BackgroundGeneral practice teaching clinics play a crucial role in the training of general practitioners, as they are more likely to enhance reception skills compared to traditional training methods. The quality of teaching clinics is largely determined by the level of patient acceptance. In recent years, the Kano model has become increasingly popular in the healthcare industry and has been used to enhance patient satisfaction. The objective of this study is to apply the Kano model to investigate the needs of patients in general practice teaching clinics and to rank the significance of each demand. This study will serve as a reference for enhancing the service quality of teaching clinics and advancing the field of general practice.MethodsA total of 101 patients of general practice at the Affiliated Hospital of Yangzhou University in Jiangsu province were selected using a random convenience sampling method to participate in a questionnaire survey. The questionnaire was designed by members of our team and was based on the Kano model. The study defined the service demand, assessed the impact of both satisfaction and dissatisfaction and created a matrix bubble diagram.ResultsThe study findings revealed that out of the 14 items of the general practice teaching clinic service demands, 1 item was categorized as a must-be requirement, 4 items were categorized as one-dimensional requirements, 2 items were categorized as an attractive requirement, 2 items were categorized as an indifferent requirement, and 5 items were categorized as mixed attributes. The findings of the matrix analysis showed that 4 items were situated in the area of one-dimensional attributes quadrant, 3 items were situated in the area of attractive attributes quadrant, 5 items were situated in the area of indifferent attributes quadrant, and 2 items were situated in the area of must-be attributes quadrant.ConclusionThe patients of general practice have positive attitudes toward teaching clinics. The findings can offer valuable insights for enhancing the quality of service and patient experience in general practice teaching clinics as well as for advancing the field of general practice.

目的 观察住培"333"工程在全科住院医师规范化培训中的应用及效果.方法 选取 2020 年 10 月—2021年 10 月扬州大学附属医院 2017、2018 级参加住院医师规范化培训(简称"住培")全科医师作为研究对象,共 100 名.2017 级(n=50)采用传统教学方法,2018级(n=50)采用以分层递进、螺旋上升的培育体系,比较学员培训前后理论知识、临床思维能力、临床技能及对住培方法满意度的得分情况.结果 学员在培训前与培训第 1 年、培训第 1 年与第 2 年、培训第 2 年与第 3 年综合成绩差异有统计学意义(P＜0.001).2018 级学员在专业理论、实操能力、科研能力、自学能力、医患沟通能力、综合素质方面的教学满意度均高于2017级学员,差异有统计学意义(P＜0.001).结论 "333"工程在全科住院医师规范化培训中应用不仅可以提升学员的全科思维能力和临床技能水平,还可以培养学员的自主学习能力与人文关怀意识,是适合全科住培的临床教学方法.

目的 分析骨质疏松性椎体压缩骨折(OVCF)采用经皮椎体成形术(PVP)治疗后再发骨折的相关危险因素.方法 将296例采用PVP治疗的OVCF患者根据术后是否发生再骨折分成再骨折组(23例)和无再骨折组(273例).采用单因素与多因素logistic回归分析筛选PVP术后再发骨折的相关危险因素.结果 单因素分析结果显示:年龄、骨密度、初次骨折椎体数量、骨水泥渗漏与PVP术后再发骨折有明显相关(P<0.05);多因素分析结果显示:年龄>80岁、初次骨折椎体数量≥2个、骨质疏松、有骨水泥渗漏是再发骨折的危险因素.结论 OVCF患者行PVP术后再发骨折的危险因素包括年龄、初始骨折椎体数量、骨密度、骨水泥渗漏.

目的 分析心率变异性(HRV)参数对接受胰岛素治疗的2型糖尿病(T2DM)患者发生夜间无症状低血糖的预测价值.方法 选取2020年3月至2021年11月于扬州大学附属医院接受胰岛素治疗的T2DM患者207例.剔除夜间有症状低血糖患者19例,根据夜间低血糖发生情况将剩余患者分为夜间血糖正常组(137例)和夜间无症状低血糖组(51例).比较两组患者基线资料、生化指标、HRV参数〔低频功率归一化值(LFnu)、高频功率归一化值(HFnu)、低频功率(LF)/高频功率(HF)、正常R-R间期的标准差(SDNN)、SDNN中每5 min R-R间期平均值的标准差(SDANN)、相邻R-R间期之差的均方根(RMSSD)、相邻R-R间期差值>50 ms的个数占总R-R间期个数的百分比(PNN50)〕.采用多因素Logistic回归分析探讨接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的影响因素.采用ROC曲线分析HRV参数对接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的预测价值.结果 夜间无症状低血糖组患者空腹血糖、糖化血红蛋白低于夜间血糖正常组(P<0.05).夜间无症状低血糖组患者HFnu、SDANN、RMSSD、PNN50低于夜间血糖正常组,LF/HF高于夜间血糖正常组(P<0.05).多因素Logistic回归分析结果显示,HFnu、LF/HF、SDANN、RMSSD、PNN50是接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的影响因素(P<0.05).ROC曲线分析结果显示,HFnu、LF/HF、SDANN、RMSSD、PNN50预测接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的AUC分别为0.768〔95％CI(0.680,0.856)〕、0.776〔95％CI(0.693,0.859)〕、0.769〔95％CI(0.693,0.845)〕、0.767〔95％CI(0.698,0.836)〕、0.770〔95％CI(0.695,0.844)〕,最佳截断值分别为38.38 Hz、1.91、52.31 ms、22.23 ms、6.14 ms,灵敏度分别为81.80％、74.50％、74.50％、70.80％、73.70％;特异度分别为66.70％、72.30％、72.50％、72.50％、74.50％.HFnu、LF/HF、SDANN、RMSSD、PNN50联合预测接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的AUC为0.936〔95％CI(0.892,0.980)〕,灵敏度为70.60％,特异度为98.50％.HRV参数联合预测接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的AUC分别大于HFnu、LF/HF、SDANN、RMSSD、PNN50单独预测接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的AUC,差异有统计学意义(Z值分别为3.324、3.341、3.688、4.035、3.737,P值均<0.05).结论 HRV参数中的HFnu、LF/HF、SDANN、RMSSD、PNN50对接受胰岛素治疗的T2DM患者发生夜间无症状低血糖具有一定预测价值,而其联合预测的价值更高,其有望成为接受胰岛素治疗的T2DM患者发生夜间无症状低血糖的新型诊断标志物.

背景 通过构建列线图模型可直观、个体化地展示脑卒中患者创伤后应激障碍(PTSD)发生风险,这对改善脑卒中患者预后具有重要的临床意义.目的 分析脑卒中患者发生PTSD的影响因素,并构建其风险预测列线图模型.方法 选取2019年1月至2020年10月扬州大学附属医院急诊科收治的脑卒中患者308例为研究对象,根据患者是否发生PTSD将其分为PTSD组(n=62)和非PTSD组(n=246).采用研究小组自行设计的一般资料调查问卷收集患者的一般资料,脑卒中患者发生PTSD的影响因素分析采用多因素Logistic回归分析;使用R软件(R 3.6.3)rms程序包构建脑卒中患者发生PTSD风险预测列线图模型;采用Bootstrap法重复抽样100次对列线图模型进行内部验证,采用Hosmer-Lemeshow拟合优度检验和校准曲线评估其一致性;绘制ROC曲线以评估该列线图模型对脑卒中患者发生PTSD的预测价值.结果 308例患者中发生PTSD 62例,PTSD发生率为20.13％(62/308).PTSD组和非PTSD组患者文化程度、家庭功能、日常生活能力(ADL)、吞咽功能障碍情况及医保类型比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,文化程度为大专及以上是脑卒中患者发生PTSD的保护因素,内向人格、ADL重度障碍、吞咽功能障碍是脑卒中患者发生PTSD的危险因素(P<0.05).基于上述影响因素构建脑卒中患者发生PTSD风险预测列线图模型,内部验证结果显示,该列线图模型的校准曲线趋近于理想曲线,该列线图模型的预测值与实际值比较,差异无统计学意义(P<0.05);ROC曲线分析结果显示,该列线图模型预测脑卒中患者发生PTSD的ROC曲线下面积为0.815〔95％CI(0.765,0.864)〕.结论 文化程度为大专及以上是脑卒中患者发生PTSD的保护因素,内向人格、ADL重度障碍、吞咽功能障碍是脑卒中患者发生PTSD的危险因素;基于上述影响因素构建的脑卒中患者发生PTSD风险预测列线图模型具有良好的一致性与区分度,可以辅助临床医护人员筛选PTSD高风险的脑卒中患者.

目的 探究血清白蛋白水平与老年冠心病患者经皮冠状动脉介入治疗(PCI)术后心源性死亡之间的关系.方法 回顾性分析500例老年冠心病患者的临床资料,所有患者均行PCI,于术后对患者进行随访,对患者一般资料行单因素分析,再经多因素Logistic回归分析老年冠心病患者PCI术后心源性死亡的影响因素,分析血清白蛋白水平与PCI术后心源性死亡之间的关系.结果 研究中500例患者PCI术后均持续接受随访,中位随访时间为12.5个月,未出现失访患者.随访期间,共有35例患者心源性死亡,死亡率为7.00％,将其归为心源性死亡组,存活的465例患者归为存活组,存活率为93.00％.心源性死亡组与存活组患者性别、饮酒史、高血压史、糖尿病史、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)、甘油三酯(TG)比较,差异无统计学意义(P>0.05);心源性死亡组与存活组患者年龄、吸烟史、心率、高密度脂蛋白胆固醇(HDL-C)、白蛋白水平比较,差异有统计学意义(P<0.05).多因素Logistic回归模型显示,影响老年冠心病患者PCI术后心源性死亡的危险因素包括年龄、吸烟史、白蛋白水平(P<0.05).结论 血清白蛋白水平是影响老年冠心病患者PCI术后心源性死亡的一个重要危险因素,早期纠正血清白蛋白水平利于改善预后.

OBJECTIVE:To explore the efficacy of Internet-based chronic disease management model combined with the modified therapy of Bushenyiliu decoction in treating patients with type 2 diabetes mellitus (T2DM) and prostate cancer and its effect on disease control rate (DCR).METHODS:120 patients with T2DM and prostate cancer admitted to the Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, from February 2019 to February 2020, were retrospectively analyzed and equally divided into the experimental group and the control group according to their admission order. Conventional treatment combined with the modified therapy of Bushenyiliu decoction was performed on all patients for 3 months, and the Internet-based chronic disease management model was adopted for patients in the experimental group additionally, so as to compare their short-term effect, survival time, disease progression, blood glucose indicators, immune function indicators, and type 2 Diabetes Self-Care Scale (2-DSCS) scores.RESULTS:Compared with the control group, the experimental group obtained significantly higher DCR and objective remission rate (ORR) (P < 0.05), higher survival time and disease progression (P < 0.001), better blood glucose indicators and immune function indicators (P < 0.001), and higher 2-DSCS scores (P < 0.001) after treatment.CONCLUSION:Combining the Internet-based chronic disease management model with the modified therapy of Bushenyiliu decoction can effectively enhance the self-care ability of patients with T2DM and prostate cancer, improve their blood glucose level, promote their body immunity, and comprehensively optimize the cancer control effect, which should be promoted in practice.

目的 探讨miR-25 调控SERCA2a抗心肌缺血再灌注损伤的作用机制.方法 在H9c2 细胞系中转染miR-25 的mimic及inhibitor,运用Real-Time PCR、Western Blotting检测miR-25 和SERCA2a的变化趋势及细胞凋亡相关蛋白caspase-3 的表达水平,通过JC-1 线粒体膜电位测定、Annexin V APC／7AAD检测细胞凋亡情况,再通过双荧光素酶报告基因验证miR-25 与SERCA2a的靶向关系.结果 与I／R组相比,miR-25minic+I／R组中细胞活力明显下降,线粒体膜电位变化显著,凋亡明显增多,同时SERCA2a蛋白表达下调、Caspase-3蛋白表达上调(n＝6,P＜0.01);而在下调miR-25 的I／R组中凋亡蛋白Caspase-3较前减少,SERCA2a活性表达上调(n＝6,P＜0.01 ),流式细胞提示细胞凋亡减少(P＜0.01 ).双荧光素报告基因显示,转染miR-25mimic可以抑制SERCA2a报告基因的荧光素酶活性(P＜0.01 ).结论 miR-25 表达下调对抗H9c2心肌细胞系缺血再灌注损伤,其作用机制可能与靶向调控SERCA2a表达有关.

目的 探究小剂量阿仑膦酸钠治疗骨质疏松症患者中的安全性以及依从性效果.方法 研究时段2016年2月到2019年2月,以60例作为研究对象,采取随机分组法将60例骨质疏松症患者分成对照组、观察组,一组30例.对照组给予常规剂量阿仑膦酸钠进行治疗,观察组给予小剂量阿仑膦酸钠治疗,对比2组患者临床疗效、药物不良反应发生率、患者用药依从率.结果 观察组患者服用药物后临床疗效与对照组比较并无统计学意义:P>0.05;观察组药物不良反应发生率低于对照组,患者用药依从率高于对照组,组间数据对比:P<0.05.结论 对骨质疏松症患者采取小剂量阿仑膦酸钠治疗不仅能够保证治疗效果,同时还能够有效降低患者不良反应发生,提升患者用药依从性,对患者预后康复具有积极意义,值得推荐.

目的 探讨慢性阻塞性肺疾病急性加重期因呼吸衰竭入住ICU行有创机械通气治疗患者的预后影响因素.方法 纳入2013年2月至2019年5月扬州大学附属医院收治的因慢性阻塞性肺疾病急性加重导致呼吸衰竭入住ICU行有创机械通气治疗的患者167例,根据预后情况分为存活组和死亡组.比较两组患者的临床特点,探索影响预后的危险因素.将单因素分析差异有显著性的指标进行多因素logistic逐步回归分析,确定独立危险因素,通过受试者工作特征曲线确定连续性独立危险因素的最佳截断值.根据各个危险因素最佳预测值分组,并通过绘制Kaplan-Meier曲线观察危险因素对患者长期预后的影响,Log-rank检验分析生存曲线差异是否有显著性.结果 单因素分析显示,两组中性粒细胞/淋巴细胞比值(Z=-2.233,P=0.020)、血小板/淋巴细胞比值(Z=-1.987,P=0.047)、D-二聚体(Z=-2.989,P=0.003)差异有显著性.多因素分析显示,中性粒细胞/淋巴细胞比值(OR=1.029,P=0.008),D-二聚体(OR=1.212,P=0.027)为影响患者预后独立危险因素.中性粒细胞/淋巴细胞比值、D-二聚体预测死亡的最佳预测值分别为5.550、1.175mg/L.Log-rank检验显示,中性粒细胞/淋巴细胞比值(χ2=8.511,P=0.004)对患者长期生存有预测价值.结论 入住ICU 24h内中性粒细胞/淋巴细胞比值及D-二聚体是慢性阻塞性肺疾病急性加重期行机械通气患者ICU住院死亡的独立危险因素,而中性粒细胞/淋巴细胞比值对患者长期生存具有预测价值.

PURPOSE:Most lung adenocarcinoma (LUAD) patients are diagnosed at the advanced stage and have poor prognosis. DNA methylation plays an important role in the prognosis prediction of cancers. The objective of this study was to identify new DNA methylation sites as biomarkers for LUAD prognosis.MATERIALS AND METHODS:We downloaded DNA methylation data from The Cancer Genome Atlas data portal. Cox proportional hazard regression model and random survival forest algorithm were applied to identify the DNA-methylation sites. Methylation of sites were validated in the Gene Expression Omnibus cohorts. Function annotation were done to explore the biological function of DNA methylated sites signature.RESULTS:Six DNA methylation sites were identified as prognosis signature. The signature yielded acceptable discrimination between the high-risk group and low-risk group. The discrimination effect of this DNA methylation signature for the OS was obvious, with a median OS of 21.89 months vs. 17.74 months for high-risk vs. low-risk groups. This prognostic prediction model was validated by the test group and GEO dataset. The predictive survival value was higher for the prognostic prediction model than that for the tumor node metastasis stage. Adjuvant hemotherapy could not affect the prediction of the signature. Functional analysis indicated that these signature genes were involved in protein binding and cytoplasm.CONCLUSION:We identified the prognostic signature for LUAD by combining six DNA methylation sites. This could service as potential robust and specificity signature in the prognosis prediction of LUAD.

目的 观察肥胖与非肥胖2型糖尿病患者血清几丁质酶-3样蛋白-1(YKL-40)水平差异及与胰岛素抵抗的相关性.方法 回顾性分析扬州大学附属医院2016年10月 ～2018年11月就诊的286例2型糖尿病患者的临床资料.按体质量指数(BMI)的不同分为2组,肥胖组患者144例(BMI≥28 kg/m2);非肥胖组患者142例(BMI 18.5～23.0 kg/m2),其中非肥胖组患者为经本院互联网慢病管理后减重为标准体质量的2型糖尿病患者.比较各组患者的血清YKL-40水平的差异,观察其与胰岛素抵抗指数(HOMA-IR)及其他相关指标的相关性.结果 肥胖组的YKL-40、糖化血红蛋白、HOMA-IR指数及脂肪细胞脂肪酸结合蛋白(A-FABP)明显高于非肥胖组(P<0.05).Pearson直线相关分析显示,BMI、腰围、HOMA-IR及A-FABP和血清YKL-40水平呈正相关关系(r=0.504,0.589,0.320,0.389,P<0.05).多重线性回归分析结果显示,在调整了相关变量因素后,BMI、腰围、HOMA-IR、A-FABP是影响血清YKL-40水平的独立相关因素(P<0.05).结论 与非肥胖2型糖尿病患者相比,肥胖糖尿病患者具有较高的血清YKL-40水平,而YKL-40水平也与胰岛素抵抗密切相关.

随着现代社会医疗水平地提高,医疗设备也在不断更新换代,医疗信息改革更是在稳步推进当中.居民生活水平日益提升的同时,传统的健康服务体系已经跟不上时代的发展需求,有限的医疗资源使得"看病难"的现状依旧存在,特别是对于慢性病患者而言,他们中的绝大多数都不需要进行住院治疗,只需要定期进行健康的指标检测,但传统的健康医疗服务体系不能提供个性化、长期性等便于检测的健康医疗服务内容,使其难以满足患者的日常生活需求.互联网的发展打破了时空的限制,能够建立起大数据平台,实现人与数据资源的无缝衔接,本文就基于互联网平台,探索区域医疗卫生服务共同体分级诊疗创新模式下,如何建立慢性病管理和双向转诊的数据共享机制.

目的 探讨分析糖尿病慢病管理模式对患者血糖及依从性的影响.方法 将至我院接受干预治疗且自愿参与本次研究的86例糖尿病患者作为研究主体,入选患者均接受慢病管理模式干预,观察对比干预前后患者血糖指标变化及治疗依从性变化情况.结果 干预后患者的空腹血糖、餐后2小时血糖及治疗依从性各指标均显著优于干预前,两组数据间对比差异性显著(p<0.05).结论 为糖尿病患者开展慢病管理模式干预对患者血糖的控制有积极的意义,同时提升患者的治疗依从性,可进一步推广.

近年来我国心脏性猝死的年发生率为41．81／10万，每年超50万人死于心脏猝死，居全球之首。而我国心脏性猝死的抢救成功率极低，尚不足1％［1］。比较急救经验丰富的美国，在过去的30年里，我国院外心脏骤停的生存率一直维持在9．6％左右［2］，如果现场自主循环没有恢复的话，其存活率只有0．9％［3］。而美国心肺复苏数据库的相关资料显示院内心脏骤停其存活率约18％［4］。说明我国心脏骤停抢救成功率较低且院外与院内急救抢救成功率存在较大差异。随着综合医院就诊人数不断攀升，虽各医院制定了相应的危重病患者转运指南，但门急诊区域就诊过程中突发心脏骤停的事件时有发生。门急诊区域突发心脏骤停的抢救成功率应介于院前与病区之间，若流程合理，救治得当，充分利用院内医疗资源，其抢救成功率将大大提高，能为更多的患者提供生存机会。现就门急诊区域心脏骤停的特点及救治基础总结如下。

The paraquat can invade human tissue through skin, respiratory tract and alimentary canal so as to cause acute poisoning including lung injury. The lung injury manifests mainly as follows: alveolar epithelial cell damage, alveolar hemorrhage edema and inflammatory cell infiltration in early injury, alveolar partial or complete dissolution and pulmonary interstitial fibrosis lately. There is no effective antidote for paraquat, therefore, the mortality of paraquat is very high. Recently, more and more researches indicated that cytokines played important roles in this process. This article reviews the interaction mechanisms of cytokines in the process of lung injury induced by paraquat and summarized current researches so as to provide references in investigating new treatments and antidotes.

Objective To investigate the risk factors of pulmonary infection secondary to organophos-phate poisoning with respiratory failure.Methods A retrospective analysis of clinical data of 250 patients of organophosphate poisoning with respiratory failure from Yangzhou City First People′s Hospital from Jan.2005 to Jan.2015 was done,and the pulmonary infection situation and related risk factors were analyzed .Results Among the 250 patients of organophosphate poisoning with respiratory failure patients,170 cases had pulmonaryinfection,making an rate of 68.0%.The pulmonary aspiration,ventilator,admission to intensive careunit time,hand hygiene,cholinesterase activity and high sensitivity C-reactive protein of pulmonary infectedpatients and non-infected patients had statistically significant differences(P <0.05).The combined aspiration,ventilator use,hand hygiene and cholinesterase activity were risk factors for lung infection secondary toorganophosphate poisoning with respiratory failure(P <0.05).Conclusion The combined aspiration andhand hygiene and respiratory machine and cholinergic activity reduction are all risk factors of pulmonaryinfection secondary to organophosphate poisoning with respiratory failure,and due attention should be paid inclinical,and control measures should be developed according to the risk factors to reduce lung infection.

[Objective]To explore the negative emotion of patients with non-organic dyspnea and its influential fac-tors.[Methods]Totally 80 patients with non-organic dyspnea in emergence department of our hospital from May 2011 to May 2015 were selected.Zung self-rating depression scale(SDS)and self-rating anxiety scale(SAS)were used to evaluate the anxiety and depression of patients.According to the anxiety and depression status,all patients were divided into anxie-ty group,non-anxiety group,depression group and non-depression group.The relationship of the factors with anxiety and depression emotion was analyzed.[Results]There were 26 patients(32.50%)with anxiety,20 patients(25.00%)with depression and 6 patients(7.50%)with anxiety and depression in 80 patients.There were significant differences in gender, education level,insomnia and accompanying depression between anxiety group and non-anxiety group(P <0.05).There was significant difference in education level,insomnia and accompanying depression between depression group and non-de-pression group(P <0.05).Logistic regression analysis showed that the gender,education level,insomnia and accompan-ying depression were independent risk factors of the anxiety in patients with non-organic dyspnea,and education level,in-somnia and accompanying depression were independent risk factors of depression in patients with non-organic dyspnea.[Conclusion]The anxiety and depression of patients with non-organic dyspnea are influenced by gender,education level and insomnia.Psychological measures for the treatment should be taken actively.