原发性与继发性失眠患者睡眠质量与焦虑抑郁情绪的研究

目的：研究原发性与继发性失眠患者在睡眠质量、焦虑抑郁情绪上有无差异以及失眠患者睡眠质量与焦虑、抑郁情绪之间的相关性。方法：就诊于我院神经内科门诊的失眠患者（173例）作为研究对象,分为原发性失眠组（119例）和继发性失眠组（54例）。采用AIS、HAD、HAMA、HAMD对失眠患者的睡眠质量以及焦虑和抑郁情绪进行测评并对数据进行统计学分析。结果：①失眠患者AIS总分均〉6分。继发性失眠组与原发性失眠组相比,其AIS总分及各因子分（对总体睡眠质量评价除外）得分较高,但两组差异无统计学意义（P〉0.05）。②继发性失眠组中焦虑抑郁情绪（HAMA、HAMD）测评得分高于原发性失眠组,这种差异尚未达到统计学意义（P〉0.05）。③两组失眠患者中存在不同程度的焦虑抑郁情绪的发生率,经χ^2验,继发性失眠组的焦虑情绪及焦虑抑郁情绪共存的发生率高于原发性失眠组（P〈0.05）。④线性相关分析显示,失眠患者AIS总分与HAD、HAD-A、HAD-D、HAMA、HAMD呈强正相关性,r值在0～1之间,P〈0.01。结论：①原发性与继发性失眠患者的睡眠质量比较差异无统计学意义。②原发性与继发性失眠患者的焦虑、抑郁情绪的严重程度差异无统计学意义。③继发性失眠患者焦虑情绪及焦虑抑郁情绪共存的发生率高于原发性失眠患者。④原发性与继发性失眠患者的失眠程度与焦虑抑郁情绪呈正相关,失眠患者的睡眠质量越差,其焦虑抑郁情绪越严重。     

慢性阻塞性肺疾病患者抑郁和认知功能损害研究

以汉密尔顿抑郁量表（HAMD）〉17分和〈17分为标准,将120例慢性阻塞性肺疾病患者分为伴发抑郁组和不伴发抑郁组,根据简易精神状态法测定患者认知功能,并测定患者血氧饱和度及肺功能。120例患者中54例合并抑郁,HAMD评分与患者的血氧饱和度以及肺功能呈负相关（P〈0．05）;多因素回归分析显示,性别、血氧饱和度及精神状态总分与患者的抑郁情绪存在统计学差异（P〈0．05）;抑郁组精神状态分数较非抑郁组明显降低（P〈0．05）,与血氧饱和度呈正相关（P〈0．01）;精神状态分数与HAMD评分呈负相关（r=-0．549,P〈0．01）。     

失独者抑郁症状的潜在类别分析

目的 对失独者抑郁症状进行潜在类别分析,了解失独者抑郁症状的个体差异,以及不同人口学特征对潜在类别的影响。方法 采取分层随机整群抽样的方法,于2014年9月-2015年12月对长沙市249例失独者进行抑郁自评量表（SDS）评分,对失独者的抑郁状况进行潜在类别分析。并分析性别、年龄、婚姻状况、家庭所在地对潜在类别的影响。结果 共发放问卷249份,剔除30份未作答问卷,回收219份有效问卷,有效回收率为88.0%。本研究探索了1～5个潜在类别模型,随着分类数逐渐增加,AIC、BIC、aBIC不断减少,Entropy在4个类别时已最大,但是LMR不显著,且BIC增大,因此,3个类别的分类模型最为合理,其中C1、C2、C3的类别概率分别为0.428、0.305、0.267。根据C1、C2、C3在SDS 20个条目上的条件概率,将其分别命名为高抑郁组（42.9%）、生理-悲观组（31.5%）、低抑郁乐观组（25.6%）。性别、年龄、婚姻状况对潜在类别的影响,差异均无统计学意义（P＞0.05）;家庭所在地对潜在类别的影响,差异有统计学意义（P＜0.05）。结论 失独者的抑郁症状有明显分类特征,可以分为3个潜在类别,分别为高抑郁、生理-悲观、低抑郁乐观,且家庭所在地可影响潜在类别。     

长期失眠与抑郁

目的：探讨长期失眠与抑郁的关系。方法：对45例长期失眠病人行汉密尔顿抑郁量表（17版本，HAMD）评分，对评分＞16给予氟西汀抗抑郁治疗，结论：38例（占84．4％）病人HAMD评分大于16分，治疗前后日平均睡眠时间延长，HAMD评分降低，结论：长期失眠有抑郁倾向，应给予抗抑郁治疗。     

对偏头痛患者睡眠质量和情绪障碍的研究

目的：了解偏头痛患者的睡眠质量和情绪障碍情况。方法：偏头痛患者50例为观察组,体检者50例为对照组,采用匹茨堡睡眠量表评分评价睡眠情况,汉密尔顿焦虑量表和汉密尔顿抑郁量表评估焦虑、抑郁状态。结果：观察组中34例（68.0%）失眠,对照组19例（38.0%）失眠,观察组睡眠障碍发生率高于对照组,差异有统计学意义（P<0.01）。观察组有40例（80.0%）存在情绪障碍,其中焦虑23例,抑郁17例,有12例为焦虑并抑郁,对照组有19例（38.0%）情绪障碍,其中焦虑10例,抑郁9例,3例为焦虑并抑郁,观察组情绪障碍发生率高于对照组,差异有统计学意义（P<0.01）。结论：偏头痛患者容易发生睡眠障碍和焦虑抑郁情绪。     

老年脑卒中患者抑郁的因素分析及整体护理干预对其疗效的影响

目的：总结分析老年脑卒中患者的抑郁因素以及整体护理干预在其治疗中的应用价值。方法：选择120例老年脑卒中患者为研究对象,通过HAMD（汉密尔顿抑郁量表）评价分析其抑郁影响因素,并将HAMD≥8分的患者随机分为观察组和对照组,其中无抑郁组（HAMD＜8分）及对照组患者给予常规护理措施,观察组患者给予整体护理措施,比较3组观察指标差异。结果：120例老年脑卒中患者HAMD评分中63例HAMD≥8分,具有抑郁症状。统计分析发现患者年龄、性别、病灶部位是其抑郁影响因素,护理干预后观察组患者HAMD、NIHSS、ADL指标均明显高于对照组及无抑郁组,差异具有统计学意义（P＜0.05）。结论：老年脑卒中患者抑郁因素较多,针对抑郁因素给予整体护理干预能有效缓解抑郁情绪,提高治疗依从性,改善预后。     

拉莫三嗪合并认知行为治疗对双相抑郁患者临床疗效研究

目的探讨认知行为治疗联合拉莫三嗪治疗双相抑郁患者的临床疗效。方法将研究对象随机分为治疗组和对照组,在药物治疗的基础上治疗组给予认知行为治疗,而对照组给予一般心理支持。测定入组基线及治疗第1、3、5及8周汉密尔顿抑郁量表（HAMD17）积分、治疗前后应付方式积分,计算两组临床总有效率、HAMD17减分率、因子分变化及应付方式积分变化。结果两组治疗方案的总体疗效相当（χ2=0．0934,P〉0．05）,且HAMD17积分均在第3周明显降低,说明两组起效时间相同（P〉0．05）;但治疗组在认知障碍、迟滞因子的改善上显著优于对照组（P〈0．05）,能更有效的改善幻想、求助因子积分（P〈0．05）。结论认知行为治疗能显著改善双相抑郁患者应付方式,重视应付方式等人格因素可能是双相抑郁预防复发的重要方面。     

中老年2型糖尿病患者焦虑抑郁情绪调查及分析

目的：调查中老年2型糖尿病血糖控制达标和不达标患者焦虑抑郁情绪的发生比例,分析其原因并提出对策。方法：随机调查门诊中老年2型糖尿病患者368例,分成血糖控制达标和不达标患者2组,分别应用汉密顿焦虑量表（HAMA）和汉密顿抑郁量表（HAMD）对患者焦虑、抑郁情绪进行评定,以HAMA评分＞14分、HAMD评分＞20分判定为存在焦虑、抑郁情绪,统计其焦虑、抑郁情绪的发生率。结果：全部368例患者中,焦虑情绪发生率为26.36%（97/368）,抑郁情绪发生率为23.64%（87/368）。其中血糖控制达标组196例,焦虑情绪发生率为21.43%（42/196）,抑郁情绪发生率为19.39%（38/196）;血糖不达标组172例,焦虑情绪发生率为31.98%（55/172）,抑郁情绪发生率为28.49%（49/172）。2组比较差异均有统计学意义（P＜0.05）。结论：中老年2型糖尿病患者中焦虑、抑郁情绪发生率较高,且血糖控制不达标患者焦虑、抑郁情绪发生率明显高于血糖控制达标患者。因此,控制血糖对预防中老年2型糖尿病患者焦虑、抑郁情绪至关重要。     

耳针联合自拟中药汤剂口服治疗中风后抑郁临床研究

目的 观察耳针联合自拟中药汤剂口服治疗中风后抑郁患者抑郁情绪及神经功能的临床效果。方法 选择张家口市中医院2018年7月—2020年12月收治的98例中风后抑郁患者,随机分为对照组49例,治疗组49例,对照组患者使用常规西医方法治疗,治疗组在对照组基础上使用耳针联合口服自拟中药汤剂治疗,治疗后比较两组患者的临床疗效及不良反应发生率;治疗前及治疗后2、4、8周,比较两组患者汉密尔顿抑郁评分量表（HAMD）评分、美国国立卫生研究院卒中量表（NIHSS）评分、匹兹堡睡眠质量指数（PSQI）及阿森斯失眠量表（AIS）评分;治疗前后比较两组患者世界卫生组织生存质量测定量表汉化版（WHOQOL-BREF）评分。结果 治疗组治疗总有效率为95.92%,高于对照组的81.63%(P<0.05);治疗前,两组患者HAMD评分比较差异无统计学意义（P>0.05）,治疗不同时间后治疗组患者HAMD评分均低于对照组（P<0.05）;治疗前,两组患者NIHSS评分比较差异无统计学意义（P>0.05）,治疗不同时间后治疗组患者NIHSS评分均低于对照组（P<0.05）;治疗前,两组患...     

认知行为护理干预对改善首发抑郁症患者抑郁情绪的影响

目的 探讨认知行为护理干预对改善首发抑郁症患者抑郁情绪的效果.方法 将65例首发抑郁症患者随机分为对照组和干预组,对照组采用常规护理措施,干预组增加认知行为护理措施,各组在入组前和治疗护理第4周,分别采用汉密顿抑郁量表（HAMD）、汉密顿焦虑量表（HAMA）进行效果评价.结果 治疗护理4周后,对照组HAMD评分为（18.97±2.21）分,HAMA评分为（12.09-2.75）分;干预组HAMD评分为（14.94±3.46）分,HAMA评分为（10.30±2.54）分,两组之间差异有统计学意义（P＜0.01）.结论 认知行为护理干预能显著改善首发抑郁症患者的抑郁情绪,提高生活质量,对抑郁症患者的治疗有一定的临床应用价值.     

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.