极低出生体重儿及超低出生体重儿宫外发育迟缓相关因素及早期干预的效果

目的：探讨影响极低出生体重儿,超低出生体重儿宫外发育迟缓的危险因素和评价早期微量喂养加腹部按摩的干预效果。方法：收集135例极低出生体重和超低出生体重儿,分析其宫外生长迟缓的发生率和并发症的发生率;通过是否发生宫外生长迟缓分组后,用 Logistic 回归分析引起宫外发育迟缓的危险因素：将研究对象根据不同的护理干预方式分为早期微量喂养加腹部按摩组（观察组）和常规喂养组（对照组）,通过观察达全量肠营养时间、吮吸吞咽建立时间等指标,评价早期微量喂养加腹部按摩的干预效果。结果：经多因素 Logistic 回归分析胎龄（OR ＝2．981）、出生体重（OR ＝4．215）、出生头围（OR＝1．989）、IUGR（OR ＝1．283）、静脉用氨基酸最大量（OR ＝2．057）、达到肠道标准热卡所需时间（OR＝4．782）是宫外生长迟缓的危险因素。观察组的达全量肠营养时间、吮吸吞咽建立时间、拨胃管时间均低于对照组,差异具有统计学意义（P＜0．05）,观察组的每日体重增长量高于对照组,差异具有统计学意义（P＜0．05）。结论：胎龄、出生体重、感染、IUGR、出生头围是极低出生体重和超低出生体重儿宫外生长迟缓的危险因素。早期微量喂养加腹部按摩有较好的干预效果。     

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。     

道路交通事故致重型颅脑损伤后并发脑积水的原因分析

目的：探讨道路交通事故致重型颅脑损伤（sTBI）后并发脑积水的危险因素。方法回顾性分析2010年1月至2014年12月海南省农垦总医院收治的316例道路交通事故致sTBI患者的临床资料。根据伤后是否并发脑积水分为脑积水组（57例）和非脑积水组（259例）。对sTBI后并发脑积水的相关因素,如患者的年龄,性别,有无脑室出血,有无颅骨损伤,有无创伤性蛛网膜下腔出血（tSAH）,颅脑损伤类型,颅内血肿位置,硬脑膜是否敞开,有无行腰椎穿刺脑脊液置换,有无行去骨瓣减压术,手术持续时间,GCS评分等进行Logistic回归分析。结果通过Logistic回归分析发现sTBI患者合并脑积水的主要影响因素为年龄（OR＝1．206,P＝0．036）,有无tSAH（OR＝2．123,P＜0．01）,颅内血肿位置（OR＝1．415,P＝0．007）,硬脑膜是否敞开（OR＝1．669,P＜0．01）,有无行去骨瓣减压术（OR＝1．610,P＝0．005）,有无行腰椎穿刺脑脊液置换（OR＝0．640,P＝0．001）,GCS评分（OR＝0．796,P＝0．007）。结论年龄大、有tSAH、硬膜下及脑内血肿、硬脑膜敞开、行去骨瓣减压术等是sTBI患者并发脑积水的危险因素;而行腰椎穿刺脑脊液置换和高GCS评分是预防脑积水发生的保护因素。     

老年2型糖尿病合并非酒精性脂肪肝相关危险因素分析

目的：分析老年2型糖尿病合并非酒精性脂肪肝的相关危险因素。方法：选择485例老年2型糖尿病患者,其中单纯糖尿病患者列为对照组,2型糖尿病合并非酒精性脂肪肝患者列为观察组,对两组患者进行相关危险因素进行检测或相关问卷调查,采用统计学方法分析2型糖尿病合并非酒精性脂肪肝的危险因素。结果：①病程≥10年、饮酒、BMI＞24．0kg／m2、HOMA－IR＞1糖尿病患者,非酒精性脂肪肝患病率明显高于病程＜10年、不饮酒、BMI≤24．0kg／m2、HOMA－IR≤1的糖尿病患者,比较差异有统计学意义（病程χ2＝0．973,饮酒χ2＝0．799,BMIχ2＝0．784,HOMA－IRχ2＝1．184,P＜0．05）;②观察组HOMA－IR、TG、HDL－c、LDL－c水平高于对照组,比较差异有统计学意义（ HOMA－IR t＝9．445, TG t＝9．832,HDL－c t＝10．314,LDL－c t＝9．876,P＜0．05）;③病程、饮酒、BMI、HOMA－IR、TG是2型糖尿病合并非酒精性脂肪肝危险因素（病程OR＝0．973,饮酒OR＝0．799,BMI OR＝0．784,HOMA－IR OR＝1．184,TG OR＝0．763,P＜0．05）。结论：影响老年2型糖尿病合并非酒精性脂肪肝因素较多,病程、饮酒、BMI、HOMA－IR、TG为独立危险因素。     

老年急腹症术后肺部感染观察及相关危险因素分析

目的】观察老年急腹症患者术后肺部感染的发生情况,并分析其相关危险因素,以期有效降低老年急腹症患者术后肺部感染的发生率。【方法】回顾性分析114例经手术治疗的老年急腹症患者,统计术后肺部感染的发生率,相关因素分析采用单因素χ2检验和多因素Logistic回归分析。【结果】114例患者中共发生肺部感染30例,发生率为26．32％（30/114）。多因素Logistic检验显示肺部感染危险因素有年龄（OR＝2．356,95％CI1．845～3．009）、合并肺部疾病（OR＝3．526,95％CI2．346～5．300）、全身麻醉（OR＝3．410,95％CI2．469～4．710）、自主排痰（OR＝0．472,95％CI0．335～0．665）、人工排痰（OR＝0．503,95％CI0．394～0．642）、口腔清理（OR＝0．481,95％CI0．369～0．627）、贫血（OR＝1．821,95％CI1．632～2．032）、免疫功能差（OR＝2．526,95％CI1．887～3．381）和住院时间（OR＝1．793,95％CI1．421～2．262）。【结论】老年急腹症患者术后肺部感染的发生率很高,并且与多种因素有关,应根据相关危险因素加强围手术期的预防、治疗和护理工作。     

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。     

手术室护理对患者术后感染的影响及相关性研究

目的：探讨手术患者医院感染与手术室护理管理的相关性。方法：总结我院行外科手术后发生医院感染的患者110例资料,随机分为两组：严格实施手术室护理管理方法的55例患者为观察组,进行普通护理的55例为对照组,对所有患者病历资料进行总结分析,最后通过单因素和多因素统计学分析探讨可能影响医院感染相关因素。结果：观察组术后并发症发生率9．1％（5/55）,术后复发率5．5％（3/55）,明显低于对照组（ P＜0．05）,单因素分析结果表明与医院感染有关的手术室管理因素有六个,其中有四个通过多因素分析结果表明是高危影响因素：手术切口（ OR＝6．68）,手术时程（ OR＝3．80）,ICU（OR＝13．19）和预防性抗生素（OR＝2．98）。结论：对影响医院感染的高危因素进行针对性防护有利于降低外科手术后医院感染率。     

医科大学三年级学生近视相关因素

目的：观察某医科大学中期学习的学生视力状况,探讨影响视力的相关因素。方法：把三年级医疗专业全体学生作为研究对象,采用问卷式调查,近视作为病例组,视力正常为对照组,进行病例对照研究的成组处理,作单因素与Logistic回归分析。结果：学生中近视率为69．19％;男生为64．3％,女生为84．4％,差异显（P＝0．011）。单因素分析表明,近视与居住在城市（OR＝2．78,P＝0．007）,眼疲劳史（OR＝2．24,P＝0．018）,阅读距离远（OR＝0．22,P＝0．000）,看电视多（OR＝3．54,P＝0．000）四种因素相关;其中居住城市、阅读距离远、看电视多与近视有一定剂量效应关系。多因素分析发现,阅读距离远（OR＝0．23）、床上阅读（OR＝2．07）、父母近视（OR＝2．47）为近视的主要保护和危险因素。结论：性别可能是混杂因素;居住城市、床上阅读、看电视多、阅读距离远与父母近视是学生近视的主要危险或保护因素。     

肝胆外科患者手术切口感染的相关因素调查研究

目的探讨肝胆外科手术患者手术切口感染情况和影响因素。方法采用自编问卷收集我院肝胆外科2005年9月～2012年9月收治的362例手术患者的临床资料,运用描述性统计方法和Logistic回归分析法找出肝胆外科手术患者手术切口感染情况和影响因素。结果肝胆外科手术患者手术切口感染发生率为3．87％。放置引流（OR=0．000,P=0．000）和抗生素切口冲洗（OR=0．005,P=0．000）是肝胆外科手术患者手术切口感染的保护因素,高龄（OR=2．230,P=0．000）、急诊手术（OR=6．367,P=0．000）、手术时间长（OR=3．958,P=0．000）和Ⅲ类切口（OR=9．489,P：0．000）是肝胆外科手术患者手术切口感染的危险因素。结论肝胆外科手术患者手术切口感染发生率较高,其发生受到诸多因素的影响。     

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。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.