中文版Morisky服药依从性评估量表在炎症性肠病患儿中应用的信效度评价

目的 探讨中文版Morisky服药依从性量表(包括监护人版和未成年人版)在炎症性肠病患儿中应用的信度与效度，并明确炎症性肠病患儿服药依从性现状与特征。方法 纳入炎症性肠病患儿141例，以中文版Morisky量表为评估工具，以现场发放与回收问卷的形式收集数据，采用克伦巴赫(Cronbach''s)a 系数和因子分析分别评价量表内部一致性信度和结构效度，采用Spearman检验评估患儿服药依从性与其疾病严重程度的相关性。结果 监护人版和未成年人版Morisky量表的Cronbach''s a系数分别为0.701和0.738；因子分析结果共提取3个公因子，累积方差贡献率分别为67.94%和72.24%；141例患儿的用药依从性评估得分为6.75(4.75，8.0)分，其中，依从性不良、中等与极好的患儿分别为58例(41.1%)，39例(27.7%)和44例(31.2%)；患儿用药依从性得分与其疾病严重程度呈显著负相关关系(R_s=-0.286，P=0.001)。结论 中文版未成年人版和监护人版Morisky量表均具有较好的信度与效度，可用于评估炎症性肠病患儿的服药依从性。近一半炎症性肠病患儿服药依从性差，忘记服药是影响依从行为的主要障碍，且患儿用药依从性与其疾病严重程度呈显著负相关，临床应予以高度重视。     

中文版MMAS-8测量类风湿关节炎患者用药依从性的信效度分析

目的:考察中文版8条目Morisky用药依从性量表(MMAS-8)测量类风湿关节炎(RA)患者用药依从性的信效度。方法:利用中文版MMAS-8就中国风湿病公众论坛微信公众号上发布的招募信息与电子版问卷作出回应的200例RA患者进行用药依从性评价,分析上述量表的项目、同质性、信度和效度。结果:量表总得分前后27%的两个极端组的8条目平均分的Levene法F检验差异均有统计学意义(P<0.001),方差不相等t检验差异均有统计学意义(P<0.001);7条目与总分的相关系数均大于0.400,且8条目与总分均显著相关(P<0.001);内部一致性系数(Cronbach’sα)为0.657,标准化Cronbach’sα为0.662;结构效度(KMO值为0.638,Bartlett’s球形检验值为246.278),采用因素分析法共提取3个公共因子,可解释总方差的58.846%;聚合效度方面中文版MMAS-8总分与用药依从性视觉模拟评分的Pearson相关系数为0.435(P<0.001)。结论:中文版MMAS-8用于测量RA患者的信效度较好。     

续配和服药依从性量表在中国老年糖尿病患者中信效度优化及验证

摘要：目的:验证续配和服药依从性量表（ARMS）在中国老年2型糖尿病患者评估中的信效度,为我国老年慢性非传染性疾病患者用药依从性评估提供新工具。方法:以老年2型糖尿病住院患者为对象,采用ARMS量表中文版进行用药依从性评估,进一步采用因子分析法以及结构方程模型对量表的信效度进行验证及优化。结果:共309例患者接受访视评估,ARMS量表中文版体现出良好内部一致性信度（Cronbach’s α=0.731）、重测信度（Spearman’s rho=0.871）以及校标效度（Spearman’s rho=0.711）,但原量表未达到最佳建构效度（χ2/df=2.883,GFI=0.935,CFI=0.922,SRMR=0.053 6,RMSEA=0.078）;优化后的10项ARMS量表中文版体现更佳信度（Cronbach’s α=0.738）,建构效度（χ2/df=2.032,GFI=0.962,CFI=0.969,RMSEA=0.058,SRMR=0.0384）以及区分效度,可有效测量老年2型糖尿病患者出现遗忘服药、正确按时服药以及定期规划开药三方面的用药依从性能力。结论:与ARMS量表中文版（12项）相比,优化的ARMS量表中文版（10项）具备更可靠的信效度,适合我国老年2型糖尿病患者用药依从性的评估。     

中文版MMAS-8评价心血管慢病患者用药依从性的信效度分析与实践

目的:分析中文版8条目Morisky用药依从性量表(MMAS-8)评价心血管慢病患者用药依从性的信效度,并用其评价药物重整对患者用药依从性的影响。方法:选取97例心血管慢病患者为观察组,进行中文版MMAS-8信效度评价并予以药物重整;选取91例心血管慢病患者为对照组,仅予以常规医疗服务。采用该量表评价两组患者不同时段的用药依从性。结果:问卷得分排序前后27%的两个极端组的8条目平均分的F检验差异、t检验差异均有统计学意义(P<0.001);8条目与总分的相关系数均大于0.400,且与总分均显著相关(P<0.001);内部一致性系数为0.763;结构效度KMO值为0.742,Bartlett’s球形检验值为266.007,共提取2个公共因子,共解释总方差的58.907%。与对照组比较,观察组患者出院1周和出院1个月时用药依从性明显提高(P<0.05)。结论:中文版MMAS-8评价心血管慢病患者用药依从性的信效度较好;药物重整可提高用药依从性。     

欧洲五维健康量表EQ-5D-5L中文版的信效度研究

本文对324名受访者进行问卷调查,通过Cronbach’s α系数和Spearman秩相关系数分别对中文版EQ-5D-5L量表的一致性信度和重测信度进行分析,通过因子分析和相关分析来考察量表的结构效度和校标效度。结果证实,中文版EQ-5D-5L量表具有较好的信度和效度,可以用于评价健康人群的生存质量。     

中文版Morisky用药依从性问卷在肾病综合征患儿中的信效度评价及应用

目的：评价中文版Morisky用药依从性问卷（MMAS-8）在肾病综合征（NS）患儿中应用的信度和效度，探讨本地区NS患儿的用药依从性水平及影响因素。方法：应用中文版MMAS-8对就诊于我院的90例NS患儿开展用药依从性问卷调查。选用Cronbach α系数评价中文版MMAS-8内部一致性信度，组内相关系数（ICC）评价重测信度；选用主成分因子分析法评价结构效度；选用Pearson相关系数评价MMAS-8得分与6个月内复发次数的相关性；对NS患儿的用药依从性影响因素选用多因素多分类有序Logistic回归方法分析。结果：中文版MMAS-8的Cronbach α系数为0.751；ICC为0.865（P<0.05）；主成分因子分析共提取3个公共因子；调查的90例患儿中有78.89%的患儿用药依从性不佳（评分<8分）；患儿6个月内复发次数与MMAS-8得分存在中度的负相关（Pearson相关系数为-0.454，P<0.01）；用药依从性影响因素分析结果显示，病程<1年较病程>3年患儿的用药依从性好（P<0.05），由父母监督服药较自行服药的患儿用药依从性好（P<0.05），患儿及家属对疾病了解越多用药依从性越好（P<0.05）。年龄、性别、复发次数对服药依从性无显著影响（P>0.05）。结论：中文版MMAS-8具有较好的信度和效度，可用于评估NS患儿的用药依从性。本地区NS患儿用药依从性水平不高，与患儿病程、用药监护人、是否了解疾病基本知识有关。     

家庭照顾者照顾能力量表在血液透析患者照顾者中的信效度研究

目的 修订家庭照顾者照顾能力量表(FCTI),并分析其在血液透析患者照顾者中应用的信效度。方法 经专家小组评议及预试验调适量表后，采用方便抽样法选取2021年2—12月广州2家三级甲等医院收治的血液透析患者照顾者195例，利用修订版FCTI对其进行调查。采用极端分组检验法(选择总分最高的27%作为高分组，最低的27%作为低分组)和相关分析法评价量表条目，采用Cronbach′s α系数和折半系数评价量表信度，采用已知族群效度、专家评定法、探索性因子分析、验证性因子分析等评价量表效度。结果 高、低分组被测者各条目得分比较，差异均有统计学意义(P<0.05);各条目得分与量表总分的Pearson相关系数为0.193～0.742,经课题组分析讨论后所有条目均保留。量表的总Cronbach′s α系数为0.886,总折半系数为0.715;各维度的Cronbach′s α系数为0.815～0.898,折半系数为0.715～0.966。量表总体内容效度指数为0.800,条目内容效度指数为0.667～1.000。探索性因子分析得到5个公因子，对应量表的5个维度，各条目在主因子的载荷为0.549...     

药物治疗管理服务对冠心病患者的效果分析

目的：探讨药物治疗管理（MTM）对冠心病患者的临床效果和人文效果。方法：将140例冠心病患者随机分为干预组（70例）和对照组（70例）,对照组给予常规医疗服务,干预组除常规服务之外, 给予规范的MTM服务。观察二组患者临床效果指标[血压达标率、低密度脂蛋白胆固醇（LDL-C）达标率和药物相关问题（MRPs个数）]和人文指标[药依从性量表（Morisky评分）、满意度、效用值和直观相似尺度（EQ-VAS）]的差异。结果：共有10例患者未完成本次研究,其中干预组3例、对照组7例;入组时二组患者的临床效果指标和人文指标比较无统计学差异。末次随访时,干预组患者的LDL-C达标率（P＜0.05）、Morisky评分（P＜0.01）、满意度（P＜0.01）、效用值（P＜0.05）和EQ-VAS评分（P ＜0.01）均显著高于对照组,MRPs个数显著低于对照组（P＜0.01）,血压达标率比较二组无统计学意义（P＞0.05）。结论：MTM可提高冠心病患者用药依从性、满意度、生活质量和LDL-C控制效果,解决MRPs,值得推广。     

149例皮肤浅部真菌病病种及致病病原菌分析

目的 分析皮肤浅部真菌病病种及主要致病菌构成,探讨其在不同情况下的分布差异。方法 选择2013年2月至2017年10月在安徽医科大学第一附属医院门诊确诊为浅部真菌病的149例患者,收集真菌镜检、培养及菌种鉴定结果。比较分析各病种及致病菌在不同性别、年龄及气候环境中的分布差异。结果 149例皮肤浅部真菌病患者的临床分型以甲真菌病为主（86例,57.72%）。皮肤癣菌在菌种构成上占据优势（125例,83.89%）。女性患者中,甲真菌病患者占69.05%,高于男性（46.88%）;男性患者中,足癣患者占32.81%,高于女性（16.47%）,差异均有统计学意义（P<0.05）。头癣是10岁以下儿童中最常见的皮肤浅部真菌病,占83.33%。温暖季节足癣发生率高于寒冷季节,差异有统计学意义（P<0.05）。结论 皮肤浅部真菌病的主要致病菌是皮肤癣菌,浅部真菌病病种及病原菌的分布在不同性别、年龄及季节环境等情况下有所不同。     

癫痫患儿心理行为特征与服药依从性的关系

目的 分析癫痫患儿服药依从性的影响因素,并分析其与心理行为特征的相关性。方法 采用便利抽样法选取2019年1~6月于南京市儿童医院就诊的癫痫患儿212例作为癫痫组,另选取同时期于我院体检的健康儿童100例作为对照组,采用一般资料调查表、艾式儿童行为量表及服药依从性问卷进行调查,分析癫痫患儿服药依从性的影响因素及其与心理行为特征的相关性。结果 不同年龄、病程以及有无提醒服药方式癫痫患儿的服药依从性得分之间差异有统计学意义（P < 0.05）。癫痫组患儿行为问题各条目得分均高于对照组,而社会能力各条目得分均低于对照组,差异有统计学意义（P < 0.05）。Pearson相关性分析显示,癫痫患儿社会能力总分与服药依从性评分呈正相关（r=0.553,P < 0.05）,而行为问题总分与服药依从性评分呈负相关（r=-0.421,P < 0.05）。结论 癫痫患儿心理行为特征与服药依从性显著相关,行为问题越严重,服药依从性越低,社会能力越强,服药依从性越好。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.