社区老年人及老年慢性病住院患者抑郁状况的研究

目的 分析社区老年人以及老年慢性病住院患者的抑郁状况,进一步探讨影响老年人以及老年慢性病住院患者抑郁状况的影响因素,以期提出一些措施来改善老年人的心理健康状况. 方法 采用自行设计的"老年人心理健康状况"和"老年慢性病患者心理状况"调查问卷,对102例60岁以上的老年慢性病住院患者和194例60岁以上的社区老年人进行问卷调查. 结果 老年慢性病患者与社区老年人的抑郁发生率具有显著性差异(P<0.05).老年慢性病住院患者抑郁发生率为49%,而社区老年人的抑郁发生率仅为8.2%.住院老年人:不同户籍,文化程度,付费方式之间的抑郁发生情况有显著差异(P<0.05).社区老年入:不同性别,文化程度,子女情况,体育活动情况之间均有显著性差异. 结论 完善医疗保障制度,特别是农村的医疗保障制度.改善老年人的生活条件,提高文化素质,加强社会支持以及鼓励老年人参加体育活动,可以提高老年人的心理健康状况.     

社区老年慢性病患者抑郁症发生率调查及干预建议

目的 探讨社区老年慢性病患者的抑郁症发生率及其人口社会学特征。方法 对2004年北京市东城区朝阳门社区卫生服务中心综合病房住院的60岁以上慢性病患者进行人口社会学特征分析及抑郁量表（GDS）调查。结果 老年慢性病患者中GDS总分≥11分共80人，为55．6％，女性明显多于男性，与文化程度、收入水平等因素密切相关。结论 老年慢性病人的抑郁情绪发生率高必须强调早发现早治疗，及早采取有效的干预措施。     

一线城市社区脑卒中后抑郁状况及影响因素分析

目的 了解社区脑卒中后抑郁的患病情况及影响因素,为社区更好的开展对脑卒中患者的心理卫生服务提供依据.方法 以上海某社区团队所管辖的116位脑卒中患者为研究对象,采用汉密顿抑郁量表（HAMD）和抑郁症状持续时间变量对患者进行PSD综合评定.调查患者的一般人口学特征、家庭照料情况、慢性病患病情况、脑卒中病程和类型以及功能障碍等情况.方法 脑卒中后抑郁的检出率为27.6％,其中轻度抑郁占22.4％,中度抑郁占5.2％.多因素回归分析结果显示：女性患者、慢性病种数越多、FAC功能障碍程度越高,PSD的患病风险越高.而配偶健在会降低PSD的患病风险.结论 社区脑卒中患者PSD的患病率较高,且PSD的发病受神经生理学和社会心理学共同作用,社区要从多个维度加强心理卫生服务,从而提高脑卒中患者的生存质量.     

老年慢性病患者抑郁状态及影响因素城乡差异研究

背景　抑郁是老年人常见的心理健康问题,而老年慢性病患者抑郁状态发生率远高于一般老年人群。目前,对于老年慢性病患者抑郁状况的研究主要集中于城市社区,对农村老年慢性病患者的关注及城乡比较研究较为有限。目的　探讨老年慢性病患者抑郁状态及其影响因素的城乡差异,为改善老年慢性病患者心理健康提供参考。方法　于2018年10月,采用多阶段随机整群的方法抽取山西省太原市的2 504例城乡老年慢性病患者为研究对象。问卷内容包括一般人口学信息、行为因素、慢性病数量及抑郁状况。采用简版老年抑郁量表（GDS-15）评估抑郁状态。运用二元Logistic回归模型分析城乡老年慢性病患者抑郁状态的影响因素。结果　在2 504例老年慢性病患者中,城市老年慢性病患者占55.39%（1 387/2 504）,农村老年慢性病患者占44.61%（1 117/2 504）,城市和农村老年慢性病患者性别、年龄、受教育程度、婚姻状况、主要经济来源、与子女关系、与配偶关系、吸烟情况、体力活动水平和慢性病数量比较,差异有统计学意义（P<0.05）。在所有被调查者中,抑郁状态的检出率为37.02%（927/2 504）,且农村老年慢性病患者抑郁状态发生率（45.66%,510/1 117）高于城市老年慢性病患者（30.06%,417/1 387）（P<0.05）。二元Logistic回归分析结果显示,与子女关系、与配偶关系、体力活动水平是城市和农村老年慢性病患者抑郁状态发生的共同影响因素（P<0.05）,年龄和患慢性病数量是城市老年慢性病患者抑郁状态的影响因素（P<0.05）,吸烟情况、饮酒情况及主要经济来源是农村老年慢性病患者抑郁状态的影响因素（P<0.05）。结论　城乡老年慢性病患者抑郁状况的影响因素不尽相同,在对老年慢性病患者抑郁状态的实际干预中要考虑城乡差异,有针对性地采取预防和改进措施。     

老年心血管病患者抑郁情绪临床分析

目的了解老年心血管病患者抑郁情绪,以便予以干预治疗。方法采用汉密尔顿抑郁量表,对267例心血管病患者进行抑郁状况的诊断评价。结果老年心血管病患者抑郁症发病率32.8%。结论心血管病和抑郁症均为增龄性疾病,严重威胁老人的健康,需要予以重视及积极干预。     

老年急性脑梗死后焦虑抑郁状态的临床研究

目的 探讨老年急性脑梗死后焦虑抑郁状态的影响因素及病因.方法 回顾性分析我院自2007年1月至2009年6月收治的89例急性脑梗死后抑郁症患者的临床资料,分析相关影响因素及病因.结果 (1)本组89例患者中属于轻度抑郁焦虑者23倒,占25.8%;属于中度抑郁焦虑者48例,占53.9%;属于重度抑郁焦虑者18例,占20.2%. (2)从性别、年龄、病变部位、病程、文化程度、吸烟史、婚姻状况等方面比较均有显著相关性(P<0.01),工作性质影响不大(P>0.05). (3)抑郁焦虑程度与神经功能缺损程度评分之间基本呈现良好的正相关关系.结论 焦虑抑郁情绪改变是老年急性脑梗死后的常见并发症,多种因素均可影响其发生率,另外,焦虑抑郁情绪不利于脑神经功能的恢复.     

基层医生对抑郁问题的认知情况及培训需求分析

目的：了解基层医生对抑郁问题认知情况及其培训需求,为全科医学培训工作提供可参考依据。方法：采用文献研究和现况调查的方法。在北京市社区卫生服务协会不同时间参加不同主题培训的8个基层医生培训班中随机选取2个班,对班级中的所有基层医生进行问卷调查。结果：在被调查的182名全科医生中,只有15．93％的人认为在其服务中开展了精神/心理卫生方面的服务;11．54％的人能够全部选对问卷中所列出的常见的9个抑郁症状,47．80％的人能够全部选对抑郁症筛检方法。仅有47（25．82％）人参加过正规的心理卫生知识和技能培训,76．37％的医生认为缺乏诊断与治疗的知识、技能是阻碍其提供心理卫生服务的重要因素。结论：抑郁是社区老年人常见的精神症状,而工作在社区中的全科医生对心理问题的识别能力较差,应加强对全科医生心理卫生知识和技能的培训,进一步改进社区精神卫生工作。     

呼吸内科住院患者焦虑及抑郁情绪现状调查分析

目的了解呼吸内科住院患者的焦虑、抑郁情绪现状及其影响因素,为进一步开展心理干预提供依据。方法采用自编问卷调查、抑郁自评量表、焦虑自评量表和匹兹堡睡眠质量指数问卷(PSQI)对2012年1月至2012年4月在我院呼吸内科住院治疗的257例患者进行测评。结果 257例呼吸内科住院患者中134例(52.14%)有焦虑情绪,158例(61.48%)有抑郁情绪,102例(45.19%)同时存在明显的焦虑抑郁情绪。多因素Logistic回归分析显示,自认为经济状况好是呼吸内科疾病患者出现焦虑情绪的保护因素,而高龄、恶性疾病、慢性疾病、有睡眠问题、恶性疾病和剧烈疼痛则是患者出现焦虑情绪的危险因素,此外还发现经济压力大、恶性疾病、慢性疾病和有睡眠问题是患者出现抑郁情绪的危险因素。结论呼吸内科住院患者焦虑情绪普遍存在,其焦虑抑郁情绪受多方面因素的影响,应采取针对性的干预措施以减少其焦虑抑郁情绪的出现。     

老年2型糖尿病患者抑郁状况调查及相关危险性分析

目的 调查老年2型糖尿病患者抑郁的患病率,分析与抑郁相关的危险因素.方法 报告了本社区2010年8-11月应用Beck抑郁问卷(BDI)进行抑郁评分的154例老年2型糖尿病患者的抑郁情况.同时采集糖尿病患者的年龄、性别、糖尿病病程,体质量数,血糖情况,糖尿病治疗情况及并发症患病情况.结果 52.6%的患者存在不同程度抑郁症,老年糖尿病患者合并抑郁的发生与性别,年龄,空腹血糖、糖尿病治疗情况,合并高血压及周围神经病变密切相关(P＜0.05).相关分析显示,抑郁与女性(r=0.297 P=0.028)、胰岛素使用(r=0.257 P=0.048)、合并高血压(r=0 257 P=0 049)、合并周围神经病变(r=0.345,P=0.020)相关.多元逐步回归分析显示,性别和周围神经病变进入回归方程,标准化回归系数分别为0.373(P=0.009)和0.380(P=0.007).结论 老年2型糖尿病患者抑郁的患病率较高,性别和合并周围神经病变是糖尿病合并抑郁的独立危险因素.     

老年慢性病共病患者抑郁 焦虑状况及影响因素

目的 研究老年慢性病共病患者焦虑、抑郁的发生率及其影响因素,为临床早期干预提供依据。方法 收集2021年6月到2022年6月在北京市大兴区林校社区卫生中心就诊老年慢性病共病患者504例,采用问卷调查方法记录患者的年龄、性别、文化程度、家庭可支配收入、居住方式、慢性病种类、慢性病支出情况等一般资料。应用Zung焦虑自评量表(SAS)和抑郁自评量表(SDS)对504例老年慢性病患者进行评分,分析不同性别、可支配收入、文化程度、慢性病数量和居住方式等患者SAS和SDS评分的差别,采用多因素logistic回归分析不同因素对老年慢性病共病患者焦虑、抑郁状态的影响。结果 老年慢性病共病患者的焦虑发生率为49.80%,抑郁发生率为51.58%,同时伴有焦虑抑郁状态的发生率46.62%。可支配收入、文化程度、慢性病种类和居住方式不同的老年慢性病患者SAS和SDS评分差异有统计学意义(P均<0.01)。logistic回归分析显示,家庭可支配收入高(OR=0.457,95%CI:0.331～0.630)是老年慢性病共病患者焦虑的保护性因素,独居(OR=1.799,95%CI:1.494～2.16...     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.