青岛市居民就诊单位选择影响因素的多项式Logistic回归分析

目的：研究影响青岛市城乡居民选择就诊单位的因素。方法：采用多项式Logistic回归分析法，分析影响青岛市城乡居民选择就诊单位的主要因素。结果：影响市区病人选择就诊单位的主要因素是医疗保健制度和 居民健康状况， 农村病人的主要影响因素是家庭收入、健康状况和受教育程度。结论：居民就诊单位选择受多种因素的影响，建议加快医疗保健制度的改革，完善医疗保健制度。     

青岛市市区居民医疗费用及影响因素分析

①目的　了解青岛市市区居民医疗费用及其影响因素。②方法　根据青岛市居民的经济状况、地理位置等因素 ,采取整群抽样法 ,抽出 1 5个居委会 ,再于每个居委会内进行随机抽样 ,共抽出 3 2 0 0人进行问卷调查。③结果　青岛市市区居民的门诊次均就诊费用的中位数是 85 .0 0元 ,患有慢性病的居民、有残障的居民、女性病人、公费及公费为主病人的次均就诊费用较高。住院病人费用中位数为 3 60 0 .0 0元 ,年龄与病人的住院费用呈正相关关系 (r=0 .356 ,P <0 .0 0 5)。住院费用的主要影响因素为年龄、职业及医疗保障方式等。④结论　青岛市市区居民医疗费用支出受多种因素影响 ,应改革医疗保健制度 ,以满足居民就诊需要     

青岛市市区居民的两周患病率及就诊状况分析

①目的了解青岛市市区居民的两周患病率及就诊状况。②方法采取整群随机抽样法，对青岛市市区15个居委会的3057人进行问卷调查。③结果市区居民的两周患病率为108．28‰(男性：103．27‰，女性：113．48‰)，每千人两周因病休工的天数为183d，每千人卧床天数为135d．两周患病率与居民年龄、文化水平、职业及医疗保健方式等因素有关。居民两周就诊率为73．60‰，未就诊者占患病人数的30．24％，④结论青岛市市区居民的医疗需求量较高，门诊利用率较低，应改革医疗保健制度，以方便居民就诊。     

青岛市市区居民的两周患病率及就诊状况分析

目的：了解青岛市市区居民的两周患病率及就诊状况。方法：采取整群随机抽样法，对青岛市市区15个居委会的3057人进行问卷调查。结果：市区居民的两周患病率为108．28‰（男性：103．27‰，女性：113．48‰），每千人两周回病休工的天数为183d ，每千人卧床天数为135d，两周患病率与居民年龄、文化水平、职业及医疗保健方式等因素有关。居民两周就诊率为73．60‰，未就诊者占患病人数的30．24％。结论：青岛市市区居民的医疗需求量较高，门诊利用率较低，应改革医疗保健制度，以方便居民就诊。     

青岛市农村居民医疗费用及影响因素分析

①目的 调查青岛市农村居民的医疗费用及其影响因素。②方法 采用整群抽样与随机抽样相结合的方法，对7个自然村的3700名18岁以上居民进行了问卷调查。③结果 青岛市农村居民门诊次均就诊费用中位数是24．39元，患有慢性病的居民、有残障的居民次均就诊费用较高，文盲、半文盲组居民的次均就诊费用低于其他组。居民因病住院的直接费用中位数：乡镇卫生院653元、县级医院2075元、市级医院3476元。居民住院费用的主要影响因素为是否患慢性病及有无残障等。④结论 青岛市农村居民医疗费用支出基本合理，居民医疗费用受多种因素影响。     

多分类Logistic回归分析研究军队人员就诊意向的影响因素

目的:寻求影响军队人员最愿意就诊单位选择的主要因素,为军队卫生资源的优化配置和卫生事业改革政策的制订提供科学依据.方法:采用多分类Logistic回归分析法,分析影响军队人员选择最愿意就诊单位的主要因素.结果:影响军队人员选择就诊单位的主要因素是军兵种和工作性质,其次是对部队医疗机构供药满意度和健康状况.结论:军队人员就诊单位选择受多种因素的影响,建议加强基层卫生机构建设,提高其卫生资源利用效率.     

昆明市城区老年人医疗保健服务需求和利用情况分析

目的 了解昆明市城区60岁以上人群医疗保健服务需求和利用情况及其影响因素，为改善老年人医疗保健服务提出建议。方法 采用家庭卫生服务调查表及深入访谈的方式对老年人的一般情况及社会医疗服务需求情况进行调查。结果 老年人两周患病率为25．9％，慢性病患病率为80．8％，两周就诊率为41．2％，年住院率为18．5％。老年患者主要选择省市级医院就诊，对杜区卫生服务站的利用较低。结论慢性病已成为影响老年人健康状况的重要因素，医疗费用过高、经济因难影响老年人对卫生服务的合理利用。完善医疗保障制度，积极开展杜区卫生服务是解决老年人医疗保健问题的有效途径。     

深圳市社区居民就诊流向及对社区卫生服务态度的调查与分析

目的调查深圳市社区居民医疗保健就诊流向及对社区卫生服务的了解程度和态度,分析其与居民年龄、职业、文化程度、健康状况的关系。方法随机抽取8个有代表性的社区,并采用整群随机法抽取2544名居民,调查他们日常医疗保健就诊流向及对社区卫生服务的了解程度和态度。结果2544名居民中选择社卫中心作为日常医疗保健就诊去向的占59.55%,认为有必要在社区内建设社卫中心者占88.71%,不同年龄、职业、文化程度、健康状况的居民就诊流向、对社区卫生服务的了解程度及其实际就诊情况间差异均有显著性意义(P<0.05),居民对社卫中心建设的态度与其年龄、文化程度、职业无关,而与其健康状况有关(P<0.05)。结论深圳市社区卫生服务中心已成为深圳市大多数居民日常医疗保健就诊的主要卫生服务机构,居民的就诊流向和对社区卫生服务的了解程度及在社卫中心的就诊率与其文化程度、职业、年龄和健康状况有关。     

石家庄市某社区居民医疗方式及社区卫生服务认知情况调查

目的 调查社区居民的就诊、用药、首诊单位、对社区卫生服务站的认知等情况及受何因素影响。方法 在某小区、随机选择10栋楼、开展入户调查。结果 在社区居民首选本单位医院就诊的最多,占44．28％。医疗定点、距离远近、服务质量优劣是影响居民选择医疗单位的主要因素,三者合计占86．65％,患病后找医生治疗的为60．48％。药品来源以去医院、诊所购药为主,占63．35％。居民对社区卫生服务有了一些初步认识。结论 随着医疗改革的不断深入、个人帐户的建立,社区卫生服务费用纳入医保等配套政策的实施,社区卫生服务具有很大的生存和发展空间。     

青岛市农村居民两周患病率及就诊状况分析

①目的 了解青岛市农村居民两周患病率及就诊状况。②方法 整群与随机抽样法相结合，抽出7个自然村的3700名18岁以上居民进行问卷调查。③结果 青岛市农村居民的两周患病率为199．37‰(男性：184．78‰，女性：211．83‰)，每千人两周因病休工天数为369．6d，每千人因病卧床天数为100．8d。两周患病率与居民年龄、收入、文化水平、是否患有慢性病和是否有残障等因素有关。居民两周就诊率为151．57‰(男：151．35‰，女：151．74‰)，主要就诊医疗机构是村卫生室；未就诊者占患病人数的24．22％。④结论 青岛市农村居民对门诊服务的利用率较低，应建立健全医疗保障制度，以满足居民的医疗需求。     

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.     

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.     

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.