高等医学院校学生学习适应性的测量与影响因素分析

目的 测量医学院校学生学习适应性现状及其影响因素，修订符合医学生特有语境的学习适应性量表。方法 采用分层抽样的方法，抽取哈尔滨医科大学1180名医学生进行问卷调查。应用SPSS22.0进行数据分析，采用内部一致性信度检验，验证修订完毕的医学生学习适应性量表的信度；利用主成份分析法的探索性因子分析提取出5个公因子；应用Logistic回归分析医学生学习适应性的影响因素。结果 修订完毕的医学生学习适应性量表（Cronbach’s Alpha=0.914）包含27个测量条目；量表包含：自主学习、信息利用、环境抉择、压力应对和目标倾向”五个维度。医学生学习适应性处于中等水平（3.28±0.52），影响因素包括：职务[OR=1.496, 95%CI（1.114~2.009）]、成绩水平[OR=1.638, 95%CI（1.386~1.936）]、学习现状满意度[OR=2.160, 95%CI（1.745~2.673）]、专业满意度[OR=1.369, 95%CI（1.092~1.718）]、专业兴趣度[OR=1.426, 95%CI（1.186~1.715）]和就业前景[OR=1.526, 95%CI（1.251~1.862）]。结论 医学生学习适应性量表信效度良好，医学生学习适应性受诸多因素影响。     

独生与非独生子女大学生人格特征比较研究

目的了解独生与非独生子女大学生人格特征及其影响因素。方法采用整群随机抽样的方法,利用大学生人格问卷(University Personality Inventory,UPI)对某综合性大学在校的独生与非独生子女大学生940人进行问卷调查。结果非独生子女大学生非健康型人格发生率高于独生子女大学生(P<0.01)。影响独生与非独生子女大学生人格类型的多因素分析结果显示,精神病性是促进独生与非独生子女大学生非健康型人格发生的共同危险因素。另外,人际关系不良是促进独生子女大学生非健康型人格发生的危险因素;家庭结构缺陷是促进非独生子女大学生非健康型人格发生的危险因素。结论在校大学生存在一定程度的心理健康问题,大学生心理健康教育应该受到学校、家庭与社会的重视。     

广西部分地区男男性行为者安全套使用情况及影响因素分析

目的 分析广西部分地区男男性行为者（men who have sex with men, MSM）的危险行为、安全套使用情况及其影响因素。方法 在广西南宁市、柳州市和贺州市通过方便抽样的方法招募MSM,开展面对面问卷调查,收集其社会人口学、行为学、艾滋病相关知识、安全套使用等基本信息。采用卡方检验、Logistic回归模型分析最近6个月同性肛交坚持使用安全套的影响因素,计算OR（95%CI）值,以P<0.05为差异有统计学意义。结果 375名MSM中,认为当地MSM疫情严重占56.3%,曾经吸食过新型毒品占5.1%,最近6个月同性肛交性行为坚持使用安全套仅占58.4%,最近6个月性伴数3人以上占25.9%,最近6个月与异性发生过性行为占14.1%。多因素Logistic回归模型分析结果显示,文化程度高中或中专及以上[OR=1.86(95%CI:1.01~3.43)]、认为当地MSM艾滋病疫情严重[OR=3.79(95%CI:1.61~8.95)]、最近1年做过HIV检测[OR=1.93(95%CI:1.18~3.15)]、最近1年患过性病[OR=0.36(95%CI:0.14~0.90)]为最近6个月同性肛交坚持使用安全套的-影响因素。结论 广西MSM安全套坚持使用率低,需结合不同特点的MSM采取针对性干预措施,提高安全套坚持使用率,减少艾滋病的传播。     

中国社区老年居民衰弱发生率与影响因素的Meta分析

目的 系统评价中国社区老年居民衰弱的发生率及其影响因素。方法 计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Embase、Web of Science、Cochrane Library相关文献,检索时限为建库至2023年2月,采用Stata 12.0和RevMan 5.3软件对中国社区老年居民衰弱的发生率及影响因素进行Meta分析。结果共纳入17篇文献,合计11 928例老年人。Meta分析结果显示,中国社区居民衰弱发生率为16%[95%CI(12%,20%)]。其危险因素包括营养不良[OR=6.68,95%CI(3.35,13.32)]、合并慢性病[OR=6.22,95%CI(5.24,7.38)]、多重用药[OR=2.71,95%CI(2.03,3.63)]、睡眠质量差[OR=2.54,95%CI(1.66,3.89)]、抑郁情绪[OR=3.42,95%CI(1.78,6.58)]、使用步行辅助工具[OR=5.42,95%CI(1.98,14.86)]、日常生活活动能力受损[OR=8.07,95%CI(5.21,15.21)]、年龄≥80岁[OR=2.68,...     

中国0～18岁人群特应性皮炎患病率及影响因素的meta分析

目的:系统评价我国0～18岁人群特应性皮炎患病情况。方法:计算机检索数据库(中国知网、万方、维普、SinoMed、PubMed、Embase、Web of Science、The Cochrane Library),搜集我国0～18岁人群特应性皮炎患病率及影响因素相关的文献至2022年3月8日。由两位研究者独立筛选文献、提取资料及质量评价,对符合标准的文献采用Stata 16.0及Revman 5.4.1软件进行Meta分析。结果:共纳入29篇研究,包括182 656例研究对象,男66 502人,女63 437人。Meta分析结果显示,中国0～18岁人群特应性皮炎总患病率11%[95%CI(9%,12%)]。各影响因素合并值为：家族过敏史[OR=2.6, 95%CI(2.41,2.8)]、年龄[OR=0.89,95%CI(0.85,0.94)]、性别[OR=1.63,95%CI(1.12,2.3)]、父母文化程度高[OR=1.62,95%CI(1.39,1.90)]、孕期母亲吸烟[OR=1.72,95%CI(1.49,2.00)]、怀孕前或孕期装修房屋[OR=0.92,95%CI(0....     

ICU高凝状态患者中心静脉导管完全血凝堵塞危险因素分析

目的分析重症监护病房(ICU)高凝状态患者中心静脉导管完全血凝堵塞的危险因素,为预防导管完全血凝堵塞提供依据。方法选择2016年1月—2019年1月上海中医药大学附属曙光医院ICU收治的高凝状态中心静脉置管患者135例作为研究对象,按是否发生完全血凝堵塞分为堵塞组(n=29)与非堵塞组(n=106),采用单因素及多元Logistic回归分析筛选ICU高凝状态患者中心静脉导管完全血凝堵塞的危险因素。结果 135例患者中,发生完全血凝堵塞29例(21.48%),堵塞发生于输液间歇期22例(75.86%),全胃肠外营养时3例(10.34%),输液过程4例(13.79%);堵塞组年龄>60岁者比例高于非堵塞组(χ~2/P=5.122/0.023);堵塞组D-二聚体(D-D)、纤维蛋白降解产物(FDP)、血小板计数(PLT)、纤维蛋白原(Fib)高于非堵塞组(t=6.839、4.848、6.833、5.084,P均=0.000);堵塞组置管类型为经锁骨上或下静脉置管(CVC)(37.93%)、置管时间> 14 d(41.38%)、封管方式为生理盐水(86.21%)、冲封管操作不规范(27.59%)所占比例均高于非堵塞组(χ~2/P=4.133/0.042、4.088/0.043、4.442/0.035、4.069/0.043);Logistic回归分析显示,年龄[>60岁,OR(95%CI)=3.543(2.112～5.994)]、D-D[≥3.0 mg/L,OR(95%CI)=5.223(3.387～8.054)]、FDP[≥25.0μg/ml,OR(95%CI)=3.755(2.717～5.188)]、PLT[≥200×10~9/L,OR(95%CI)=2.776(1.040～7.411)]、Fib[≥5.0 g/L,OR(95%CI)=3.206(2.108～4.877)]、置管类型[CVC,OR(95%CI)=3.130(1.184～8.274)]、置管时间[>14 d,OR(95%CI)=5.842(2.994～11.397)]、封管方式[生理盐水,OR(95%CI)=3.068(1.018～9.249)]为ICU高凝状态患者中心静脉导管完全血凝堵塞的危险因素,冲封管规范操作为其保护因素(OR=0.360,95%CI 0.144～0.900)。结论 ICU高凝状态患者中心静脉导管完全血凝堵塞发生率较高,老年、高凝状态、CVC置管、置管时间> 14 d、生理盐水封管均为完全血凝堵塞的危险因素。     

支气管哮喘患儿的危险因素分析

目的:探讨儿童哮喘(asthma,As)的危险因素。方法:收集我院门诊As患儿100例(哮喘组),通过查阅病历及问卷调查的方法对患儿进行相关危险因素分析,并收集同期就诊的非哮喘患儿100例作为对照(非哮喘组),调查相同资料,查找As发病相关因素。结果:调查了哮喘组及非哮喘组8个危险因素,其中年龄[OR=1.62,95%CI(1.2,2.18)]、家族过敏史[OR=1.92,95%CI(1.28,2.88)]、被动吸烟[OR=0.24,95%CI(0.12,0.46)]、特应质[OR=1.98,95%CI(1.04,3.77)]、肥胖[OR=0.81,95%CI(0.72,0.91)]对As发作有显著影响(P<0.05)。结论:遗传因素与As密切相关,特应质是儿童As的危险因素,呼吸道感染可促使As发展为持续性的,不良环境与As有关。     

医学生职业素养发展态势预测模型的建立与初步验证

目的建立医学生职业素养发展态势预测模型并加以初步评价。方法 2020年12月采用分层随机抽样的问卷调查法, 对汕头大学医学院2015～2019级477名临床医学、护理学和口腔医学专业的学生展开调查, 了解其职业素养影响因素。通过单因素分析和多因素logistic回归分析等建立预测模型和评分系统, 通过ROC曲线下面积进行初步评价。结果性别、年级、性格、朋辈关系、"医者之心"教育模式、医疗社会环境和临床实践环境等7个因素为医学生职业素养发展的独立预测因子, 其OR和95%CI可信区间分别为2.223[95%CI(1.335～3.704)]、4.705[95%CI(1.761～12.574)]、3.222[95%CI(1.869～5.555)]、3.117 [95%CI(1.867～5.202)]、3.840 [95%CI(2.276～6.480)]、0.479[95%CI(0.282～0.816)]、2.136[95%CI(1.257～3.629)]。预测模型的ROC曲线下面积为0.871[95%CI(0.839～0.903)]。医学生职业素养发展态势评分系统的分值为-1～10分, 评分...     

孕晚期妇女焦虑、抑郁发生状况及影响因素研究

目的 :了解孕晚期妇女焦虑、抑郁的发生状况,探讨影响因素,为孕晚期妇女的心理健康调适提供科学依据。方法 :采用横断面研究方法,于2014年6月~2014年7月选取湖南省妇幼保健院住院待产的孕晚期妇女606名进行自填式匿名问卷调查。结果 :焦虑发生率为33.3%(95%CI:29.5%~37.1%);抑郁发生率为56.7%(95%CI:42.8%~60.6%)。个人为独生女(OR=0.55;95%CI:0.36~0.83),计划内妊娠(OR=0.54;95%CI:0.35~0.81),参与医保(OR=0.75;95%CI:0.43~0.87)是发生焦虑的保护因素;有重大疾病史(OR=2.34;95%CI:1.15~4.77),和丈夫家人同住(OR=2.75;95%CI:1.72~4.39)、和自己家人同住(OR=2.25;95%CI:1.23~4.10),妊娠压力源3升高(OR=1.65;95%CI:1.19~2.27),其他妊娠压力升高(OR=1.63;95%CI:1.11~2.39)是发生焦虑的危险因素。文化程度越高(OR=0.53;95%CI:0.39~0.73),职业为工人(OR=0.45;95%CI:0.28~0.73),有不良妊娠史(OR=0.26;95%CI:0.12~0.59),计划内妊娠(OR=0.39;95%CI:0.26~0.59)是抑郁发生的保护因素。居住在农村(OR=3.23;95%CI:1.73~6.03),妊娠压力源3升高(OR=1.41;95%CI:1.03~1.92)是抑郁发生的危险因素。焦虑、抑郁自评得分与社会支持得分呈负相关。结论 :孕晚期妇女的焦虑、抑郁发生率较高,应重视该人群的心理健康调适。危险因素的研究有助于有针对性采取干预措施。     

术中低体温发生的相关因素及护理预防对策

目的:分析术中低体温的发生影响因素,为护理预防对策提供依据。方法:医院2016年外科手术患者1284例,发生术中低体温(核心温度36℃)381例,纳入病例组,未出现低体温的对象903例,纳入对照组,收集资料,进行因素分析。结果:病例组老年人、肥胖、急诊手术、全麻、术前禁食水时间≥6h、术中输血、术中输液500ml、术中冲洗液量≥500ml、手术时间≥2h比重差异有统计学意义(P0.05)。手术时间≥2h[OR=4.37,95%CI(2.43~15.58)]、全麻[OR=1.24,95%CI(1.98~3.54)]、急诊手术[OR=1.19,95%CI(1.40~2.76)]、老年人[OR=1.39,95%CI(1.80~3.26)]、术前禁食水时间≥6h[OR=1.15,95%CI(1.20~1.98)]成为独立影响因素(P0.05)。结论:需重视风险管理,特别重视术前准备。     

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.