子宫颈癌术后化疗患者心理状态调查状况及相关因素分析

目的：探讨分析子宫颈癌术后化疗患者心理状态调查状况及相关因素。方法：选择2017年3月~2019年6月在我院行子宫颈癌根治术术后化疗患者94例作为研究对象,调查患者一般资料、抑郁自评量表(SDS)、焦虑自评量表(SAS)以及社会支持情况,采用单因素及多因素Logistic回归分析,分析可能影响患者抑郁、焦虑情绪的相关因素。结果：94例患者按照SDS标准分评价标准,无抑郁患者48例(51.06%)、轻度抑郁患者28例(29.79%)、中度抑郁患者15例(15.96%)、重度抑郁患者3例(3.19%)；按照SAS标准分评价标准,无焦虑患者52例(55.32%)、轻度焦虑患者32例(34.04%)、中度焦虑患者9例(9.57%)、重度焦虑患者1例(1.06%)。单因素多因素Logistic回归分析结果显示,社会支持、家庭年均收入、年龄以及对疾病了解程度为影响患者抑郁情绪的重要因素(P<0.05),社会支持、化疗不良反应、文化程度以及对疾病了解程度为影响患者焦虑情绪的重要因素(P<0.05)。结论：子宫颈癌术后化疗患者存在广泛的焦虑、抑郁情绪,影响患者焦虑、抑郁情绪的因素主要包括社会支持、经济条件、年龄以及对疾病的了解情况等。     

多因素对急性脑梗死患者发生抑郁障碍的影响

目的 探究多因素对急性脑梗死患者发生抑郁障碍的影响。 方法 选择2014年1月—2015年1月衢州市第三医院的急性脑梗死患者352例,按照性别分为对照组和实验组。对照组为男性患者,实验组为女性患者。2组患者得知病情后(1、3个月)的焦虑和抑郁情绪程度心理状态用抑郁自评量表(SDS)进行评估,并对部分影响患者发生抑郁障碍的因素进行单因素和多因素分析;性别对急性脑梗死患者发生抑郁障碍的影响参考对患者的单因素和多因素的分析结果。 结果 在患者得知病情1个月后和3个月后,实验组患者的SDS评分明显高于对照组:实验组患者SDS评分为(81.86±4.45)分;对照组SDS评分为(58.48±4.38)分,数据显示女性患者的焦虑抑郁情况较男性更重,2组患者统计数据比较差异有统计学意义(P<0.05);对脑梗死患者抑郁发病状况调查发现,患者年龄对比差异无统计学意义(P>0.05)。文化程度、婚姻状况等数据比较差异均有统计学意义(P<0.05)。除年龄外,经济来源、文化程度等因素均有可能导致急性脑梗死患者发生抑郁障碍。对脑梗死患者抑郁发病状况调查数据进行回归分析,文化程度、婚姻状况、业余爱好、睡眠质量、体育锻炼、社会支持为患者发生抑郁障碍的主要因素(P<0.05)。 结论 急性脑梗死女性患者发生抑郁的几率比男性大,且文化程度、婚姻状况、业余爱好、睡眠质量、体育锻炼、社会支持为患者发生抑郁障碍的主要因素。      

肿瘤患者主观睡眠质量与心身状况相关分析

目的了解肿瘤患者的睡眠质量与焦虑、抑郁情绪等心身状况以及它们之间的关系。方法采用匹茨堡睡眠质量指数量表(PSQI)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、状态特质焦虑问卷(STAI)和症状自评量表(SCL90)调查88名肿瘤住院患者主观睡眠质量与心身状况。结果患者在PSQI量表调查中总均分为(6.88±4.08)分,男、女患者分别为(6.47±4.08)分和(7.61±3.97)分,性别间差异无显著性(P>0.05),PSQI≥8分者占32.4%;SAS与SDS得分分别为(43.5±9.5)分,(44.5±10.8)分。而PSQI得分与SAS、SDS、SCL90总分间存在显著的相关性(r分别为0.544与0.399,0.493;P<0.01)。结论肿瘤患者的主观睡眠较差,并存在着焦虑及抑郁情绪。睡眠质量与焦虑、抑郁情绪密切相关,PSQI值越高,抑郁及焦虑越严重。     

建筑工地农民工精神状况调查与对策探讨

目的 调查建德市建筑工地农民工精神状况,以制定合理的应对措施,改善农民工生存状况,从而促进社会和谐发展。 方法 选取2015年2月—2015年4月在建德市4个建筑工地工作的215名农民工,采用症状自评量表(SCL-90)进行问卷调查;结合现有文献筛选出农民工精神状况的影响因素,经多因素非条件Logistic回归分析,确定建德市建筑工地农民工精神状况的影响因素,并结合现有文献提出相应对策。 结果 建德市建筑工地农民工在躯体化、强迫症状、抑郁、焦虑、敌对、恐怖、偏执以及精神病性等因子上的得分分别是(1.46±0.51)分、(1.71±0.60)分、(1.59±0.63)分、(1.56±0.61)分、(1.60±0.59)分、(1.47±0.50)分、(1.63±0.65)分、(1.52±0.51)分,均显著高于全国常模,且其差异具有统计学意义(P＜0.05);建德市建筑农民工SCL-90量表各因子的阳性检出率分别为躯体化24.73%、强迫症状48.65%、人际关系敏感18.28%、抑郁21.59%、焦虑23.96%、敌对36.21%、恐怖25.08%、偏执51.74%和精神病性31.65%。经Logistic回归分析,年龄、性别、婚姻状况、文化程度、就业压力、月工资等因素与建德市建筑工地农民工的精神状况相关。 结论 建德市建筑工地农民工精神状况显著差于全国常模,年龄、性别、婚姻状况、文化程度、就业压力、月工资等因素是其精神状况的影响因素,应采取相应对策予以改善。      

心理干预对强直性脊柱炎患者生存质量及心理健康状况的影响

目的探讨心理干预对强直性脊柱炎患者的生存质量及心理健康状况的影响。方法采用病例对照研究方法,测查一般资料、生理指标、健康状况调查问卷(SF-36)、社会支持量表(SSRS)、艾森克个性问卷(EPQ)、医学应对问卷(MCMQ)、抑郁自评量表(SDS)和焦虑自评量表(SAS)。对82例强直性脊柱炎患者进行为期1个月的追踪研究,42例常规治疗联合心理干预,40例常规治疗。结果1.SF-36生存质量影响因素逐步回归结果:影响有性别、受教育程度、家庭人均收入、社会支持、应对方式(回避和屈服)和人格特质。2.①SDS分值具有随治疗时间逐渐下降的趋势[心理干预组:(57.24±8.85)分,(54.71±7.51)分,(54.00±8.10)分;对照组:(57.98±8.11)分,(56.71±7.51)分,(55.00±8.11)分,F=4.501,P<0.05],心理干预组SDS分较无干预组下降明显(P<0.05)。②SAS分值具有随治疗时间逐渐下降的趋势[心理干预组:(50.10±9.41)分,(48.20±6.82)分,(47.29±7.84)分;对照组:(51.23±10.10)分,(50.10±7.24)分,(48.29±7.38)分,F=1.801,P<0.05],两组SAS分下降程度类似(P>0.05)。3.治疗前后心理干预组在生理机能、躯体疼痛、精力、情感职能四个方面较无心理干预组改善明显。结论1.影响强直性脊柱炎患者生存质量因素包括性别、受教育程度、家庭人均收入、社会支持、应对方式(回避和屈服)和人格特质。2.心理干预可以明显缓解强直性脊柱炎患者抑郁情绪和生存质量。     

广州市中专生的抑郁状况及影响因素分析

目的了解广州市中专生抑郁情绪的发生情况并探讨可能的影响因素,为其心理健康教育及咨询提供依据。方法应用Zung′s抑郁自评量表(SDS)及自制抑郁相关因素调查表对224名广州市某职业学校学生进行调查。结果 SDS总标准分为(47.92±9.50),抑郁检出率为42.0%;非条件Logistic回归分析结果为和父母一起居住是抑郁的保护因素(OR=0.259),学习成绩差、家庭经济困难是抑郁的危险因素(OR=1.783、1.896);抑郁状况在1周内感到孤独的天数、是否想过离家出走、是否想过自杀等方面的分布差异均有统计学意义(P<0.05)。结论广州市中专生抑郁较严重,可通过让学生和父母一起居住、改善由学习成绩差及家庭经济困难带来的心理负面影响以降低其抑郁情绪的发生。     

社区孕妇孕期体重自我管理状况和一般自我效能影响因素调查

目的 探讨孕妇孕期体重自我管理、自我效能及社会支持状况,为有效控制孕期体重增长提供依据。 方法 选取2017年1月—2018年4月上海某社区早孕建册的孕妇1 041例为研究对象,早孕期采用一般自我效能量表、社会支持量表进行问卷调查,分娩后根据美国医学研究所体重增加指南,分为孕期体重增长过多组和体重增长正常组,以自拟的孕期体重管理问卷进行调查,并对影响体重增长的因素进行分析。 结果 有效调查900例,孕期体重增长正常组507例(56.3%),一般自我效能平均得分为(2.83±0.53)分,社会支持量表平均得分为(36.28±5.23)分;孕期体重增长过多组393例(43.7%),一般自我效能感得分为(2.49±0.58)分,社会支持量表得分为(34.07±5.80)分。Logistic回归分析显示:一般自我效能感、社会支持状况、产检医生是否固定、对医生指导的配合度、停止工作的孕周和年龄、产检医生对孕期体重增长的重视程度、孕前体重指数是孕期体重增长是否过多的影响因素(均P<0.05)。 结论 社区医生在早孕期应加强孕妇规范化的体重管理,同时进行一般自我效能感、社会支持状况评估,可为有效体重管理提供依据。      

合同制护理人员焦虑抑郁和社会支持之间的相关性研究

目的:分析合同制护理人员焦虑抑郁情绪与社会支持间存在的相关性.方法:选取于该院工作且愿意参与本研究的合同制护理人员60名,应用焦虑自评量表(SAS)与抑郁自评量表(SDS)评估60名护士焦虑抑郁情况,同时应用社会支持量表(SSRS)评估护士社会支持情况,并与国内常模相比较,分析合同制护士焦虑抑郁与社会支持之间存在的相关性.结果:60名合同制护士48.3%存在抑郁情况,33.3%存在焦虑情况.合同制护士SAS评分为(43.8±7.5)分,SDS评分为(45.3±8.6)分,SSRS为(41.5±5.3)分,明显高于国内常模(P<0.05);相关性分析显示合同制护士社会支持度负相关于SAS、SDS,且P<0.05.结论:为合同制护士提供更多社会支持可减轻其焦虑抑郁情绪.     

慢性心力衰竭患者焦虑抑郁影响因素分析

目的：了解慢性心力衰竭患者产生焦虑抑郁症状的影响因素。方法：慢性心衰患者99例,采用焦虑自评量表（SAS）和抑郁自评量表（SDS）进行调查,并与全国常模对比,分析影响焦虑抑郁的相关因素。结果：99例慢性心衰患者SAS评分和SDS评分分别为43.17±14.47分和45.33±11.29分,明显高于全国常模的29.78±10.07分和33.46±8.55分,差异有统计学意义（P＜0.05）。39例（39.40%）存在焦虑,38例（38.39%）存在抑郁。心脏射血分数、糖尿病、家庭收入、病程为SAS的独立影响因素,心脏射血分数、糖尿病为SDS的独立危险因素。结论：慢性心力衰竭患者易产生焦虑抑郁情绪,需引起临床医师高度重视,必要时给予适当干预。     

心理干预对高危儿母亲情绪的影响

目的探讨心理干预对高危儿母亲不良情绪的影响。方法把280例高危儿的母亲随机分为干预组(140例)和对照组(140例),干预组在对高危儿常规保健的同时,按“母亲情绪管理方案”对母亲进行干预;对照组仅对高危儿进行常规保健。采用抑郁自评量表(SDS)和焦虑自评量表(SAS)进行母亲情绪状态评估。结果高危儿的母亲产后3个月内SDS标准分≥50分者59例,占21.07%;母亲产后抑郁自评标准分:1个月(44.75±9.94)分,2个月(42.22±10.55)分,3个月(40.57±10.68)分;产后3个月母亲各月抑郁标准分呈逐月下降趋势(P<0.01);SDS标准分≥50分者,第1个月SDS标准分干预组和对照组分别为(55.50±3.90)分,(52.88±9.05)分;SAS标准分干预组和对照组分别为(46.81±6.82)分,(42.80±8.38)分,2组无显著差别,而干预组SDS标准分第2个月(44.53±7.56)分、第3个月(41.35±7.56)分低于对照组(51.63±10.23)分,(52.46±10.55)分(P<0.01),SAS第3个月标准分(38.45±6.68)分低于对照组(45.53±9.65)分,差异有显著性(P<0.05)。结论高危儿的母亲产后3个月处在情绪障碍的高危状态,在高危儿保健过程中实施母亲情绪干预有效。     

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.