父母视力健康知识对子女寻求视力健康服务的影响

目的：通过研究父母视力知识的认知水平对其为子女寻求视力健康服务的影响,为有效防控学生视 力不良提供科学依据。方法：横断面调查研究。基于陕西省、甘肃省共252所农村小学5 236名学生 的调研数据,采用多元Logistic回归模型分析父母认知水平对子女寻求视力健康服务的影响,并采 用倾向匹配对结果进行稳健性检验。结果：从5 236个全样本学生看来,样本地区学生近视率高达 46.31%,其中74.54%的学生没有进行视力检查。在2 425个近视样本中,只有15.09%的学生配戴眼镜。 父母对视力问题的认知存在较大的误区,全样本和近视样本中父母对视力健康知识的正确回答率都 较低。多元Logistic分析结果显示父母视力健康知识的掌握情况对是否带子女进行视力检查和是否 给视力不良孩子配戴眼镜均存在显著影响：近视及其成因（OR=1.15,95%CI：1.00～1.33,P=0.043; OR=1.20,95%CI：1.03～1.41,P=0.023）、戴眼镜会使得视力越来越差（OR=1.23,95%CI：1.06～1.46, P=0.007）、学生应该经常检查视力（OR=1.40,95%CI：1.15～1.69,P=0.001）以及小学生不应该戴眼 镜（OR=1.05,95%CI：0.91～1.22,P<0.001）均对父母是否带孩子去检查眼睛具有显著的影响;父 母知道近视是看不清远处东西（OR=1.35,95%CI：1.04～1.76,P=0.024）、近视不戴眼镜会影响学习 （OR=1.54,95%CI：1.16～2.05,P=0.003）以及小学生不应该戴眼镜（OR=1.61,95%CI：1.23～2.10, P=0.001）均对孩子戴镜行为有显著的影响。结论：在我国农村地区,学生的视力不良已成为一个严 重的问题,且父母对视力问题的认识存在较大的误区。作为孩子行为的决策者,父母对视力健康知 识的认知会影响他们对孩子的视力检查及配镜等视力健康寻求行为的决策。     

The patient-reported outcome of age-related cataract using Catquest-8SF questionnaire

AIM: To assess the patient-reported outcome of phacoemulsification with posterior chamber single focus foldable intraocular lens (SIOL) using the Chinese version of Catquest-8SF questionnaire (Catquest-8SF-CN), evaluate the applicability of Catquest-8SF scale in northern Chinese and its sensitivity to cataract surgery. METHODS: Prospective clinical case follow-up study. The patients were recruited from the Central Hospital of Tai’an and completed the Catquest-8SF questionnaire by face-to-face interviews before and 3mo after surgery at the hospital. RESULTS: A total of 120 cataract patients with median age 67.6y and 52.5% female completed the Catquest-8SF. The Cronbach’s α coefficient of the total scale, daily-activity sub-table and comprehensive-evaluation sub-table were 0.861, 0.853 and 0.748 respectively. There was a high level of consistency between two investigators. The cumulative contribution rate was 66.64% by using the principal component analysis and the maximum variance orthogonal rotation method. The preoperative score of the Catquest-8SF-CN had a significant negative correlation with preoperative binocular mean weighted visual acuity and age (P<0.05), while a significant positive correlation with education level (F=6.094, P<0.001). The patients without systemic comorbidities got higher score than those who with (P<0.05). Three months after surgery, 102 (85%) patients came for follow-up and completed the questionnaire. Significant improvement of visual acuity was observed in both binocular and monocular surgery groups (t=10.404, P<0.001). There was higher improvement in binocular weighted visual acuity of binocular surgery group than in monocular surgery group (t=-20.77, P<0.001). The postoperative score was significantly higher in both groups than before (P<0.001). There was a significant improvement in the total score after cataract surgery. The 94 patients (92.2%) were very satisfied or satisfied with the operation; 92 patients (90.2%) thought the surgery achieved their expectations, and they all felt satisfactory. The degree of satisfaction was significantly correlated with the improvement score of the scale and it was also correlated with their expectation of the surgery. CONCLUSION: The Chinese version of Catquest-8SF questionnaire is suitable for the age-related cataract population in northern China. It is highly responsive to cataract surgery and brief, so it may have the potential to become part of a routine clinical assessment for cataract surgery in China. The patient’s overall satisfaction is high, which illustrates that the medical service we provide matches the patient’s needs. The degree of satisfaction was significantly correlated with the improvement score of the scale and it was also correlated with their expectation of the surgery.     

获得性免疫缺陷综合征合并梅毒患者的眼底病变构成分析

目的 分析获得性免疫缺陷综合征（AIDS）合并梅毒患者的眼底病变构成特点。设计 回顾性病例系列。研究对象 2012-2019年北京佑安医院AIDS患者395例。方法 根据是否合并梅毒分为AIDS组和AIDS合并梅毒组。患者进行最佳矫正视力(BCVA)、裂隙灯、眼压、散瞳眼底检查及彩色眼底照相等眼科检查,并行艾滋病、梅毒相关全身检查。主要指标 BCVA、眼前节反应、眼底病变情况、高效抗逆转录病毒治疗（HAART）状态、CD4+T细胞计数、血HIV-RNA载量以及血CMV-DNA。结果 AIDS组患者266例,眼底异常者163例（61.3%）,其中男性149例（91.4%）,HIV相关视网膜微血管病变66例（40.5%),巨细胞病毒视网膜炎94例（57.7%),血CD4+T细胞计数中位数27个/μl; AIDS合并梅毒组患者129例,眼底异常者93例（72.1%）,与AIDS组比较,差异有统计学意义（P=0.035）,其中男性92例（P=0.014）,HIV相关视网膜微血管病变40例（31.0%）,梅毒相关眼底改变26例（20.2%）,巨细胞病毒视网膜炎25例（19.4%）,眼前节阳性反应者23例 (P=0.010),63例（67.7%）患者眼底病变位置为中央型（P=0.040）,血CD4+T细胞计数中位数33.5个/μl（P=0.007）,均明显高于AIDS组。结论 AIDS合并梅毒患者眼底病变患病率高于单纯AIDS组患者,且血CD4+T细胞计数更高。     

蛭草茶合剂对糖尿病小鼠视网膜Müller细胞的保护作用及炎症因子表达的影响

目的:观察蛭草茶合剂对糖尿病小鼠视网膜Müller细胞的保护作用及对炎症因子表达的影响。方法:健康清洁级雄性C57BL/6J小鼠75只,采用随机数字表法随机分为正常对照组、糖尿病组、低浓度蛭草茶合剂治疗组(低浓度治疗组)、中浓度蛭草茶合剂治疗组(中浓度治疗组)、高浓度蛭草茶合剂治疗组(高浓度治疗组),每组15只。糖尿病组、不同浓度治疗组小鼠按60 mg/kg剂量腹腔注射STZ诱导糖尿病动物模型。建模后4周,低浓度治疗组、中浓度治疗组、高浓度治疗组大鼠分别按30、60、120 ml/kg的浓度行蛭草茶合剂灌胃治疗。每两周测定各组小鼠体重及血糖。第8周后,采用Western blot检测各组小鼠视网膜Müller细胞中胶质纤维酸性蛋白(GFAP)表达;免疫荧光检测GFAP、谷氨酰胺合成酶(GS)表达;实时荧光定量PCR(RT-qPCR)、ELISA分别检测VEGF、TNF-α、IL-1β、IL-6 mRNA和蛋白表达。组间比较采用单因素方差分析。结果:糖尿病组小鼠体重较正常对照组降低,血糖升高;不同浓度治疗组小鼠血糖呈降低趋势。与正常对照组比较,糖尿病组小鼠视网膜Müller细胞GFAP蛋白表达升高(t=38.318,P<0.001),GS蛋白表达降低(t=29.737,P<0.001),差异有统计学意义;与糖尿病组比较,低浓度治疗组、中浓度治疗组、高浓度治疗组小鼠Müller细胞GFAP蛋白表达下降(t=13.677、19.387、16.305,P<0.05),GS蛋白表达升高(t=5.170、19.399、6.705,P<0.05),差异均有统计学意义。糖尿病组小鼠视网膜Müller细胞VEGF、TNF-α、IL-1β、IL-6 mRNA和蛋白表达均升高,不同浓度治疗组均降低。结论:蛭草茶合剂可降低糖尿病小鼠血糖,减轻糖尿病视网膜炎症反应。     

低位直肠癌造口患者围手术期护理

直肠癌是我国常见的恶性肿瘤之一，近年来其发病率有升高趋势，其中以中低位直肠癌多见。目前，治疗低位直肠癌多采用腹会阴联合直肠癌根治术（Mile’s），需建立永久性结肠造口。造口改变了患者原有的正常生理排便方式，给患者日常生活造成极大不便，使患者的生活质量受到很大的影响。同时，也给患者造成巨大的心理压力。加强结肠造口患者围手术期的护理，不仅能提高手术成功率，改善患者术后生存质量，而且也能有效地减轻患者的心理压力。     

2013年某县慢性病现状及其危险因素监测的分析

目的掌握山东省东阿县城乡居民的慢性病现状及其相关危险因素特点,通过分析慢性病相关危险因素,找到东阿县疾病防控的重点,为制定适合东阿县的慢性病防控干预计划提供依据。方法采取随机抽样方法抽取1100个家庭,每户根据KISH表法确定1例18岁及以上常住居民作为调查对象。采用问卷调查、身体测量和实验室检测三种方法。结果东阿县城乡居民慢性病患病率为23.28%(291/1250)。居民的主要的慢性病为高血压(13.80%)及糖尿病(3.44%);东阿县18岁以上城乡居民普遍存在吸烟、饮酒、不合理膳食、体力活动不足、超重、肥胖是的主要危害因素,其中吸烟、饮酒在男性中的分布明显高于在女性中的分布。结论根据东阿县居民慢性病患病特点及相关危险因素现况,可结合一级"控制危险因素"、二级"治疗患者"、三级"促进康复"来控制和管理慢性病。     

缬沙坦联合氨氯地平或氢氯噻嗪治疗对老年高血压患者血压变异性及一氧化氮、内皮素的影响

目的：探讨缬沙坦联合氨氯地平或氢氯噻嗪治疗对老年高血压患者血压变异性（ BPV）及一氧化氮（ NO）、血浆内皮素的作用。方法选择552例老年高血压患者,采用随机数字表法将其分为观察组和对照组各276例,给予观察组氨氯地平联合缬沙坦进行治疗,对照组给予氢氯噻嗪联合缬沙坦进行治疗,连续治疗3个月,对两组患者治疗后的BPV及NO、血浆内皮素的含量进行对比分析。结果治疗后,观察组24 h SBPV、日SBPV、24 h DBPV、日DBPV均较治疗前明显下降（t＝20．09、15．97、9．31、9．41,均P＜0．05）,对照组患者仅24 h SBPV及日SBPV[分别为（9．12±2．57）％,（8．43±1．97）％]显著低于治疗前（t＝12．31、9．53,均P＜0．05）;观察组治疗后日SBPV、24 h DBPV、日DBPV[分别为（7．21±1．34）％、（12．31±2．54）％、（10．59±2．73）％]显著低于对照组（t＝10．52、12．34、8．35,均P＜0．05）,治疗后两组NO[分别为（66．12±23．57）％、（68．29±21．52）％]与血浆内皮素水平[分别为（34．43±7．97）％、（34．21±7．34）％]显著低于治疗前（t观察组＝31．39,11．79,t对照组＝28．31,9．35,均P＜0．05）。结论缬沙坦联合氨氯地平或氢氯噻嗪能有效控制血压,明显升高NO水平,降低血浆内皮素水平,值得在临床中推广应用。     

手术与保守治疗对阻塞性睡眠呼吸暂停低通气综合征多导睡眠图监测参数的影响

目的：探讨手术与保守治疗对阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）多导睡眠图（ PSG）监测参数的影响。方法选取60例OSAHS患者为研究对象,根据治疗方法的不同分为观察组30例和对照组30例,观察组采用手术治疗,对照组采用非手术处理。应用PSG 监测设备监测呼吸暂停／低通气指数（ AHI）、每小时发生呼吸暂停低通气时间指数（ AHTI）、呼吸暂停低通气的总时间（ AHT）、氧饱和度低于90％的时间（SAT 90％）,最低SaO2和平均SaO2等。结果治疗后,对照组、观察组SAT90％为（38．4＆#177;13．4）％、（17．5＆#177;12．5）％,均显著降低,最低SaO2两组分别为（79．6＆#177;12．4）％、（83．7＆#177;11．2）％,均显著升高,平均SaO2为（85．4＆#177;16．3）％、（90．8＆#177;12．4）％,均显著升高,与治疗前比较差异均有统计学意义（t ＝10．13、22.42、4．76、9．76、3．65、6．65,均P＜0．05）。且观察组改善更显著（t＝17．32、3．76、3．76,均P＜0．05）。两组治疗后AHI、AHT及AHTI分别为（22．4＆#177;3．4）次／h、（14．5＆#177;2．5）次／h,（9．6＆#177;2．4） min、（5．7＆#177;1．2） min、（1.4＆#177;0．3）min、（0．8＆#177;0．4）min,均显著降低,与治疗前比较差异均有统计学意义（t＝9．63、12．12、7．51、19.27、21．42、10．63,均P＜0．05）。且观察组降低更显著（t＝8．97、9．76、6．57,均P＜0．05）。结论 OSAHS患者采用手术治疗后,各PSG监测参数显著改善,优于保守治疗,应作为其首选的治疗方法。     

江西省第6次碘缺乏病病情调查结果分析

目的通过调查全省碘缺乏病病情和居民碘营养水平,为调整江西省食盐加碘浓度提供依据。方法按人口比例概率抽样方法在全省抽取30个县（市、区）的30所小学．每所小学采用B超法测定40名学生甲状腺容积．抽取上述小学8～10岁儿童尿样345份,并在每所学校周边的3个乡（镇）分别采集孕妇和哺乳期妇女尿样共894份．采用砷铈催化分光光度法进行尿碘含量检测,并对学校所在村分别采集饮用水进行水碘含量检测。结果监测结果表明．全省儿童学生甲状腺肿大发生率为1．25％;盐碘中位数为30．80mg／kg,居民合格碘盐食用率为97．00％;儿童、孕妇和哺乳期妇女尿碘中位数分别为308．95、206．75、206．72μgg/L,其中儿童尿碘大于或等于300μg／L的样品数占52．20％,而孕妇尿碘小于150μg/L的样品数占34．73％;全省水碘中位数4．62μg/L。结论江西省人群碘缺乏状况总体控制良好,仍要加强对重点人群碘营养水平的监测,适时调整碘盐浓度。     

Antagonists of the Vasopressin V1 Receptor and of the β1-Adrenoceptor Inhibit Cytotoxic Brain Edema in Stroke by Effects on Astrocytes – but the Mechanisms Differ

Brain edema is a serious complication in ischemic stroke because even relatively small changes in brain volume can compromise cerebral blood flow or result in compression of vital brain structures on account of the fixed volume of the rigid skull. Literature data indicate that administration of either antagonists of the V1 vasopressin (AVP) receptor or the β₁-adrenergic receptor are able to reduce edema or infarct size when administered after the onset of ischemia, a key advantage for possible clinical use. The present review discusses possible mechanisms, focusing on the role of NKCC1, an astrocytic cotransporter of Na⁺, K⁺, 2Cl^- and water and its activation by highly increased extracellular K⁺ concentrations in the development of cytotoxic cell swelling. However, it also mentions that due to a 3/2 ratio between Na⁺ release and K⁺ uptake by the Na⁺,K⁺-ATPase driving NKCC1 brain extracellular fluid can become hypertonic, which may facilitate water entry across the blood-brain barrier, essential for development of edema. It shows that brain edema does not develop until during reperfusion, which can be explained by lack of metabolic energy during ischemia. V1 antagonists are likely to protect against cytotoxic edema formation by inhibiting AVP enhancement of NKCC1-mediated uptake of ions and water, whereas β₁-adrenergic antagonists prevent edema formation because β₁-adrenergic stimulation alone is responsible for stimulation of the Na⁺,K⁺-ATPase driving NKCC1, first and foremost due to decrease in extracellular Ca²⁺ concentration. Inhibition of NKCC1 also has adverse effects, e.g. on memory and the treatment should probably be of shortest possible duration.