社区老年慢性阻塞性肺疾病患者自我管理现状及影响因素分析

目的：调查社区老年COPD患者自我管理现状及影响因素。方法采用便利抽样法对广东、安徽和河南社区的206例老年COPD患者进行问卷调查。结果患者自我管理知识技能各维度中,疾病与吸烟的关系得分最高,康复锻炼相关知识技能得分最低,病情加重的预防、识别与应对次之;自我效能的各维度中,得分从高到低依次为：行为危险因素、强烈的情绪唤起、躯体活动、天气／环境、负面影响;自我管理各维度中,得分从高到低依次是：日常生活管理、情绪管理、自我效能管理、症状管理、信息管理。影响自我管理行为得分的因素有年龄、自我效能得分和有无病友交流。相关分析显示患者的知识技能与自我效能（r＝0.266,P＜0.01）、自我效能与自我管理行为（r＝0.667,P＜0.01）、知识技能与自我管理行为（r＝0.488,P＜0.01）之间均存在正相关。结论本组患者自我管理行为处于中等水平;影响因素较多;知、信、行三者之间存在正相关关系。应依据影响因素的不同进行针对性的护理干预,进一步提高患者自我管理能力。     

社区2型糖尿病患者建立自我管理小组的效果分析

目的 探讨社区2型糖尿病患者建立自我管理小组开展自我管理的效果。方法 2013年4月—2014年4月,选取上海市浦东新区花木街道由由七居委小区的52例2型糖尿病患者纳入糖尿病自我管理小组,糖尿病自我管理小组干预前和干预后1年分别采用糖尿病知识问卷对患者糖尿病知识掌握情况进行测评,采用糖尿病自我管理活动问卷（SDSCA）对患者自我管理状况进行测评,并测定空腹血糖（FBG）、餐后2 h血糖（2 hPBG）及糖化血红蛋白（HbA1c）水平。结果 干预前后患者糖尿病知识掌握情况比较,差异有统计学意义（u=-5.47,P＜0.05）。干预后SDSCA总分、饮食治疗得分、运动治疗得分、药物治疗得分、血糖监测得分、足部护理得分均较干预前升高（P＜0.05）。干预后患者FBG、2 hPBG、HbA1c水平均较干预前降低（P＜0.05）。结论 糖尿病自我管理小组能够提高健康教育效果,普及健康知识,有利于患者"知信行"健康信念模式的转变,改善血糖水平,促进自我管理。     

轻中度COPD患者自我管理行为现状及影响因素

目的 了解轻中度慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者自我管理行为现状，并结合个人与家庭自我管理理论（individual and family self-management theory，IFSMT）进行影响因素分析。方法 便利抽样法选取2021年9至12月某三甲医院呼吸内科门诊就诊的130例轻中度COPD患者为调查对象，采用一般基线资料调查问卷和COPD自我管理问卷对其进行调查。经单因素及多元线性回归分析轻中度COPD患者自我管理行为的影响因素。结果 130例轻中度COPD患者自我管理行为得分（107.29±18.64）分。经多元线性回归分析，结果显示，不同居住地，不同家庭月收入，过去1年因COPD住院次数及是否获得COPD信息是轻中度COPD患者自我管理行为的影响因素（P<0.05），可解释的变异总量为40.1%。结论 轻中度COPD患者的自我管理行为不容乐观，居住在农村，家庭收入低，过去1年住院次数少以及没有获得COPD信息的患者是自我管理指导的重点人群。医护人员可以在IFSM理论指导下，结合影响患者的自我管理行为的影响因素制定个性化自我管理干预计划。     

冠心病患者恐惧疾病进展对自我管理意向的影响

目的 探讨冠心病患者恐惧疾病进展和自我管理意向现状,分析冠心病患者的恐惧疾病进展对自我管理意向的影响及因素。方法 采用冠心病患者一般资料问卷、恐惧疾病进展量表和自我管理意向问卷对河南大学淮河医院心内科住院的256例冠心病患者进行调查。采用多重线性逐步回归法进行自我管理意向多因素分析及恐惧疾病进展和自我管理意向的相关性分析。结果 冠心病患者自我管理意向总分为(82.02±9.68)分,多重线性逐步回归分析结果显示冠心病患者性别、医疗费用所占月收入比率、家族史、恐惧疾病进展是冠心病患者自我管理意向的影响因素(P<0.001)。结论 冠心病患者恐惧疾病进展得分较高,自我管理意向得分较低,医务人员应实施有效的个性化心理干预,激发患者进行有效自我管理的积极性,促使患者主动参与疾病管理,有效执行自我管理。     

老年2型糖尿病患者自我管理状况及影响因素分析

目的：探讨老年2型糖尿病患者自我管理的状况及其影响因素.方法：采用糖尿病自我管理活动问卷及影响因素问卷对320例老年2型糖尿病患者调查.结果：老年2型糖尿病患者自我管理能力较差,自我管理各维度得分分别为：饮食自我管理（4.24±2.57）分,运动自我管理（4.87±2.33）分,遵医嘱服药自我管理（6.21±1.65）分,血糖监测自我管理（1.08±1.79）分,足部护理自我管理（2.79±2.18）分.自我管理现状的多元逐步回归结果显示自我效能、文化程度、糖尿病知识、性别是饮食自我管理的主要影响因素;年龄、自我效能、医疗费用支付方式是运动自我管理的主要影响因素;自我效能、糖尿病知识及是否因糖尿病住院是遵医嘱服药的主要影响因素;自我效能、糖尿病知识、文化程度及社会支持是血糖监测自我管理的主要影响因素;病程、糖尿病知识及自我效能是足部护理自我管理的主要影响因素.结论：老年2型糖尿病患者的自我管理现状不理想,其中遵医嘱服药最好,足部护理及血糖监测最差,患者的自我效能、年龄、糖尿病知识等是主要影响因素.     

社区老年糖尿病患者家庭功能与自我管理行为相关性研究

目的：探讨社区老年糖尿病患者家庭功能与自我管理行为的相关性,为社区老年糖尿病患者自我管理干预提供依据。方法采用便利抽样入户调查法,应用家庭功能评估量表和糖尿病自我管理活动量表对670名社区老年糖尿病患者进行调查。结果社区老年糖尿病患者家庭功能总得分为（6．95±2．91）分,自我管理行为总得分为（20．06±5．80）分,其中,运动自我管理维度得分最高、血糖监测自我管理维度最低;且社区老年糖尿病患者家庭功能与自我管理行为呈正相关（r＝0．156,P ＜0．05）。结论社区老年糖尿病患者家庭功能与自我管理行为密切相关,良好的家庭功能有助于提高患者的自我管理行为。     

苏州社区糖尿病前期人群疾病不确定感和应对方式调查

目的：探讨糖尿病前期人群疾病不确定感现状,分析和应对方式的相关性。方法2013年10～12月筛查出苏州社区糖尿病前期患者148例,采用许淑莲修订的M ishel疾病不确定感量表、医学应对方式问卷对患者进行调查,分析影响疾病不确定感的因素及疾病不确定感与应对方式的相关性。结果苏州社区糖尿病前期人群疾病不确定感总分平均为（81．35±16．57）分,其中不明确性维度得分为（48．59±8．59）分,复杂性维度得分为（32．76±8．95）分。在年龄、性别、医保方式、吸烟、糖尿病家族史、高血压史、疾病不确定感总分间差异有统计学意义（P＜0．05）。面对维度与疾病不确定感呈负相关,回避和屈服维度得分与疾病不确定感的2个维度得分及总分均呈正相关（P＜0．05）。结论医务人员应指导患者采取有效的应对方式,以降低疾病的不确定感,从而提高患者的生活质量。     

1型糖尿病患者血糖波动的影响因素研究

背景1型糖尿病（T1DM）患病率逐年增加,其自身免疫的特性易导致患者出现胰腺β细胞破坏和胰岛素缺乏症,进而使患者血糖不易达标。目的应用瞬感扫描式血糖监测系统（FGMS）探讨T1DM患者血糖波动的影响因素,为未来临床采取针对性降糖治疗措施提供依据。方法应用便利抽样法选取2019年5月至2020年4月南京医科大学附属淮安第一医院收治的85例T1DM患者作为研究对象。收集患者性别、年龄、糖尿病病程、婚姻状况、文化程度、吸烟、饮酒等基线资料,测定体质指数（BMI）、腰臀比（WHR）、血压（BP）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（HDL-C）、估算肾小球滤过率（eGFR）和尿微量白蛋白/尿肌酐比值（UACR）等临床资料,依据患者平均血糖波动幅度（MAGE）是否高于总体均值0.82 mmol/L将患者分为血糖波动高组与血糖波动低组,评估糖尿病自我管理行为量表（SDSCA）总分及糖尿病授权简化量表（DES-SF）总分,采用多元线性回归分析探讨T1DM患者血糖波动的影响因素。结果两组患者年龄、糖尿病病程、HbA1c、TG、UACR、平均血糖浓度（MEAN）、血糖标准差（SD）、血糖在正常范围内时间（TIR）、DES-SF得分和SDSCA得分比较,差异均有统计学意义（P<0.05）。多元线性回归分析结果显示,年龄是MEAN（β=-0.272,P=0.019）、SD（β=-0.300,P=0.009）、MAGE（β=-0.254,P=0.007）的影响因素;糖尿病病程是MEAN（β=0.466,P=0.029）的影响因素;HbA1c是MEAN（β=0.416,P<0.001）、SD（β=0.330,P=0.004）、TIR（β=-0.287,P=0.014）、MAGE（β=0.182,P<0.001）的影响因素;UACR是SD（β=0.264,P=0.040）、TIR（β=-0.350,P=0.006）、MAGE（β=0.236,P=0.009）的影响因素;SDSCA总分是MEAN（β=0.416,P<0.001）、SD（β=0.330,P=0.004）、TIR（β=-0.287,P=0.014）的影响因素;DES-SF总分是MEAN（β=-0.271,P=0.045）、TIR（β=0.865,P=0.016）的影响因素。结论T1DM患者血糖波动的影响因素包括年龄、糖尿病病程、HbA1c、UACR、自我管理行为以及自我管理潜能,临床应根据这些因素为患者制订个体化降糖策略,从而减少患者的血糖波动,延缓并发症的发生、发展。     

基于病案首页数据挖掘的老年糖尿病患者住院日影响因素分析

目的：回顾性分析老年糖尿病患者住院日的影响因素,探讨其平均住院日的控制方法。方法收集主要诊断为糖尿病或糖尿病相关并发症的老年患者病案首页数据,将可能影响其住院日的因素分为社会学因素、疾病因素和临床因素。用Mann－Whitney U检验和Kruskal－Wallis H检验,逐个筛选出影响住院日的因素,对筛选出的影响因素进行logistic 回归,建立老年糖尿患者住院日分布的预测概率方程。结果（1）年龄（ P＜0.001）、职业（P＝0.001）、付费方式（P＜0.001）、住院次数（P＜0.001）、伴随疾病（P＜0.001）、慢性并发症（P＜0.001）、医院感染（P＜0.001）、手术（P＜0.001）、3 d确诊（P＜0.001）、转科（P＝0.007）、疗效（P＝0.003）等11个因素对住院日有影响,差异有统计学意义。（2）经logistic回归分析,共筛选出8个对糖尿病患者住院日有显著影响的因素,按各因素优势比大小依次为：医院感染、手术、伴随疾病、慢性并发症、住院次数、年龄、付费方式、疗效。结论老年糖尿病患者住院日受多种因素综合影响,医院感染、手术、合并伴随疾病或慢性并发症、多次住院、年龄增加、社会基本医疗保险付费、追求疗效等均可明显影响老年糖尿病患者住院日。     

消化系统癌症高危人群预防主动行为现状调查与影响因素分析

目的调查消化系统癌症高危人群相关预防知识、行为、动机和技巧,了解其癌症预防的主动行为水平并分析影响因素。 方法采用方便抽样,对2022年6月—8月在同济大学附属第十人民医院内镜中心完成胃镜和（或）肠镜的322例患者进行消化系统癌症高危人群预防主动行为调查,使用消化系统癌症高危人群预防主动行为测评量表分析高危人群的预防主动行为水平及不同维度的影响因素。 结果322例消化系统癌症高危人群的预防主动行为总分为（83.63±10.89）分,处于优秀水平;DSC-PPBS总分单因素分析显示仅吸烟史、饮酒史组内差异具有统计学意义（P＜0.05）;相关性分析显示年龄、性别、家族史、吸烟史、饮酒史、胃肠镜经历6个特征与消化系统癌症高危人群预防主动行为得分具有相关性（P＜0.05）;线性回归分析显示回归模型具有显著的统计学意义（F=5.568,P＜0.001）,自变量能解释预防主动行为变化的6.6%;年龄、家族史、吸烟史、胃肠镜经历对预防主动行为的影响具有统计学意义（P＜0.05）。 结论消化系统癌症高危人群的预防主动能力尚可,年纪越大、有癌症家族史、有吸烟史、有胃肠镜经历的人群采取预防癌症的行为更加积极主动。     

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.