Objective:To investigate the effects of hydroxysafflor yellow A (HSYA) on depressive-like behavior and expression of type A γ-aminobutyric acid receptor(GABAAR)in hippocampus of chronic restraint stress model mice.Methods:The SPF grade male C57BL/6C mice were divided into Control group, HSYA group, Model group, Model + HSYA group and Model + fluoxetine group according to random number table method, with 12 mice in each group.Mice model of depression was established by chronic restraint stress.Mice in HSYA group and Model+ HSYA group were intraperitoneally injected with HSYA(20 mg/kg), mice in Model+ fluoxetine group were injected intraperitoneally with fluoxetine (10 mg/kg), and mice in Control group and Model group administered with 0.9% sodium chloride solution intraperitoneally once a day for 14 days.Then, the forced swimming test (FST) and tail suspension test (TST) were performed to evaluate the depressive-like behavior of mice, and the protein expression levels of different subtypes of GABAAR in the hippocampus of mice were determined by Western blot.SPSS 19.0 and GraphPad Prism 8.0 software were used for data statistical analysis and mapping.One-way ANOVA was used for comparison among groups, and Tukey-HSD test was used for further pairwise comparison.Results:(1) In the behavioral tests, there were significant differences in swimming immobility time of FST and tail suspension immobility time of TST among the five groups ( F=21.59, 20.81, both P<0.05). The swimming immobility time ((143.91±9.97) s) and tail suspension immobility time (( 107.00±6.54) s) in Model group were higher than those in Control group ((52.92±6.70) s, ( 43.50±5.96) s, both P<0.05). There were no significant difference in swimming immobility time and tail suspension immobility time between Model+ HSYA group ((26.17±7.69)s, ( 20.17±7.89)s) and Model+ fluoxetine group ((61.60±16.22)s, (34.14±10.74)s)(both P>0.05), but the swimming immobility time and tail suspension immobility time in these two groups were lower than those in Model group (both P<0.05). (2) The Western blot results showed that there were significant differences in the expression of GABAARβ1 and GABAARβ2 protein in hippocampus among the four groups ( F=12.21, 11.40, both P<0.05). The expression levels of GABAARβ1(45.60±10.76) and GABAARβ2 (46.27±4.82) protein in hippocampus of Model group were lower than those in Control group ((100.00±3.44), (100.00±3.26), both P<0.05). Compared to Model group, the expression of GABAARβ1 (79.91±5.00) and GABAARβ2 (79.08±5.53) protein in hippocampus of Model+ HSYA group were higher (both P<0.05). In addition, the expression of GABAARα1 and GABAARγ1 proteins in hippocampus were not significantly different among the four groups( F=0.23, 0.10, both P>0.05). Conclusion:HSYA can effectively alleviate depressive-like behavior in depression model mice, which may be related with the upregulation of GABAARβ1 and GABAARβ2 of hippocampus tissue.

目的 探究胃癌根治术患者外周血中性粒细胞淋巴细胞比值(NLR)、癌胚抗原(CEA)、D-二聚体水平在预后评估中的价值.方法 回顾性分析66例胃癌根治术患者的临床资料,对全体研究对象进行为期1年的随访并评估其预后.通过调取医院信息系统(Hospital information system)收集患者住院期间外周血NLR、CEA以及D-二聚体数据,分别采用单因素回归分析以及Logistic多因素回归分析探究其与研究对象胃癌根治术后预后的相关性.结果 预后不良组与预后良好组患者在NLR>4、CEA>6 U/mL、D-二聚体呈升高趋势方面具有显著差异(P<0.05);Logistic多因素回归分析结果显示,NLR>4以及CEA>6 U/mL是胃癌根治术预后不良的独立危险因素(P<0.05).结论 胃癌患者NLR、CEA以及D-二聚体水平与胃癌根治术预后均存在关联,其中NLR>4及CEA>6 U/mL可视为影响胃癌根治术预后的独立危险因素.

Depression is a common mental illness in the elderly, which is associated with compromised quality of life, disability, suicide risk and mortality.Drug treatment of late-life depression has large adverse reactions and is prone to drug resistance.Therefore, non-pharmacological interventions have gradually become a research hotspot.This paper reviewed the research progress of non-pharmacological interventions of late-life depression at home and abroad in recent years, and provides a theoretical basis for further research on effective treatment of late-life depression.

目的 探讨人文关怀式健康教育对甲状腺癌手术患者负性情绪及自我效能的影响.方法 采用随机数字表法将接受甲状腺癌手术治疗的102例甲状腺癌患者分为对照组(n=51)和研究组(n=51).对照组给予常规健康教育,研究组在此基础上给予人文关怀式健康教育.对比干预前后两组患者负性情绪、自我效能、应对方式、生活质量以及满意度.结果 干预后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均降低,且研究组患者SAS、SDS评分均低于对照组,差异均有统计学意义(P﹤0.05).干预后,两组患者一般自我效能感量表(GSES)、健康调查简表(SF-36)评分均升高,且研究组患者GSES、SF-36评分均高于对照组,差异均有统计学意义(P﹤0.05).干预后,两组患者积极应对评分均升高,消极应对评分均降低,且研究组患者积极应对评分高于对照组,消极应对评分低于对照组,差异均有统计学意义(P﹤0.05).研究组患者总满意度高于对照组,差异有统计学意义(P﹤0.05).结论 人文关怀式健康教育对甲状腺癌手术患者的临床干预效果显著,能够明显减轻患者负性情绪,提高患者自我效能和生活质量,并有助于患者采取积极的应对方式,患者满意度较高.

Objective:To investigate the effect of recombinant human growth hormone on the outcome of in vitro fertilization-embryo transfer (IVF-ET) in patients with low ovarian reserve function at different ages.Methods:A total of 90 patients with low ovarian reserve function who underwent IVF-ET treatment in Luoyang Central Hospital from January 2017 to December 2019 were selected. All of them received conventional long-acting down-regulation of gonadotropin-releasing hormone agonists, and were treated with recombinant human growth hormone, and they were set as the research group. Another 90 patients with low ovarian reserve function who were treated with conventional long-acting down-regulation therapy alone during the same period were selected as the control group. The general information, laboratory test results and pregnancy outcomes of the two groups were analyzed, and the clinical effects of recombinant human growth hormone on patients with low ovarian reserve function at different ages were summarized.Results:There was no significant difference in infertility duration, basal follicle stimulating hormone, and antral follicle count among patients of different ages between the two groups ( P>0.05). For patients < 35 years old, the use time of gonadotropin (Gn) and the total amount of Gn in the study group were slightly lower than those in the control group, and the number of oocytes retrieved was slightly higher than that in the control group, but the difference was not statistically significant ( P>0.05). For patients ≥35 years old, the Gn usage time and Gn total amount in the study group were lower than those in the control group, while the estradiol (E2) on the day of human chorionic gonadotropin (HCG) injection and the number of oocytes retrieved in the study group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The implantation rate and pregnancy rate of patients of different ages in the study group were slightly higher than those in the control group, but the difference was not statistically significant ( P>0.05). Conclusions:The low ovarian reserve function gradually worsens with the increase of age of patients. The use of recombinant human growth hormone in patients ≥35 years old has a certain impact on IVF-ET treatment. It can improve ovarian responsiveness, increase E2 level on the day of HCG injection, and increase the number of oocytes retrieved.

目的 探讨重症肺炎支原体肺炎(SMPP)患儿血清肝细胞生长因子(HGF)、前清蛋白(PAB)水平与病情危重程度和预后的关系.方法 选取102例SMPP患儿,根据简化小儿危重病例评分法将其分为非危重组(n=35)、危重组(n=31)、极危重组(n=36),根据治疗28 d后的预后将其分为预后不良组(n=26)和预后良好组(n=76).收集所有患儿的临床资料和实验室指标.比较不同病情危重程度SMPP患儿血清HGF、PAB水平,使用多因素logistic回归分析法分析SMPP患儿预后不良的影响因素,使用受试者操作特征(ROC)曲线评价血清HGF、PAB水平对SMPP患儿预后不良的预测价值.结果 非危重组、危重组、极危重组血清HGF水平依次升高,血清PAB水平依次降低(均P＜0.05).多因素logistic回归分析结果显示,血清HGF水平升高为SMPP患儿预后不良的独立危险因素,血清PAB水平升高为独立保护因素(均P＜0.05).ROC曲线显示,血清HGF、PAB水平联合预测SMPP患儿预后不良的曲线下面积大于二指标单独预测(均P＜0.05).结论 血清HGF、PAB水平与SMPP患儿病情危重程度和预后相关,可能成为SMPP患儿预后的预测指标.

目的:分析360度评价方法在我国住院医师规范化培训工作中的应用.方法:检索中国知网中文期刊全文数据库、万方数据库、维普期刊全文数据库自建库起至2020年3月31日收录的有关住院医师规范化培训360度评价的文献,阅读分析并总结.结果:入选的38篇文献来自22个地区的32家医院.文献通过采用调查数据分析、对照分析或论述的方式对360度评价体系进行探讨分析,研究一致认为360度评价在住院医师规范化培训中的应用效果显著,可明显提升培训学员的临床职业素养及满意度.结论:360度评价是提高住院医师规范化培训教学质量的重要方法,值得推行.

目的 研究非对称回波的最小二乘估算法迭代水脂分离(IDEAL-IQ)技术在进行性肌营养不良诊断及分级中的意义.方法 收集18例确诊为进行性肌营养不良患者的影像及临床资料,对下肢肌肉脂肪浸润及水肿程度进行分级;在IDEAL-IQ序列上分别在相应肌肉上测量脂肪分数(FF)和R2?值;采用单因素方差分析,利用受试者工作特征(ROC)曲线判断脂肪分级及水肿分级的相应诊断临界值.结果 不同脂肪分级其FF不同,随分级增加,FF呈增加趋势(F=449.118,P=0.001).各级别诊断分界值分别为0级<7.75％;1级7.75％～20.35％;2级20.35％～36.5％;3级≥36.5％;不同水肿分级其R2?值不同,随分级增加,R2?值呈下降趋势(F=63.424,P=0.001),各级别诊断分界值分别为0级≥40.65 Hz,1级35.5～40.65 Hz,2级30.4～35.5 Hz,3级<30.4 Hz.结论 IDEAL-IQ技术可以以定量优势协助进行性肌营养不良的诊断,随脂肪分级的增加FF呈增长趋势,随水肿分级的增加R2?值呈下降趋势.

The asymmetric carbenoid C-H insertion of 3-diazooxindoles into 1,4-cyclohexadiene has been accomplished in the presence of chiral bis(imidazoline) NCN pincer iridium(III) complexes as the catalysts. With a catalyst loading of 0.5 mol%, the reactions proceeded smoothly at 0 degrees C to afford a variety of chiral 3-substituted oxindoles in good yields with moderate to excellent enantioselectivities (up to 99% ee). The protocol exhibits good functional group tolerance with respect to 3-diazooxindoles and is readily scaled up to 2 mmol scale without any loss in activity and enantioselectivity. Density functional theory (DFT) calculations have been performed to better understand the reaction mechanism and to explain the stereochemical outcome of the reactions. (C) 2021 Published by Elsevier B.V. on behalf of Chinese Chemical Society and Institute of Materia Medica, Chinese Academy of Medical Sciences.

女性家庭决策赋权程度作为家庭集体决策的重要部分在农户家庭决策中扮演着十分重要的角色.本文运用2014-2016年中国家庭追踪调查(CFPS)微观农户数据,通过构建Probit模型和Tobit模型分析了女性家庭决策赋权程度对农户创业行为的影响及异质性,并探究了家庭融资在其中的中介传导作用.结果表明:(1)女性家庭决策赋权程度对农户的创业行为具有一定的抑制作用.稳健性检验和内生性问题处理后,结果依然显著.(2)中介效应检验表明,家庭融资在女性家庭决策赋权程度影响农户创业行为的过程中存在显著的中介作用.(3)异质性分析结果表明,女性家庭决策赋权程度对受教育水平较低的女性及中东部地区农户家庭的创业行为具有更明显的负向影响.最后,提出加快发展普惠金融提高农户的金融可得性、多措并举提升农村女性的人力资本水平、创业培训及政策的推广与宣传要多向女性决策人倾斜等相关对策建议.

基于不同的粮食功能区,分别运用超效率DEA模型和Malmquist指数法对2001—2019年中国三大粮食功能区的农业科技创新效率及其变化进行测度和比较.结果表明:2001—2019年3个区域的农业科技创新效率均呈现波动上升的趋势;各粮食功能区之间农业科技创新效率差异明显,由低到高依次为主产区、产销平衡区和主销区;粮食主产区规模效率优势明显,主销区技术进步优势较强,而产销平衡区各分解因素的波动幅度最大.最后,从宏观统筹和优化各粮食功能区农业科技创新要素配置、合理推进各粮食功能区农业科技创新、提高农业科技创新效率的视角提出了对策建议.

Objective:To explore the application effect of empowering psychological nursing intervention on young patients with breast cancer and their spouses.Methods:Using the convenient sampling method, a total of 240 breast cancer patients and their spouses in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2020 were selected as the research objects. According to the random number table method, they were divided into the observation group and the control group, with 120 cases in each group. The observation group was given empowering psychological nursing intervention, while the control group was given routine psychological nursing intervention. The psychological stress response and negative emotion of the patients and their spouses in two groups before and after intervention were compared.Results:Before intervention, there were no statistically significant differences in scores of Resilience Scale for Adults (RSA) , Symptom Check List 90 (SCL-90) , Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) of patients and their spouses between the two groups ( P>0.05) . After the intervention, the RSA scores of patients and their spouses in the observation group were higher than those in the control group, and the scores of SCL-90, BAI and BDI were lower than those in the control group, and the differences were all statistically significant ( P<0.05) . Conclusions:Empowering psychological nursing intervention can effectively relieve psychological stress reaction and alleviate negative emotions of young patients with breast cancer and their spouses.

目的 分析重症手足口病患儿外周血T淋巴细胞亚群、NK细胞及细胞因子水平变化及临床指导意义.方法 分析2018年1月—2020年4月在我院诊治的97例手足口病患儿资料,按病情分为重症组(25例),轻症组(72例);纳入同期50例健康体检儿童为对照组.检测T淋巴细胞亚群(CD3+T细胞、CD4+T细胞、CD8+T细胞)、NK细胞及细胞因子(TNF-α、IL-23、IL-22、IL-17)水平.对比上述指标在对照组、轻症组、重症组之间,重症组不同感染类型(Cox A16型、EV 71型、其他型)组间,重症组急性期组与恢复期组间及重症组预后不良组和预后良好组间的差异.分析4项细胞因子预测患儿预后的效能.结果 CD3+T细胞、CD4+T细胞、NK细胞水平从高到低均依次为对照组、轻症组、重症组,CD8+T细胞水平从低到高依次为对照组、轻症组、重症组;血清TNF-α、IL-23、IL-22、IL-17水平从低到高均依次为对照组、轻症组、重症组.组间上述指标比较差异均具有统计学意义(P均<0.05).重症组不同感染类型组间T淋巴细胞亚群、NK细胞和细胞因子水平比较,差异均无统计学意义(P均>0.05).与恢复期组相比,急性期组CD3+T细胞、CD4+T细胞、NK细胞水平更低,CD8+T细胞、TNF-α、IL-23、IL-22、IL-17水平更高,差异均具有统计学意义(P均<0.05).与预后良好组相比,预后不良组CD3+T细胞、CD4+T细胞、NK细胞水平更低,CD8+T细胞、TNF-α、IL-23、IL-22、IL-17水平更高,差异均具有统计学意义(P均<0.05).4项细胞因子联合预测不良预后敏感度为83.33％,准确度为71.43％.结论 检测外周血T淋巴细胞亚群、NK细胞和细胞因子水平有助于手足口病病情判断,可对重症手足口病患儿进行预后预测.

目的:研究医学模拟教学在产科住院医师临床技能操作培训中应用的意义.方法:将2015年参加培训的34名妇产科住院医师随机分成实验组(n=17)和对照组(n=17),探讨模拟教学和传统教学两种方式在两组住院医师操作培训中有无差异.结果:经模拟教学方式培养的住院医师其临床技能操作能力及规范性明显优于经理论指导直接在患者身上进行临床操作的住院医师.结论:医学模拟教学对提高住院医师临床技能操作能力有着重要的意义,通过模拟强化训练使住院医师能够更加自信、更加规范地进行临床操作.

目的:探讨分析以问题为导向的管理模式对体检中心护理质量的影响.方法:随机选取2018年2月～2019年2月到我院体检中心的50例体检者为研究对象,分析并观察该50例体检者以问题为导向管理模式对医护人员的礼仪、沟通能力、服务、健康教育和满意度进行评估.结果:体检后接受以问题为导向模式后医护人员的礼仪、沟通能力、服务、健康教育和满意度明显高于未接受前(P＜0.05).结论:以问题为导向的管理模式应用在体检中心具有好的效果,并且能够提高工作效率和渐渐体检者的依从性,值得推广.

Objective:To report the diagnosis, treatment, and follow-up of a 21-hydroxylase deficiency boy with central precocious puberty caused by complex heterozygous mutation of CYP21A2 gene.Methods:The child was symptomatic of rapid growth and secondary sexual characteristics at the age of 6. The diagnosis of central precocious puberty was confirmed by serum testosterone, gonadotropin levels, and gonadotropin-releasing hormone (GnRH) stimulation test. 21-hydroxylase deficiency was diagnosed clinically based on the serum adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone levels, and images on the computed comography (CT) of the adrenal glands.Results:The CYP21A2 gene was detected to have a compound heterozygous mutation by Sanger sequencing and multiplex ligation-dependent probe amplification. During the 3 years follow-up, the effects of glucocorticoids, GnRH analogs, and recombinant human growth hormone were regularly monitored and evaluated.Conclusions:Glucocorticoid replacement followed the principle of the lowest effective dose. GnRH analogs showed an effective inhibition of the hypothalamus-pituitary-gonadal axis, while recombinant human growth hormone had no such growth-promoting effect.

目的 探讨不同降调节方案对子宫内膜异位症(EM S)患者的妊娠结局及新生儿结局的影响.方法 回顾性分析2009年1月至2019年12月在我院生殖中心行长/短效促性腺激素释放激素激动剂(GnRH-a)降调节方案促排卵后首次鲜胚移植或冻融胚胎移植(FET)的1805例EMS患者的临床资料,按降调节方案不同分为长效组(n=1499)和短效组(n=306),再根据移植周期的不同分为A组(长效方案所获胚胎新鲜移植周期,n=1394)、B组(长效方案所获胚胎FET周期,n=105)、C组(短效方案所获胚胎新鲜移植周期,n=274)、D组(短效方案所获胚胎FET周期,n=32).比较A、B、C、D组间的临床妊娠率、活产率和单胎活产儿的出生体重、孕周、大于胎龄儿(LGA)发生率、小于胎龄儿(SGA)发生率和巨大儿发生率等临床结局.分析降调节方案和移植周期对上述结局变量的影响.结果 长效组内,A组的活产率、新生儿的出生体重显著低于B组(P<0.05),孕周显著短于B组(P<0.05).短效组内,C组的活产率、LGA发生率显著低于D组(P<0.05).新鲜移植周期相比,A组的临床妊娠率、活产率显著高于C组(P<0.05),巨大儿发生率显著低于C组(P<0.05).FET周期相比,B组的LGA发生率显著低于D组(P<0.05).多因素Logistic回归分析显示:与短效组相比,长效组临床妊娠率高、活产率高、LGA发生率低、巨大儿发生率低(a P<0.05);与FET周期相比,新鲜周期的LGA发生率和巨大儿发生率均显著降低(a P<0.05),而临床妊娠率和活产率无显著差异(aP>0.05).结论 长效GnRH-a降调节方案有利于EMS患者在新鲜移植周期中获得较高的活产率和较低的巨大儿发生率.

目的 探讨血清趋化因子8(CXCL8)、白三烯(LTB4)及S-100β在肠道病毒71型(EV71)感染引起的手足口病中的应用价值.方法 选取2017年1月 ～2019年6月在笔者医院治疗的EV71感染手足口病患儿148例(观察组),其中轻症患儿56例,重症患儿67例,危重症患儿25例,同时选取健康儿童60例作为对照组,检测血清CXCL8、LTB4及S-100β水平.结果 观察组血清CXCL8、LTB4及S-100β 分别为5102.02±872.21pg/ml、45.51±10.22ng/L和4.89±1.01mg/L,明显高于对照组(P<0.05).危重症患儿血清CXCL8、LTB4及S-100β分别为6557.13±780.11pg/ml、61.34±11.30ng/L和7.93±1.44mg/L,明显高于轻症和重症患儿(P<0.05).重症患儿血清CXCL8、LTB4及S-100β 分别为5120.63±810.05pg/ml、48.89±10.32ng/L和5.01±1.02mg/L,明显高于轻症患儿(P<0.05).重症预后不良患儿血清CXCL8、LTB4及S-100β 分别为5791.36± 808.25pg/ml、49.38±8.74ng/L和5.71±0.94mg/L,明显高于预后良好患儿(P<0.05).危重症预后不良患儿血清CXCL8、LTB4及S-100β分别为6758.47±812.87pg/ml、68.37±9.46ng/L和8.49±1.08mg/L,明显高于预后良好患儿(P<0.05).血清CXCL8和S-100β预测患儿预后不良的ROC曲线下面积分别为0.860和0.730(P<0.05).观察组恢复期血清CXCL8、LTB4及S-100β分别为2113.16±120.10pg/ml、28.10±5.55ng/L和1.39±0.44mg/L,明显低于治疗前(P<0.05).结论 EV71感染的手足口病患儿血清CXCL8、LTB4及S-100β水平升高,与患儿病情及预后有一定关系,其中CXCL8和S-100β 在预后预测中有一定价值.

本文基于河南、山东和陕西三个省份的实地调研数据,运用有序Logistic模型实证分析了农户特征、金融环境特征、政策认知和正规信贷约束类型等因素对农户参与农地抵押融资意愿的影响.研究表明:农户参与农地抵押融资意愿较高,且潜在需求大;但农户对农地抵押融资政策的认知水平普遍不高,受信贷约束的情况较为普遍.户主年龄、家庭常住人口、外出务工人数等因素对农户参与农地抵押融资意愿均有显著影响.了解农地抵押融资政策以及数量约束型信贷约束对农户参与农地抵押融资意愿有显著正向影响,所在地区开展了农地抵押贷款以及风险约束型信贷约束则对农户的参与意愿有显著负向影响.

目的:探讨鼠神经生长因子干预早产儿脑损伤的临床疗效及预后评估.方法:回顾性分析2016年1月—2018年12月某院儿科门诊就诊的98例早产儿脑损伤患儿的临床资料,随机分为干预组和对照组,每组49人,对照组进行常规治疗口服脑蛋白口服液+赖氨肌醇B12口服液,干预组给予鼠神经生长因子(mouse nerve growth factor,mNGF)18μg+生理盐水2 ml肌注,隔日1次,每个疗程1个月,连续治疗3个疗程,比较两组治疗后临床有效率及智力运动发育评估(Children,s De?velopment Center of China,CDCC)评分结果.结果:CDCC评分结果显示干预组总有效率为89.8％,高于对照组的73.5％,差异有统计学意义(χ2=4.356,P<0.05);疗程结束后CDCC评分结果比较,干预组仍高于对照组,差异有统计学意义(t值分别为10.927、4.309,P值均<0.05);随访至纠正胎龄1岁时CDCC评分比较,干预组亦高于对照组,差异有统计学意义(t值分别为10.013、3.238,P值均<0.05).结论:应用mNGF单药早期干预早产儿脑损伤,可加快患儿症状改善,促进神经功能恢复,疗效肯定,且经济方便,可减轻患者家属的经济负担,临床值得推广.