人格特征等因素对非典时期高危医务人员心理健康影响的Logistic回归

目的探讨个性特征、防御方式及社会支持对非典时期高危医务人员心理健康状况的影响。方法以134名高危医务人员为研究对象，用症状自评量表(SCL-90)筛选出因子分≥2的50人为病例组，其余84人为对照组，采用病例对照研究方法，探讨个性特征、防御方式及社会支持在两者之间的差异。结果单因素非条件Logistic出回归分析，个性忧虑等9个因素进入回归方程；经多因素条件Logistic回归分析，人格特征忧虑性、世故性及对社会支持的利用度进入回归模型。结论人格特征的忧虑性、世故性及对社会支持的利用度是非典期间高危医务人员心身健康的重要影响因素。     

剖宫产术后经阴道再分娩孕妇分娩成功率的影响因素分析

目的分析剖宫产术后经阴道再分娩孕妇分娩成功率的影响因素。方法选取2014年8月至2017年2月郑州市妇幼保健院126例剖宫产术后再次妊娠产妇作为研究对象,采用Logistic多因素回归分析法分析阴道分娩史、宫颈管消失状况等危险因素对剖宫产术后经阴道再分娩孕妇分娩成功率的影响。结果 Logistic分析显示,宫颈管消失≤50%、宫口开大≤3 cm、无阴道分娩史、本次分娩距前次剖宫产时间≤2 a、前次剖宫产指征为复发型均为影响孕妇分娩成功率的危险因素(P<0.05)。结论宫颈管消失≤50%、无阴道分娩史、宫口开大≤3 cm、本次分娩距前次剖宫产时间≤2 a、前次剖宫产指征为复发型均为影响孕妇分娩成功率独立危险因素,为剖宫产术后产妇选择有效分娩方式提供重要依据。     

剖宫产后再妊娠孕妇分娩方式选择剖宫产的影响因素

目的:探讨剖宫产后再妊娠孕妇分娩方式选择剖宫产的影响因素。方法:选取80例剖宫产后再妊娠孕妇为研究对象,调查所有孕妇分娩方式意愿,并收集孕妇临床资料,采用Logistic回归分析剖宫产后再妊娠孕妇分娩方式选择剖宫产的影响因素。结果:80例剖宫产后再妊娠孕妇选择剖宫产35例(43.75%),阴道试产45例(56.25%);选择剖宫产孕妇的年龄、户口类型、孕次、宗教信仰、剖宫产次数、工作状况、家庭年收入、配偶分娩方式意愿、产前体质量指数与选择阴道试产孕妇比较,差异均无统计学意义(P>0.05);选择剖宫产孕妇的受教育程度、对阴道试产了解程度、周围剖宫产后再次妊娠阴道分娩(VBAC)案例、医生与孕妇深度沟通占比均低于选择阴道试产孕妇,差异有统计学意义(P<0.05);经Logistic回归分析结果显示,受教育程度在高中及以下、不了解阴道试产、周围无VBAC案例、医生未与孕妇深度沟通均为剖宫产后再妊娠孕妇分娩方式选择剖宫产的影响因素(OR>1,P<0.05)。结论:受教育程度在高中及以下、不了解阴道试产、周围无VBAC案例、医生未与孕妇深度沟通均为剖宫产后再妊娠孕妇分娩方式选择剖宫产的影响因素。     

医学博士生16PF人格因素调查分析

对百名医学博士的16种人格因素及8种次级因素的调查发现，该群体基本人格心理因素处于常态水平；男性在兴奋性、敢为性、世故性、忧虑性、独立性因素上高于常模均值，在恃强性、有恒性、实验性、自律性上低于常模均值。女性在敢为性、世故性上高于常模均值，在恃强性上低于常模均值；男女博士生在独立性、实验性、自律性3项人格因素中存在显著性差异。     

二次分娩选择剖宫产手术的原因及其分析

目的分析足月妊娠孕妇二次分娩时选择剖宫产手术的影响因素。方法选择2017年6月至2018年12月期间我院收治的78例足月妊娠二次分娩孕妇作为研究对象,采用单因素和多因素Logistic回归分析其选择剖宫产术作为分娩方式的主要因素。结果单因素Logistic回归分析显示:孕妇的年龄、民族、居住地、文化程度、孕前BMI、上次妊娠间隔年数、家庭年收入、多胎妊娠、孕期合并症、既往病史、产前自然分娩教育、负面情绪、医疗保险方式与孕妇二次分娩时选择剖宫产手术有关(P0.05)。多因素Logistic回归分析显示:孕妇的年龄、孕前BMI、家庭年收入、多胎妊娠、孕期合并症、负面情绪、既往病史是孕妇二次分娩时选择剖宫产手术的独立危险因素,产前自然分娩教育是孕妇二次分娩时选择剖宫产手术的保护因素(P0.05)。结论孕妇二次分娩时选择剖宫产手术与孕妇的年龄、孕前BMI、家庭年收入、多胎妊娠、孕期合并症、负面情绪、既往病史具有密切相关性,临床上应结合孕妇的实际情况,合理控制剖宫产指征,降低二次分娩剖宫产率。     

剖宫产术后瘢痕子宫足月分娩结局的影响因素分析

目的探讨剖宫产术后瘢痕子宫足月分娩的方式选择及瘢痕子宫足月分娩对妊娠结局的影响。方法将2010年11月至2013年11月石柱县人民医院收治的103例剖宫产术后瘢痕子宫足月分娩产妇作为观察组,其中阴道分娩45例、再次剖宫产58例。另外选择同期常规妊娠的非瘢痕子宫足月分娩产妇作为对照组。比较阴道分娩组与再次剖宫产组的临床效果及瘢痕子宫对妊娠结局的影响。结果再次剖宫产组与阴道分娩组住院时间、出血量和Apgar评分比较差异均有统计学意义(P<0.01);两组盆腹腔粘连及产后发热方面的差异均有统计学意义(P<0.05或P<0.01);多元Logistic回归分析,剖宫产术后瘢痕子宫足月分娩影响妊娠结局的因素为:先兆子宫破裂及社会因素。结论剖宫产术后瘢痕子宫影响妊娠结局的因素较多,应对这些因素进行控制,以改善妊娠结局。     

百名医学博士16PF人格因素调查分析

对百名医学博士的16种人格因素及8种次级因素的调查发现,该群体基本人格心理因素处于常态水平;男性在兴奋性、敢为性、世故性、忧虑性、独立性因素上高于常模均值,在恃强性、有恒性、实验性、白律性上低于常模均值。女性在敢为性、世故性上高于常模均值,存恃强性上低于常模均值:男女博士生在独立性、实验性、自律性3项人格因素中存在显著性差异;以10年为界划分专业年限,不同年限组在稳定性、有恒性、幻想性、感情用事与安详机警性、专业成就方面存在显著性差异;对不同年龄段和不同专业类型组间人格因素的方差分析也表明有些人各因素间存在显著性差异。     

生活事件、应对方式及人格特征与成年男性酒精依赖的关系

目的:分析生活事件、应对方式及人格特征与成年男性酒精依赖的关系。方法:选取2017年1月至2018年1月在精神卫生中心戒酒区住院的114例酒精依赖成年男性作为观察组,另选取同期116例中国健康成年男性作为对照组,分别采用卡特尔十六种人格因素量表(16PF)和应对方式问卷(CSQ)调查,比较两组成年男性的社会人口学资料、人格特征及应对方式,并对酒精依赖的多因素进行Logistic回归分析。结果:两组年龄、婚姻状况、出生地、居住方式等人口学资料比较,差异无统计学意义(P>0.05);观察组学历明显低于对照组,情感虐待、躯体虐待、感情忽视、躯体忽视、家庭暴力、父母离异或分居、家庭有犯罪史及物质滥用经历的人数明显多于对照组,差异均有统计学意义(P<0.05);观察组稳定性、聪慧性、独立性得分明显低于对照组,敏感性、世故性、乐群性、敢为性、幻想性、忧虑性、紧张性、实验性得分明显高于对照组,差异均有统计学意义(P<0.05);两组特强性、兴奋性、有恒性、怀疑性、自律性得分比较,差异无统计学意义(P>0.05);观察组解决问题、合理化得分明显低于对照组,求助、自责、幻想、退避得分明显高于对照组,差异均有统计学意义(P<0.05);多因素logistic回归分析结果显示,情感虐待、躯体虐待、躯体忽视、物质滥用、家庭暴力、敏感性、忧虑性、独立性、自责、幻想、退避是成年男性酒精依赖的独立危险因素。结论:情感虐待、躯体虐待、躯体忽视、物质滥用、家庭暴力、敏感性、忧虑性、独立性、自责、幻想、退避均是成年男性酒精依赖的独立危险因素。因此,必要时需给予患者心理干预,创造一个和谐的环境,培养其积极的应对方式及健全的人格,降低酒精依赖程度。     

妇女产前保健服务与分娩方式的关联研究

目的探讨芜湖及周边地区妇女剖宫产流行病学分布特征及其与孕产妇保健服务的关联性。方法选取安徽省巢湖和芜湖市2009年有过分娩史的产妇共计490例,采用自填式问卷的方法收集孕产妇的基本信息。调查内容包括人口统计学变量、孕产妇保健服务情况及本次实际采取的分娩方式等。采用多因素Logistic回归模型进行分析。结果 490例孕产妇中139例(28.4%)的分娩方式为自然分娩,180例(36.7%)的分娩方式为医学指征剖宫产,171例(34.9%)的分娩方式为社会因素剖宫产。多因素Logistic回归显示,产检次数>8次[OR=2.386,95%CI(1.124,5.064)]、入院时有临产先兆[OR=0.091,95%CI(0.031,0.269)]、有流产史[OR=1.867,95%CI(1.000,3.505)]是影响医学指征剖宫产的因素。而第一次产检时孕周>12周[OR=0.447,95%CI(0.230,0.868)]、产检医院为社区与乡镇医院[OR=0.406,95%CI(0.200,0.825)]、产检有异常[OR=0.285,95%CI(0.108,0.746)]、入院时有临产先兆[OR=0.053,9...     

实习护生与新护士人格特征分析

目的探讨实习护生和新护士人格特征,优化其个性。方法采用卡特尔16种个性因素量表对实习护生和新护士进行测试。结果①实习护生与新护士在聪慧、稳定、有恒、世故、忧虑、自律性6项主要人格因素存在显著差异,在适应与焦虑、心理健康因素、创造能力、新环境成长能力4项次级因素也存在显著差异。②新护士与实习护生同样存在低敢为性、低独立性、低世故性及低心理健康因素,忧虑、怯懦不果断。结论新护士与实习护生独立和适应能力低,不善于表达,处理问题和心理耐受调节能力差,在实践中需加强其个性特征培养和优化。     

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.