目的 了解青春期儿童维生素D(VD)水平状况及其影响因素,分析导致VD不足的原因,为后续研究和防治提供科学依据.方法 2015-2016年随机抽取哈尔滨市某城区某中学603名6～8年级11～17岁青春期儿童进行体格检查、问卷调查及实验室检测血清25(OH)D、甲状旁腺素(PTH)、钙(Ca)、磷(P)和碱性磷酸酶(ALP)的水平.结果 603名青春期儿童血清25(OH)D的中位数和四分间距位数为14.16 (10.68,18.46) ng/ml,VD不足和缺乏占81.1％.血清PTH、Ca、P、ALP水平分别为42.7(31.90,60.70)pg/ml、(2.47±0.13) mmol/L、(1.57±0.21)mmol/L、(275.23±127.60) U/L.血清25(OH)D与PTH水平和ALP水平之间呈负相关(r=-0.039、-0.141,P＜0.001),与Ca呈正相关(r=0.312,P＜0.001),与P无明显相关性.PTH和25(OH)D为对数关系,当PTH达到最大抑制状态时无25(OH)D拐点值.户外活动时间、补充VD制剂与血清25(OH)D水平呈正相关(P趋势＜0.001),户外活动时间、VD制剂的补充是青春期儿童VD水平的重要影响因素.结论 11～17岁青春期儿童VD缺乏情况普遍存在.血清PTH、ALP和Ca,这些指标的测定有助于评价青春期儿童VD水平状况,建议通过鼓励青春期儿童增加户外活动,补充VD制剂等手段,可以提高血清25(OH)D水平.

近年来有关维生素D研究进展迅速,其中维生素D与大脑的发育之间的关系日益受到关注.维生素D是一种具有类固醇激素作用的物质,可参与调节细胞增殖、分化及凋亡,大量研究表明,维生素D除了具有促进钙磷吸收、骨骼发育及发挥免疫调节的作用,还可作为一类神经激素影响神经系统的发育和功能,本文将从大脑中的维生素D及维生素D受体、维生素D对脑发育可能的调控作用及维生素D与儿童神经精神障碍疾病的相关性等几方面进行阐述.

目的:本研究通过对子代小鼠维生素D的干预,探讨维生素D对子代小鼠行为的重要影响,为孕期补充维生素D提供理论依据.方法:建立孕鼠维生素D缺乏的实验模型.将子代小鼠分为三组:肌注维生素D的低剂量饮食组(a组,补充组)、肌注生理盐水的低剂量饮食组(b组,缺乏组)和正常饮食组(c组).在第24天和第60天时,采用旷场实验、Morris水迷宫实验、社交试验对子代小鼠的行为进行监测.结果:孕期维生素D缺乏对子代小鼠的维生素D水平有显著的影响,子代小鼠出生10天时血清维生素D的浓度分别为:低剂量饮食组12.98±0.65 μg/L,正常饮食组35.38± 1.13 μg/L,两组浓度值差异显著(P＜0.05).旷场实验中,第24天时,缺乏组子代小鼠的运动总路程为1044±89.21 cm,显著少于补充组(1701.56±150.5 cm)和正常组(1755±154.2 cm),而其在中央区停留的时间为34.84±3.54 s,显著高于补充组(21.36±3.05 s)和正常组(21.77±3.64 s),其在周边停留的时间为265.2±3.54 s,显著少于补充组(278.6±3.05 s)和正常组(278.2±3.64 s);第60天时缺乏组子代小鼠在中央区停留的时间为28.79±3.68 s,显著高于补充组(17.21±2.59 s)和正常组(18.37±1.99 s),其在周边停留的时间为271.2±3.68 s,显著少于补充组(282.7±2.54 s)和正常组(281.6±1.99 s).缺乏组在第60天时行动总路程为1653±141 cm低于其他两组,但差异不显著.Morris水迷宫实验中,三组子代小鼠第24天的穿越次数均显著高于第60天,呈现先增加后降低的趋势,而缺乏组的降低趋势更为明显.平台停留时间方面,三组子代小鼠在第60天均多于第24天,呈增加趋势.社交实验中,第24天时三组小鼠探索空笼子的时间没有明显差异,但缺乏组小鼠与代表新伙伴的陌生鼠1接触的时间低于与空笼子的接触时间,而正常组和补充组小鼠与陌生鼠接触的时间明显多于空笼子.第60天时三组小鼠探索空笼子的时间也没有明显差异,虽然缺乏组小鼠与陌生鼠的接触时间略高于与空笼子的接触时间,但差异不显著,而正常组和补充组小鼠与陌生鼠接触的时间仍明显多于空笼子.结论:向维生素D缺乏的子代小鼠补充维生素D能够对子代小鼠的兴奋性、空间认知能力、学习记忆能力和社交行为产生良性影响,在发育早期进行维生素D补充具有重要的预防作用.

以前,人们认为新生儿坏死性小肠结肠炎与早产、缺氧、人工喂养、败血症、肠缺血和肠道致病菌感染等因素有关.近些年来,不断增多的研究结果显示,肠道菌群失调在新生儿坏死性小肠结肠炎的发病中也扮演重要角色.本文就肠道菌群对新生儿坏死性小肠结肠炎的影响进行综述,以期为新生儿坏死性小肠结肠炎的防治提供参考.

目的 探讨血糖控制优化方案(BGCOP)在肝胆外科术后应激性高血糖( SHG)病人中的应用效果.方法 采用简单化随机分组法将2015年1—12月山东大学齐鲁医院86名符合条件的肝胆外科病人分为试验组(43例)和对照组(43例).试验组采取BGCOP控制血糖,对照组采取常规胰岛素强化治疗方案( CIIT)控制血糖.比较术后两组病人的血糖控制效果、不良反应发生率和并发症发生率.结果 两组病人的一般资料在年龄、体质指数( BMI)、急性生理与慢性健康评分( APACHE)等方面差异无统计学意义(P＞0. 05),对后续研究没有影响.试验组采取BGCOP方案后血糖控制到目标值的时间为(4. 54 ± 1. 51)h,对照组采用CIIT方案后血糖控制到目标值的时间为(8. 54 ± 2. 68)h,试验组采用BGCOP方案后血糖控制到目标值的时间明显低于对照组,高血糖指数(0. 86 ± 0. 24)也明显低于对照组(1. 97 ± 0. 94),差异有统计学意义(t=8. 724,t=7. 895,P＜0. 001);试验组病人50%葡萄糖救援、低血糖、严重低血糖发生率明显低于对照组,均差异有统计学意义(P＜0. 05);两组病人发生高渗性昏迷的比率差异无统计学意义(P＞0. 05);试验组病人发生肺部感染、腹部感染和切口感染的比率明显低于对照组病人,差异有统计学意义(P＜0. 05).结论 与CIIT相比,BGCOP方案能更有效地控制肝胆外科术后SHG病人的血糖水平.

目的 分析肠道微生态变化与小儿反复呼吸道感染的相关性,为小儿反复性呼吸道感染的防治提供依据.方法 2017年1月～9月,门诊收治的小儿反复性呼吸道感染50例纳入病例组,普通健康小儿50例纳入对照组,进行粪便菌群检测,对比菌种与菌属含量、真菌检出情况.结果 病例组大肠杆菌、肠球菌含量高于对照组,病例组乳酸菌属、普雷沃氏菌属、双歧杆菌属含量低于对照组,差异有统计学意义(P<0.05).病例组与对照组真菌检出情况差异无统计学意义(P>0.05).结论 肠道微生态变化与小儿反复呼吸道感染存在相关性,小儿反复性呼吸道感染表现为乳酸杆菌、双歧杆菌益生菌含量下降,大肠杆菌等条件致病菌含量上升;对于小儿反复呼吸道感染,需要重视肠道微生态改善.

Objective Milk formulae is the main source of food protein for infants in addition to breastfeeding, so cow's milk protein allergy (CMPA) is the most common type of food allergy.Its symptoms are diverse and not specific, therefore the diagnosis and treatment of CMPA is still a challenge at present.A challenge test is considered as the golden standard diagnostic test of CMPA.The Cow's milk related symptom score (CoMiSSTM) may be a valid diagnostic tool.Breastfeeding is the best way to feed baby.Guidelines recommend eHF as the first option, while AAF is reserved for the most severe cases.Oral immunotherapy remains an investigational treatment to be further studied before advancing into clinical practice.The administration of probiotics may contribute to the efficacy of an elimination diet in CMPA and accelerate the acquisition of tolerance.Literature was searched and reviewed in this study to find the diagnosis and treatment of CMPA, in order to provide new ideas for the diagnosis and treatment of CMPA.

维生素D不仅对骨代谢有着经典的作用,同时在免疫、细胞增殖和分化中有重要的作用.最近的研究发现,孕期维生素D水平也可能通过表观遗传修饰影响到后代儿童期非骨骼系统疾病的易感性,如哮喘,自身免疫性疾病和神经精神疾病等.本文将综述维生素D缺乏与儿童疾病表观遗传学的研究进展.

The aim of the present study was to investigate the antioxidant response mechanism of epigallocatechin‑3‑gallate (EGCG) in H2O2‑induced mouse renal tubular epithelial cells (MRTECs). The cultured MRTECs were divided into normal, H2O2 (control) and EGCG treatment groups. The MTT assay was used to assess cell viability, and reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR), immunocytochemical and western blot analyses were performed to detect the expression of nuclear factor erythroid 2‑related factor 2 (Nrf2) and γ‑glutamyl cysteine synthetase (γ‑GCS). EGCG was able to mitigate H2O2‑mediated cell damage. The RT‑qPCR results demonstrated that EGCG was able to upregulate the gene expression of Nrf2 and γ‑GCS in MRTECs in a dose‑dependent manner. The immunocytochemistry and western blot analyses demonstrated that EGCG was able to increase the protein expression of Nrf2 and γ‑GCS in MRTECs in a dose‑dependent manner. Oxidative stress may lead to a decrease in the viability of MRTECs, while EGCG was able to promote the expression of Nrf2 and γ‑GCS in MRTECs, thereby improving the antioxidant capacity of the cells and promoting the repair of oxidative stress injury.

Objective To identify the high-touched object surface in different special intensive care units(ICUs) through the observation and statistical analysis on the number of touching with common object surfaces in different ICUs, so as to provide basis for hospital environmental management.Methods Direct observation method was used to observe the daily activities of health care workers, the number of touching with various common object surfaces was recorded, Poisson distribution was adopted to statistically analyze the data.Results The average number of touching from high to low was as follows : medical record folder(n=28.00), chair(n=18.38), emergency rescue cart(treatment cart, n=17.29), bed surface(n=13.90), intravenous infusion line(n=13.76), medical pen(n=13.38), and intravenous transfusion pump(n=11.81), these objects accounted for 64.01% of all surface touching number.Different special ICUs were slightly different, general ICU high-touch object included the first 6 categories;cardiothoracic surgery ICU included the above 7 categories besides keyboard and mouse;internal medicine ICU included the first 6 categories and mobile phone.Conclusion High-touched object surface varied with different special ICUs of the same hospital, hospital should make the corresponding disinfection management measures according to the actual situation of high-touched surface of each department, so as to reduce the incidence of healthcare-associated infection.

目的:探讨以成果为导向护理本科人才培养方案构建过程.方法:以成果导向教育理论为指导,以哈尔滨医科大学护理学院为研究场所,采用行动研究法对护理本科人才培养方案进行研究.结果:以成果为导向构建出新一轮人才培养方案.结论:方案符合护理专业发展需求和学院办学定位,将为促进我院护理本科生培养质量提供重要保障.

根据美国住院医师胜任力模型提出适合中国住院医师培养的胜任力模型,结合国家住院医师规范化培训政策及黑龙江省住院医师培训实施方案对培训内容的要求制定了包含医学知识、临床技能、人文技能、科研教学能力、健康教育及健康促进等相关内容的课程体系.

近年来,我国医患纠纷等事件越来越多,给医院的正常经营和外部形象都带来了较大的影响.虽然造成这种情况的原因是多元化的,但是其中主要的原因之一就是住院医师的综合素质有一定的欠缺与不足.因此,针对于住院医师的规范化培训能够给我国医疗事业提供必要的医学人才,从而更好地促进我国医疗体系的发展.本文先分析了近一段时间来我国进行的住院医师专培制度试点工作的内容、目标、特点和意义,并从培训的针对性不强、培训保障体制不全面、待遇与制度的衔接存在脱节三个方面,探讨了我国住院医师规范化培训制度存在的不足,并结合自己的理解提出了相应的解决策略.

The mechanisms that eliminate activated platelets in inflammation-induced disseminated intravascular coagulation (DIC) in micro-capillary circulation are poorly understood. This study explored an alternate pathway for platelet disposal mediated by endothelial cells (ECs) through phosphatidylserine (PS) and examined the effect of platelet clearance on procoagulant activity (PCA) in sepsis. Platelets in septic patients demonstrated increased levels of surface activation markers and apoptotic vesicle formation, and also formed aggregates with leukocytes. Activated platelets adhered were and ultimately digested by ECs in vivo and in vitro . Blocking PS on platelets or αvβ3 integrin on ECs attenuated platelet clearance resulting in increased platelet count in a mouse model of sepsis. Furthermore, platelet removal by ECs resulted in a corresponding decrease in platelet-leukocyte complex formation and markedly reduced generation of factor Xa and thrombin on platelets. Pretreatment with lactadherin significantly increased phagocytosis of platelets by approximately 2-fold, diminished PCA by 70%, prolonged coagulation time, and attenuated fibrin formation by 50%. Our results suggest that PS-mediated clearance of activated platelets by the endothelium results in an anti-inflammatory, anticoagulant, and antithrombotic effect that contribute to maintaining platelet homeostasis during acute inflammation. These results suggest a new therapeutic target for impeding the development of DIC.

文章通过护理专业内外科护理学课程整合的探讨,明确了整合的原则与方向,加强了教师队伍的培养,加快了教学方法的改革,并大胆尝试了整合教材的编写,为高等护理教育课程设置改革与创新提供了借鉴和指导.

目的：对性早熟儿童的家庭社会行为因素进行分析探讨。方法以我院2013年1月至2016年1月收治的54例性早熟儿童作为观察组，以同期在我院进行健康体检的60例非性早熟儿童作为对照组，对比两组研究对象的家庭因素及社会行为因素。结果两组患儿的家长溺爱、经常咨询育儿知识、经常食用动物性食物、经常食用滋补品、课外体育运动的时间及家庭关系的和睦情况具有明显差异（P ＜0.05）。结论常食用营养滋补品及动物性食物、课外体育运动的时间少、接触成人化学用品等均为引起儿童性早熟的家庭社会因素，应引起重视。

Establishing a scientific and rational opening report evaluation index system for the graduate students of nursing (Index system is called for short in paper)is the basic criteria to ensure and evaluate the graduate program quality,as well as,is a great significance for training graduate students of nursing have a high level of academic research and its training quality.The Harbin University used the two rounds Delphi method constructed the evaluation system included the different indexes and the weight of the indexes.The evaluation index system included 4 primary,19 secondary and 36 tertiary indicators.The evaluation system constructed has high reliability,authority,can provide the basis for the assessment and evaluation to balance the opening report quality.

目的:调查了解护理兼职教师的培训需求,分析形成的原因,找出主要需求和问题.方法:采用自设问卷,以本学院全体兼职教师为研究对象进行问卷调查.结果:教学方法设计、教学内容设计、启发学生思考能力及国内外护理教育发展现状及趋势居需求前列,其他方面需求呈现多元化趋势.结论:课堂教学能力培训应针对护理兼职教师实际需求进行多无化设计与实施,以求取得培训实效.

住院医师规范化培训是提高住院医师核心胜任力、提高医疗服务质量的重要途径,面对医学教育全球化发展,要不断深化和细化住院医师职业化培训体系,从而不断地提高临床医师的整体水平,促进中国医疗服务的现代化发展.总结以核心胜任力为基础的住院医师规范化培训的经验,剖析规范化培训过程中尚存在的问题,提出建设性意见.

目的:构建护理学博士学位论文评价指标体系,为客观评价并提高其学位论文质量提供依据和对策.方法:选取38名专家作为函询对象,对构建的体系应用德尔菲法进行2轮函询.结果:构建体系涵盖一级、二级、三级指标分别为8、24、51项.结论:专家的代表性、积极程度、权威程度、意见的协调程度及集中程度均较高;基于德尔菲法构建的护理学博士学位论文评价指标体系可以全面、科学地评价护理学博士学位论文质量.