01)及社会支持总分(F=4.629,P＜0.01)间差异均有统计学意义;(4)医护人员的社会支持与替代性创伤存在显著的负相关(r=-0.319,P＜0.05);(5) 回归分析中医护人员的社会支持对替代性创伤有预测作用.结论 医护人员的社会支持和替代性创伤存在性别及年龄的差异,且受地区灾情程度的影响;医护人员获得的社会支持越多,所受的替代性创伤越小.     

黑白与彩色多普勒阴道超声对早孕胚胎绒毛超微结构影响的研究

目的 分析黑白与彩色多普勒阴道超声不同检查时间对早孕胚胎绒毛超微结构的影响.方法 选取人工流产的早孕者120例,随机分为两组,彩超组60例予阴道彩色多普勒超声检查,其中检查5 min者20例,10 min者18例,15 min者22例.黑白组60例予阴道黑白B超检查,其中检查5 min者19例,10 min者19例,15 min者22例.对比两组胚胎绒毛超微结构变异率及绒毛DNA单链断裂和双链断裂的情况.结果 检查5 min和10 min,两组胚胎绒毛超微结构变异率差异无统计学意义(P＞0.05);检查15 min,彩超组绒毛超微结构变异率高于黑白组(P＜0.05).检查5 min,两组DNA单链和双链断裂情况比较差异无统计学意义(P＞0.05).检查10 min及15 min,彩超组绒毛DNA单链、双链断裂均较黑白组增加,差异均有统计学意义(P＜0.05).彩超组:绒毛超微结构变异率,5 min组和10 min组无差异,15 min组高于10 min组.随着检查时间延长,DNA单链、双链断裂增加,5 min组＜10 min组＜15 min组.黑白组:检查15 min内,绒毛超微结构变异率无差异.15 min组DNA单链、双链断裂较10 min组增加(P＜0.05).结论 阴道黑白超声检查15 min内,对胚胎绒毛超微结构影响较小.阴道彩色多普勒超声检查超过10 min,对胚胎绒毛超微结构影响会增加.超声检查选择应结合临床情况,并控制检查时间.     

哮喘患者诱导痰液安全性分析

目的:研究支气管哮喘不同发作期的哮喘患者痰液诱导方法的安全性.方法:给予患者200 μg沙丁胺醇吸入后用3%高渗盐水雾化吸入,留取对照组和哮喘不同发作期的各组诱导痰液,对诱导痰液成功率、痰量、诱导痰液前后肺通气功能指标及其与肺通气功能基础值进行比较分析.结果:哮喘各组成功率除中重度组与对照组比较差异有显著性外,其余各组之间没有统计学差异,各组痰量比较差异无显著性.缓解期组诱导痰液15 min后FEV1%、PEFR%较吸入沙丁胺醇前增加(t=2.13,P＜0.05;t=2.09,P＜0.05).轻度、间歇发作组吸入沙丁胺醇及诱导痰液10 min后,FEV1%和FVC%较吸入前明显增加(t=2.14、2.78,P＜0.05、＜0.01;t=2.10、2.18,P＜0.05、＜0.01).中重度吸入沙丁胺醇后肺通气功能指标均有不同程度增高,但没有统计学差异.各组肺通气功能指标下降值≥10%例数各组之间进行率的比较差异均无显著性(P＞0.05).肺通气功能各项指标变化值与肺通气功能基础值无相关性(P＞0.05).结论:对于支气管哮喘不同发作期患者,本试验仍不适为一种有效的痰液诱导方法.     

不停跳心内直视术中P-选择素在肺循环的表达研究

目的:观察不停跳心内直视术下P-选择素在肺循环中的表达.方法:将室间隔缺损患者28例,随机分成停跳组14例,行停跳体外循环下室间隔缺损修补术.不停跳组14例,行不停跳体外循环下室间隔缺损修补术.于转机前(T1)、转机20 min(T2)、转机末(T3)、转机结束15 min(T4)分别自肺静脉采血,采用酶联免疫吸附法检测血中P-选择素的表达并作出对比分析.结果:体外循环前、后患者P-选择素表达变化差异有统计学意义(F=416.622,P＜0.01);组内比较P-选择素表达随时间的变化具有递增性,差异均具有统计学意义(F=29.543,P＜0.01);组间同一时间检测点的比较,体外循环后不停跳组P-选择素的水平均低于停跳组,差异有统计学意义(P＜0.05).结论:心内直视术下P-选择素在肺循环中表达增强,但在不停跳体外循环下的表达增强程度要弱于停跳体外循环下.     

卒中后失语患者非语言性认知功能特点的临床研究

目的 探讨卒中后失语患者的非语言性认知功能特点.方法 纳入30例卒中后失语患者和30例卒中后非失语患者,对失语组采用汉语失语检查量表（Aphasia Battery of Chinese,ABC）进行失语评估,并用非语言性的认知功能评定量表（The Non-language-based Cognitive assessment,NLCA）评估卒中后失语患者和非失语患者的认知功能.用卒中后失语患者抑郁问卷（医院版）（Stroke Aphasic Depression Questionnaire Hospital Version,SADQ-H）评估卒中后失语患者的抑郁情绪,比较失语患者的抑郁情绪与认知功能损伤之间的关系.结果 失语组的NLCA总分（50.01±14.01）分显著低于非失语组（66.13±5.95）分,差异具有统计学意义（P＜0.05）;失语组的NLCA总分及其各亚项分值均与ABC总分及其各亚项分值具有相关性（P＜0.01,P＜0.05）;失语组SADQ-H总分（21.83±7.37）分显著高于非失语组SADQ-H总分（16.13±5.84）分,差异具有统计学意义（P＜0.01）;失语组SADQ-H评分与NLCA总分呈显著负性相关（r=-0.468,P＜0.05）.结论 卒中后失语患者存在非语言性认知功能障碍,并且失语患者抑郁情绪的严重程度对认知功能的损伤有影响.     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.