新型冠状病毒肺炎防控期间居家隔离人群心理健康状况调查及影响因素分析

目的 了解新型冠状病毒肺炎防控期间居家隔离人群心理健康状况并分析其影响因素,为进一步做好疫情防控工作,疏导不良情绪及心理恐慌提供依据.方法 选取2020年2月15 17日本研究团队7名研究生居住地为调查单位,采用自制一般情况调查表及12项一般健康问卷(GHQ-12)量表调查居家隔离的380人的心理健康状况.根据GHQ-12评分,将调查对象分为GHQ-12≥3分为阳性组(n=212)和GHQ-12＜3分为阴性组(n=168).采用Logistic回归模型分析居家隔离人群心理健康状况的影响因素.结果 两组在年龄、性别、是否独生子女、经济收入方面比较,差异无统计学意义(P＞0.05);而在居住地、婚姻状况、生育情况、担心感染、文化程度、职业方面差异有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,居住地农村、初中及以下文化程度、已婚、学生、外出务工人员、担心感染是居家隔离人群心理健康的危险因素,年龄是其保护因素.结论 新型冠状病毒肺炎防控期间,居家隔离人群存在一定心理健康问题,其受多种因素影响.医院或社区卫生中心应针对不同人群进行心理疏导,改善其身心健康.     

超声乳化术对伴有睑板腺功能障碍的白内障患者眼表的影响

目的:观察超声乳化术对伴有睑板腺功能障碍(MGD)的白内障患者眼表功能的影响。方法:前瞻性队列研究。选取金华文荣医院2016年3月至2018年2月伴有MGD的白内障78例(81眼),均行超声乳化人工晶状体植入术。术后随访3个月观察眼表功能。结果:术后3天泪液分泌情况(SIt)、泪膜破裂时间(BUT)高于术前1天(P<0.05);术后3个月的SIt、BUT高于术前1天,P<0.05,低于术后3天(P<0.05)。睑板腺分泌物形态:术前1天与术后3天相比,差异无统计学意义(P>0.05);术后3天与术后3个月相比,差异无统计学意义(P>0.05);术前1天与术后3个月相比,差异有统计学意义(P<0.05)。结论:伴有MGD的白内障患者超声乳化术后依旧出现眼表功能障碍,随访至术后3个月,并未见明显恢复。     

不同负荷的游泳训练及雌激素对去卵巢大鼠骨质疏松症的影响

目的:观察不同负荷的游泳训练和雌激素,对去卵巢大鼠血中生化指标和骨矿盐及其密度的影响,从而为因雌性激素减少而发生骨质疏松症的患者进行运动康复提供理论依据。方法:实验于2005-09/11在徐州医学院实验动物中心实验室完成。选取3月龄清洁级雌性SD大鼠75只,按体质量分层随机分为假手术组、骨质疏松模型组、中等负荷运动组、大负荷运动组、雌激素干预组,每组15只。骨质疏松模型组、中等负荷运动组和大负荷运动组、雌激素干预组行去卵巢术,假手术组行假手术。中等负荷运动组术后1周后进行游泳训练,45min/次,6次/周,休息1d。大负荷运动组游泳条件与中等负荷运动组相同,120min/次;雌激素干预组给予17β-雌二醇20μg/(kg·d),皮下注射,2次/周。假手术组和骨质疏松模型组正常饲养。6周后,测血清中钙、磷、总碱性磷酸酶和抗酒石酸酸性磷酸酶的变化,观测大鼠股骨远端骨松质骨矿盐含量、骨松质骨矿盐密度。结果:实验过程中各组大鼠均有死亡,死亡大鼠被剔除,共纳入结果分析66只。①6周后中等负荷的游泳运动训练和雌激素干预组大鼠与骨质疏松模型组大鼠相比,血清中钙、磷浓度及总碱性磷酸酶的活性均显著或非常显著升高(P<0.05～0.01),两组钙浓度和总碱性磷酸酶的活性分别上升8.4%,11.7%;20.1%,21.2%;骨股远端总的骨矿盐含量上升39%和33.4%,而大负荷的运动训练对钙和磷的效果不明显(P>0.05)。②4组的抗酒石酸酸性磷酸酶的活性均高于假手术组,其中骨质疏松模型组和大运动量组较假手术组显著升高(P<0.01);中等负荷的游泳运动训练和雌激素干预组血中的抗酒石酸酸性磷酸酶的活性相对于骨质疏松模型组下降31.8%和35.0%,差异有非常显著性意义(P<0.01)。③与骨质疏松模型组比较,中等负荷运动组和雌激素干预组大鼠骨松质骨矿盐含量升高明显(97.1%,88.6%,P<0.01);大负荷运动组的效果不明显。结论:中等负荷的游泳训练能像注射雌激素一样改善去卵巢大鼠的骨代谢状况,提高骨的形成,抑制骨的吸收,改善骨质疏松症状。     

不同短轴切面的面积变化分数的研究

胸骨旁左室短轴乳头肌水平切面的面积变化分数与射血分数呈高度相关,但对其他切面的面积变化分数却少有研究。对25例心功能正常者,选择二维超声心动图各左室短轴切面,应用手动描迹球法与声学定量技术分别计算各相应切面的面积变化分数。结果:手动描迹球法及声学定量技术测得各短轴切面的面积变化分数均呈高度相关(r=0.88～0.96);各切面面积变化分数测值无显著差异(P>0.05)。结论:声学定量技术与手动描迹球法测量的面积变化分数相关良好;左室收缩功能正常者不同左室短轴切面的面积变化分数相同。     

推拿加鹿衔草为主组方干预老年性膝骨关节炎

目的:观察推拿和鹿衔草为主组方治疗老年性膝关节骨关节炎的干预效果。方法:选择2002-03/2004-06在上海交通大学附属第一人民医院推拿科、中医科门诊就诊的老年性膝关节骨关节炎患者86例,均自愿参加观察。按随机分组表分成4组,即推拿 鹿衔草组、推拿组、鹿衔草组及自我锻炼组,分别为22,22,22及20例。①推拿组患者取俯卧位,以滚法作用于患肢后侧5min,重点在部委中(、委阳(;取仰卧位,用滚法作用于患者患侧大腿股四头肌,着重于膝关节髌骨上部5min;继而以按揉与弹拨法交替作用于患肢,配合点按犊鼻、内外膝眼、阳陵泉、鹤顶、膝阳关、梁丘等(位;作屈膝法,配合膝关节伸屈、旋内、旋外被动运动;最后以擦法擦热患膝。3次/周,共治疗4周。②鹿衔草组患者服用汤药(鹿衔草为主的基础方),辩证加减。1剂/d,分2次口服,共服用4周。③推拿 鹿衔草组治疗方法:在推拿治疗同时服用鹿衔草为主组方的汤药,共治疗4周,方法同上。④自我锻炼组:进行知识教育,并嘱患者自行进行功能锻炼,包括牵张训练、主动和被动活动度训练及增力训练等,锻炼时间为4周。采用WOMAC评分(包括疼痛、僵硬、日常生活3大类,用0～100mm视觉量表评分法,分数越高患者的机体功能越差,对生活的影响程度也越大)和20m步行时间对治疗前及治疗4周后的膝关节功能进行评估,并在治疗4周后评估疗效,疗效评定标准:①有效:关节疼痛、肿胀消失,活动功能恢复正常,理化检查正常。②好转:关节疼痛、肿胀减退,活动功能好转。结果:86例患者均进入结果分析,无脱落。①各组患者治疗4周后的WOMAC评分和20m步行时间均较治疗前显著降低(P<0.05)。治疗4周后推拿 鹿衔草组的WOMAC评分显著低于自我锻炼组(P<0.05);推拿 鹿衔草组和推拿组的20m步行时间显著短于自我锻炼组(P<0.05)。②经过4周的治疗和锻炼,推拿 鹿衔草组、推拿组、鹿衔草组及自我锻炼组患者的治疗有效率分别为86%,82%,82%和60%,各组比较差异均无显著性意义(P>0.05)。结论:单纯推拿、单纯服用鹿衔草及自我功能锻炼均能有效治疗老年性膝关节骨关节炎,明显改善患者膝关节运动功能,但推拿加鹿衔草综合治疗的疗效更优。     

宾州忧虑问卷在中国大学生人群中的初步修订

目的:考察宾州忧虑问卷在中国非临床样本中的因素结构,并检验宾州忧虑问卷的总分和各素分的性别差异。方法:于2005-11选择北京大学2002～2005级的本科生677人为量表结构分析和一致性信度检验的测试样本。第一次施测8周后选择2004级本科生40人作为重测样本。调查问卷包括宾州忧虑问卷(16个项目,各项目均采取5点程度评估);Padua问卷(包括60个项目,各项目均采取5点程度评估,包含4个因素,因素Ⅰ:思维失控与怀疑感。因素Ⅱ:污染。因素Ⅲ:检查。因素Ⅳ:受驱使与行为失控感);状态特质焦虑问卷(状态焦虑量表和特质焦虑量表两个分量表共40个描述题组成,用来测量个体作为人格特质的焦虑倾向);贝克抑郁问卷(评价抑郁的严重程度,4级评分,总分范围为0～39分)。采用集体测试采集数据。结果:发放问卷677份,全部收回且合格,均进入结果分析。①探索性因素分析获得宾州忧虑问卷的2个因素:一般焦虑和焦虑缺失。②宾州忧虑问卷信度检验:总分的α系数为0.89,一般焦虑和焦虑缺失的α系数分别为0.91,0.69,重测信度分别为0.72,0.55。③宾州忧虑问卷的总分及一般焦虑和焦虑缺失因素的得分与状态特质焦虑问卷总分,贝克抑郁量表总分,Padua强迫问卷的因素1(思维失控与怀疑感)得分有较高的相关,说明有良好的汇聚效度。④男女被试在宾州忧虑问卷总分及一般焦虑和焦虑缺失因素得分差异无显著性意义。结论:宾州忧虑问卷在中国大学生人群中具备合格的信度和汇聚效度,需进一步研究其区分效度。     

结直肠癌基因治疗研究进展

【摘要】〓结直肠癌是常见的消化道恶性肿瘤,传统治疗以外科手术为主,辅以放、化疗,术后5年生存率仅为50%左右。近年来结直肠癌基因治疗备受人们青睐,且有许多研究成果成功运用于临床。目前对结直肠癌基因治的方法主要有原癌基因治疗、抑癌基因治疗、免疫基因治疗以及多基因联合治疗等。     

Nonlinear Trajectory of GFR in Children before RRT

GFR decline in patients with CKD has been widely approximated using linear models, but this linearity assumption is not well validated. We conducted a matched case-control study in children from the Chronic Kidney Disease in Children (CKiD) cohort ages 1–16 years with mild to moderate CKD to assess whether GFR decline follows a nonlinear trajectory as CKD approaches ESRD. Children (n=125) who initiated RRT (cases) during follow-up were individually matched by CKD stage at baseline and glomerular/nonglomerular diagnosis with children (n=125) who remained RRT-free when the corresponding case initiated RRT (controls). GFR trajectories were compared using log-linear and piecewise log-linear mixed effects models adjusted for baseline characteristics. From study entry to 18 months before RRT, GFR declined 7% faster among cases compared with controls. However, GFR declined 26% faster among cases compared with controls (P<0.001) during the 18 months before RRT. Nonlinearity in the rate of kidney function loss, which was shown in this cohort, may preclude accurate clinical prediction of the timing of RRT and adequate patient preparation. This study should prompt the characterization of predictive factors that may contribute to an acceleration of kidney function decline.GFR is a key measurement of kidney function, and the degree of GFR decline over time is a reflection of the severity of CKD progression. GFR decline has been approximated as linear or log-linear in most analyses of progression, an assumption that has been consistent with available data.^1–4 However, many studies rely on relatively short follow-up periods and few repeated measures. Given the convenience of assuming a linear GFR trajectory, which results from the ease of modeling and interpreting linear slopes, few studies have sought to validate the linearity assumption and explore the possibility of nonlinear GFR decline. However, nonlinearity in GFR decline has been observed in some epidemiologic studies,^5–7 and the implications on the risk for adverse outcomes have generated interest.⁸ A CKD cohort study in France found that about one half of its patients experienced nonlinear GFR decline during the last year before dialysis.⁵ A study by Li et al.⁹ used a flexible approach to model nonlinearity in GFR trajectories. Li et al.⁹ found evidence of nonlinear GFR trajectory behavior in adult patients with CKD, and furthermore, the probability of having nonlinear features in an individual trajectory was associated with known risk factors for CKD progression. O’Hare et al.¹⁰ found several distinct nonlinear patterns of GFR decline in the 2 years before dialysis initiation in Veterans Affairs patients.Clinical strategies and subsequent patient response to care could potentially benefit from new insights into the variable paths of progression in patients with CKD.^10,11 The question of whether characterizing the nonlinearity in the GFR trajectory can assist the identification of risk groups for outcomes, such as ESRD, remains unexplored. The implications on future outcomes of an increased rate of GFR decline could inform clinical decisions about screening frequencies, treatment, or preparation for RRT.The Chronic Kidney Disease in Children (CKiD) study is an ongoing cohort study of children with CKD who, at baseline, had an eGFR between 30 and 90 ml/min per 1.73 m³ and were ages 1–16 years. An end point of the study is RRT defined as transplant or dialysis. To determine whether trajectories of GFR accelerate before RRT, we nested a case-control study, in which cases were children observed to have received RRT and controls were children with CKD who remained RRT-free at the time when the corresponding case initiated RRT.There were 147 children who experienced RRT during follow-up. Each case was matched individually to an eligible control at the time of the case occurrence. The matching factors included baseline CKD stage, glomerular/nonglomerular diagnosis, and, through design, the amount of follow-up time from study entry. Matching was done without replacement, and 22 cases were excluded from the analyses, because no appropriate control was available. We used a random sequence to determine the order of matching. The analysis was, thus, based on 125 matched case-control pairs. Demographic and clinical characteristics of cases and controls at baseline are shown in