导致在校大学生近视的因素分析

目的:观察某医学院校学生的视力状况,探讨影响视力的相关因素,并对在校学生视力保健提供依据。方法:用常规视力检查和问卷式调查方法,对874名18岁～22岁医学院校的青年学生进行视力调查。结果:学生中近视率为64.3%,城市学生近视率高于农村学生。结论:分析表明近视与居住在城市、眼疲劳史、阅读距离、看电视多、床上阅读有密切关系,父母近视为近视的主要因素。     

烟草暴露与肺结核发病的病例对照研究

目的探讨烟草暴露与肺结核发病的关系,揭示肺结核危险因素。方法采用病例对照设计。应用自行设计的问卷调查济宁市136例肺结核病例和149例对照的烟草暴露及其它肺结核潜在危险因素情况,并进行单因素和多因素条件Logistic回归分析。结果单因素分析显示：吸烟（OR=6．011,OR95％CI：3．648—9．905,P=0．000）和已戒烟（OR=5．125,OR95％CI：2．100—12．507,P=0．000）有统计学意义;被动吸烟（OR=1．042,OR95％CI：0．642—1．693,P=0．868）无统计学意义。多因素条件Logistic回归分析显示：吸烟（OR=6．282,OR95％CI：3．188～12．382,P=0．000）和已戒烟（OR=9．938,OR95％CI：2．851—34．634,P=-0．000）均是肺结核危险因素。结论有吸烟史是肺结核发病的危险因素。     

急性脑梗死患者卒中后6个月残疾预后的危险因素分析

目的：探讨急性脑梗死患者卒中后6个月残疾的危险因素。方法前瞻性收集2010年8月至2014年8月在济南军区总医院神经内科住院治疗的1137例急性脑梗死患者,其中女性424例;牛津郡社区卒中计划分型完全前循环型275例,部分前循环型377例,后循环型305例,腔隙性脑梗死型180例。记录其年龄、性别、美国国立卫生研究院卒中量表（ NIHSS）评分等基线资料。于病后6个月通过电话随访,采用改良Rankin量表（ mRS）对其预后进行评价（ mRS≤2分为预后良好,2＜mRS≤5分为残疾）。用双元回归分析、多元回归分析法分析性别与残疾的关系及预后相关因素。结果123例急性脑梗死患者病死,剩余的1014例中,376例女性患者残疾127例,638例男性残疾156例;女性患者残疾的比例（33．8％）高于男性（24．5％）,差异有统计学意义（χ2＝9．86,P ＝0．002）。单因素相关性分析示女性（P＝0．002）、年龄≥73岁（P＝0．000）、NIHSS≥8（P＝0．000）、心肌梗死（P＝0．001）、心力衰竭（P＝0．000）、糖尿病（P＝0．002）、心房颤动（P＝0．000）、高脂血症（P＝0．003）、复发脑梗死（P＝0．000）、吸烟嗜好（P＝0．003）、饮酒嗜好（P＝0．004）、腔隙性脑梗死（P＝0．000）与急性脑梗死患者发病6个月残疾显著相关。多因素分析示女性[1．681（95％CI：1．183～2．390,P＝0．004）]、年龄≥73岁[3．955（95％CI：2．708～5．776）,P ＝0．000]、NIHSS≥8[7．473（95％CI：5．154～10．837）,P＝0．000]、复发性脑梗死[3．149（95％CI：2．150～4．614）,P＝0．000]、心房颤动[2．558（95％CI：1．465～4．466）,P＝0．001]和糖尿病[2．010（95％CI：1．415～2．855）,P＝0．000]是急性脑梗死患者发病6个月残疾的独立危险因素。而腔隙性脑梗死[0．226,（95％CI：0．112～0．456）, P＝0．000]是急性脑梗死患者发病6个月残疾的独立保护因素。结论急性脑梗死患者中风后的致残与包括女性性别在内的多个危险因素相关。     

恩施州婴幼儿过敏性疾病患病率及其影响因素分析

目的：了解恩施州6～24个月龄婴幼儿过敏性疾病患病情况及其影响因素,为婴幼儿过敏性疾病的预防提供依据。方法采取多阶段分层整群抽样的方法,抽取1724名婴幼儿,使用问卷调查收集婴幼儿的一般情况、家庭情况、看护人情况及看护行为和过敏性疾病情况。多因素Logistic回归分析用于探索婴幼儿过敏性疾病的影响因素。结果接受调查的婴幼儿中,过敏性疾病患病率为11．83％,主要为湿疹,患病率为7．54％,其次为过敏性哮喘（1．97％）。单因素分析显示,民族（χ2＝17．865, P＝0．000）、月龄（χ2＝9．420,P＝0．009）、喂养方式（χ2＝6．304,P＝0．043）、添加辅食时间（χ2＝12．695,P＝0．002）和家庭收入（χ2＝9．259,P＝0．010）与婴幼儿过敏性疾病有关;多因素 Logistic回归分析结果表明,少数民族[OR95％ CI：1．86（1．27～2．73）, P＝0．001]、人工喂养[OR95％ CI：1．17（1．01～2．82）,P＝0．045]的婴幼儿患过敏性疾病的危险较高,月龄18～24个月[OR95％CI：0．57（0．39～0．84）,P＝0．005]和家庭年收入大于30000元[OR95％ CI：0．64（0．43～0．96）,P＝0．030]与婴幼儿过敏性疾病呈负相关。结论恩施州6～24个月龄婴幼儿过敏性疾病患病率较高,少数民族、低月龄、人工喂养和低家庭收入的婴幼儿患过敏性疾病的风险大。     

胃癌危险因素的病例对照研究

目的：探索湖南省胃癌发生的危险因素和保护因素,为综合防治提供流行病学依据。方法：采用1：1配对的病例对照研究,对175对病例及对照进行饮食及生活行为问卷调查,用比值比（OR）来估计各危险因素与胃癌的联系强度,采用Logistic回归进行单因素和多因素分析,筛选出胃癌的危险因素。结果：影响胃癌发生的主要危险因素有：饮酒（OR＝1．58,95％ CI1．18－2．13）,饮食不规律（OR＝2．00,95％CI 1．34－3．10）,高盐饮食（OR＝1．82,95％,CI1．21－2．74）等;饮绿茶（OR＝0．47,95％CI0．26－0．85）是胃癌发生的保护因素,结论：纠正不良的饮食及生活行为,经常饮绿茶可能减少胃癌的发生的危险性。     

糖尿病合并肺结核的环境危险因素调查

目的：调查研究2型糖尿病（T2DM）合并肺结核（PTB）的环境危险因素,以为其临床预防提供理论依据。方法选择2006年7月至2013年8月梧州市第三人民医院收治的200例T2DM合并肺结核患者和200例T2DM患者进行病例对照研究,采用多因素条件Logistic回归分析T2DM合并肺结核的环境危险因素。结果人均居住面积（OR＝6．878,95％CI 0．956～6．778）,室内采光不良（OR＝5．675,95％CI 0．654～5．767）,室内通气不良（OR＝4．345,95％CI 0．567～7．675）,家庭或同事有结核患者（OR＝5．785,95％CI 0．753～6．677）,化学烟雾接触（OR＝4．242,95％CI 0．753～6．900）,粉尘接触（OR＝4．478,95％CI 0．867～6．896）是导致 T2DM 合并肺结核的环境危险因素。结论T2DM合并肺结核与多种环境因素有关,应积极控制环境危险因素,以减少 T2DM 合并肺结核的发生率。     

急性缺血性脑卒中患者重度脑白质病变的危险因素分析

目的：探讨急性缺血性脑卒中患者重度脑白质病变（WML）发生情况及其危险因素。方法入选248例急性缺血性脑卒中患者,调查患者的一般资料,Fazekas量表对WML严重程度评定并根据评定结果分为重度组和非重度组,对比观察两组患者一般资料差异,以重度WML为应变量,将单因素筛选的可能影响因素作为自变量进行多因素Logistic回归分析。结果248例急性缺血性脑卒中患者中发生重度WML106例,发生率为42．74％;单因素分析发现,重度组年龄显著高于非重度组,合并高血压、糖尿病发生率显著高于非重度组,差异均有统计学意义（P＜0．05）;多因素Logistic回归分析发现,年龄（OR＝4．116,95％CI：1．816～6．454,P＝0．000）、高血压（OR＝1．462,95％CI：0．842～1．946,P＝0．026）和糖尿病（OR＝1．157,95％CI：0．698～1．673,P＝0．038）是急性缺血性脑卒中患者发生重度WML的独立危险因素。结论急性缺血性脑卒中患者重度WML发生率较高,临床要对高龄及合并高血压、糖尿病等高危人群采取针对性预防措施,以降低重度WML发生。     

高热惊厥患儿预后及其影响因素分析

目的：分析高热惊厥患儿预后,找出影响高热惊厥患儿预后的因素,旨在为采取针对性的预防干预措施提供参考依据。方法：选择我院儿科2010年6月-2011年6月收治的50例高热惊厥患儿为研究对象,采用自编问卷收集高热惊厥患儿临床资料,运用描述性统计方法和二分类Logistic回归分析找出高热惊厥患儿预后和影响高热惊厥患儿预后的因素。结果：高热惊厥患儿预后良好率为82．00％,而预后不良率为18．00％,多因素Logistic回归分析发现初发年龄＜1岁（OR＝1．67,P＝0．000）,持续时间≥15min（OR＝7．03,P＝0．000）和发作次数≥3次（OR＝4.92,P＝0．000）是高热惊厥患儿预后差的危险因素。结论：高热惊厥患儿总体预后欠佳,该病患儿预后受众多因素影响。临床治疗过程中,足量足疗程治疗高热惊厥,发作时最短时间内止痉,提高治疗疗效,改善患儿的预后。     

小儿微创经皮肾镜术后残留结石的危险因素分析

目的：研究分析导致小儿微创经皮肾镜（MPCNL ）术后结石残留的相关危险因素。方法收集2009年1月至2014年11月在新疆维吾尔自治区人民医院泌尿外科行 MPCNL 治疗的患儿240例,根据Ⅰ期净石率分为结石清除组（202例）和结石残留组（38例）,对两组间可能影响 M PCNL 术后结石残留的危险因素进行统计学分析,找出影响结石残留的危险因素。结果240例接受 MPCNL 治疗的患儿,首次净石率为84．2％（202／240）。单因素分析发现结石位置（P ＝0．001）、结石大小（P＝0．014）、结石数目（P＝0．005）与患儿 M PCNL 术后首次净石率有显著相关性,而患儿年龄、性别、患侧、肾积水程度、尿路刺激症、肾绞痛、血尿、术前感染与 M PCNL 术后结石残留无明显相关性（P＞0．05）,多变量 Logistic 回归分析显示结石位置（OR ＝2．593,95％ CI ：1．228～5．475）、结石大小（OR ＝2．674,95％ CI ：1．290～5．540）、结石数目（OR ＝2．397,95％ CI ：1．145～5．019）与患儿MPCNL 术后结石残留有显著的相关性。结论结石位置、大小及数目是导致患儿 MPCNL 治疗术后残留结石的重要危险因素,术前评估患儿病情,选择合适的治疗方案。     

5-HTTLPR基因多态性与脑卒中后抑郁关系的meta分析

目的：探讨五羟色胺转运体基因启动子区域（5-HTTLPR）基因多态性与脑卒中后抑郁（PSD）的关系。方法：通过Review Manager 5．2软件对筛选出的6项国内外有关5-HTTLPR基因多态性与PSD关系的文献进行综合评价,分别从基因型和等位基因两个方面进行分析,并进行异质性检验、合并效应量分析。结果：各研究间基因型及等位基因的检验结果均无异质性（I2＝0％,P＞0．05）。合并效应量：L／L基因型OR（95％CI）＝0．53（0．37～0．76）,综合检验Z＝3．47,P＜0．001;S／S基因型OR（95％CI）＝2．19（1．66～2．89）,综合检验Z＝5．54,P＜0．001;S／L基因型OR（95％CI）＝0．67（0．51～0．88）,综合检验Z＝2．84,P＝0．005;L等位基因OR（95％CI）＝0．55（0．45～0．67）,综合检验Z＝5．83,P＜0．001;S等位基因OR（95％CI）＝1．81（1．48～2．21）,综合检验Z＝5．83, P＜0．001。结论：5-HTTLPR 基因多态性中S／S基因型及S等位基因可能是患PSD的危险因素,L／L、S／L和L等位基因可能是保护性因素。     

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.