环境适老化是一个多维度、跨学科、系统化的概念,综合护理学、康复学、建筑学及社会学等多学科观点,需要环境与老年人能力相匹配,满足老年人个性化的生理、心理及社会需求,实现安全性、舒适性、便利性的目标.目前我国居家养老主要依靠人力提供服务,这种模式在未来养老服务需求持续上涨、劳动力人口减少的形势下将面临巨大挑战.通过环境的改造和辅具的配置可以代替一部分由服务者直接提供的服务,帮助老年人充分利用现有能力完成日常生活活动,并提高自尊和自主生活意愿,降低养老服务的风险,控制养老服务的成本,提升居家养老的品质.

随着我国老龄化程度逐渐加深,社会化养老服务需求不断增加.现阶段,很多大城市受限于公共物业资源有限、机构扩容基础缺乏,导致机构养老资源极度紧张.同时,社区居家养老服务能力有限,普遍存在服务形式片面,缺乏连续性和整合性,服务人员专业化程度低,服务质量不佳等问题,难以满足老年人对专业照护的需求.

目的 探讨老年人不明原因头晕与脑小血管病的关系.方法 回顾性分析2020-01—2022-01在郑州大学第二附属医院神经内科就诊的符合标准的132例老年头晕患者,分为头晕诊断不明确组、头晕诊断明确组.对比2组临床数据,并进行Logistic回归分析.结果 神经内科老年人头晕诊断明确组中,头晕病变部位以前庭中枢系统(短暂性脑缺血发作、脑梗死)居多.头晕发病形式以反复发作性头晕(短暂性脑缺血发作、良性阵发性位置性眩晕等)最多.头晕诊断不明确组症状表现为头晕,头晕诊断明确组中眩晕多见.头晕诊断不明确组中,高脑小血管病影像学总负荷、中重度脑白质高信号、脑小血管病高于头晕诊断明确组,高中性粒细胞/淋巴细胞比值低于诊断明确组.中重度脑白质高信号是不明原因头晕的危险因素.脑白质负荷越高,残障量表评分越高.结论 老年人头晕诊断不明确时,脑小血管病的中重度脑白质脱髓鞘可能导致头晕发生.

Objective:To investigate the value of peripheral blood procalcitonin (PCT), serum amyloid A (SAA) and neutrophil surface molecule CD64 (CD64) in the diagnosis of neonatal sepsis.Methods:One hundred and twenty neonatal sepsis cases admitted to Children’s Hospital Affiliated to Zhengzhou University from December 2020 to December 2021 were selected as the observation group, 120 non-infected neonates admitted during the same period were selected as the control group 1, and 120 healthy neonates received during the same period were selected as the control group 2. The levels of PCT, SAA, and CD64 in the peripheral blood of the newborns in the three groups were detected, while the observation group underwent blood culture, and the types of bacterial infection were summarized. The test results of the three groups were compared, the value of the three single diagnoses and combination of them were compared, and the test results of patients with different bacterial infections were compared.Results:The levels of PCT, SAA and CD64 in the observation group were significantly higher than those in the control group 1 and the control group 2, and the differences were significant ( P<0.05); and the levels of PCT, SAA and CD64 in the control group 1 were higher than those in the control group 2 ( P<0.05). The sensitivity, specificity and accuracy of combined detection were higher than those of PCT, SAA, and CD64 single diagnosis, and the differences were all statistically significant (all P<0.05). There was a significant difference in PCT and CD64 level between patients with gram-negative bacterial infection and with gram-positive bacterial infection, and the former was higher ( P<0.05), but there was no significant difference in SAA level between patients with gram-negative bacterial infection and with gram-positive bacterial infection ( P>0.05). Conclusions:Compared with non-infected neonates and healthy neonates, septic neonates have significantly increased levels of PCT, SAA, and CD64 in peripheral blood. The combined diagnosis of PCT, SAA, and CD64 can improve the diagnostic value, and can also identify the types of pathogenic bacteria, so as to provide a reliable basis for clinical diagnosis and treatment of neonatal sepsis.

教育数据共享是教育治理能力优化的重要途径,但其普遍面临数据存储分散、数据安全风险、流程烦琐、数据维度有限等问题,而新兴的区块链技术可以有效解决这些问题.本研究提出了一种基于区块链的教育数据共享方案,能够安全、公平、高效地实现教育数据共享,提升教育治理能力.

目的 探讨人巨细胞病毒(HCMV)感染患儿的实验室指标及细胞免疫功能特征.方法 选择郑州大学附属儿童医院2019年1月至2021年12月收治的197例HCMV感染患儿纳入病例组,选取同时期在郑州大学附属儿童医院体检的111例健康儿童纳入对照组.比较两组儿童外周血T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+;比较白细胞(WBC)、血小板(PLT)、C-反应蛋白(CRP)、血红蛋白(Hb)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(GGT)、肌酸激酶同工酶(CK-MB)水平.采用Pearson相关性分析患儿HCMV-DNA载量与外周血T淋巴细胞亚群之间的相关性.将母乳喂养患儿分为母乳HCMV DNA阳性组(50例)和阴性组(33例),比较两组患儿外周血T淋巴细胞亚群CD3+、CD4+、CD8+水平及CD4+/CD8+.结果 病例组AST、ALT、LDH、GGT、CK-MB、WBC、PLT、CRP、PCT、CD3+、CD4+、CD4+/CD8+水平低于对照组,但CD8+水平高于对照组(P<0.05).HCMV感染患儿HCMV-DNA载量与CD4+及CD4+/CD8+水平呈负相关,而与CD8+水平呈正相关(P<0.05).母乳HCMV-DNA阳性组与阴性组CD3+、CD4+、CD8+及CD4+/CD8+水平比较,差异无统计学意义(P>0.05).结论 HCMV感染的患儿的实验室指标异常,细胞免疫功能紊乱,HCMV-DNA载量与细胞免疫功能具有一定相关性.

目的 观察采用矫形器治疗下肢功能障碍患儿的康复效果.方法 选择2015年2月—2019年1月期间在该院接受康复治疗的78例下肢功能障碍患儿,随机将患儿分为观察组与对照组各39例,对照组采取自我训练方法 ,观察组采用矫形器治疗,对比矫正效果与生活自理能力.结果 观察组采用矫形器治疗后,显效22例,有效14例,矫正总有效率为92.31％,明显低于对照组的69.23％,同时观察组矫正治疗后Barthel指数明显高于对照组,两组之间差异有统计学意义(P<0.05).结论 对下肢功能障碍患儿采用矫形器治疗能够有效纠正下肢畸形,提高生活自理能力,值得在儿童康复治疗中推广应用.

目的 了解大学生礼仪素养现状,并对其影响因素进行分析,以期提升大学生礼仪素养.方法 采用方便抽样法,抽取河南省某高校共1059人为调查对象,利用大学生礼仪素养现状调查问卷对其进行调查,并对数据进行描述性分析、独立样本t检验等.结果 大学生礼仪素养得分为(3.828±0.605)分,性别、年级、专业因素对大学生礼仪素养有显著影响.结论 大学生的礼仪素养状况整体一般,提示高校应加强礼仪教育,积极改进教育模式,提高大学生礼仪素养.

目的 探讨帕金森病合并失眠患者应用重复经颅磁刺激技术治疗的效果及预后.方法 选取帕金森合并失眠的患者80例,采取数字表抽取法随机分组,对比分析神经内科常规治疗方案(对照组,n=40)与联合重复经颅磁刺激技术治疗(观察组,n=40)的效果及预后.结果 观察组总有效率经评定高于对照组(P<0.05).2组治疗前帕金森病统一评分量表(UPDRS)各维度评分经评测无显著性差异(P>0.05),治疗后各测验分值均有所降低,观察组降低程度显著低于对照组(P<0.05).2组治疗前睡眠质量量表(PSQI)各维度评分经评测无显著性差异(P>0.05),治疗后各维度评测分值均不同程度降低,观察组降低程度显著低于对照组(P<0.05).2组治疗前神经递质多巴胺(DA)、5-羟色胺(5-HT)无显著性差异(P>0.05),治疗后各测验值均有所升高,观察组更为显著(P<0.05).2组间不良反应比较无明显差异(P>0.05).结论 重复经颅磁刺激可提高帕金森合并失眠患者总有效率,改善临床症状,提高睡眠质量,且具有较高安全性.

目的 探讨针刺联合足部中药熏洗对脑卒中患者睡眠质量及下肢运动功能恢复的影响.方法 该次研究纳入的病例来自该院在2018年1月—2019年1月期间诊治的74例脑卒中患者,使用抽签方式对患者进行分组,对照组和观察组各37例,对照组单纯采用针刺方法治疗,观察组采用针刺联合足部中药熏洗方案治疗,对两组治疗的情况进行比较分析,确定最佳的治疗方案.结果 观察组治疗的有效率为97.30％,明显高于对照组的81.08％,两组比较差异有统计学意义(P<0.05);经过治疗,观察组睡眠质量评分明显改善,与对照组比较差异有统计学意义(P<0.05);治疗后,观察组患者下肢运动功能评分明显提升,与对照组比较差异有统计学意义(P<0.05).结论 对脑卒中患者采用针刺联合足部中药熏洗方案治疗,效果显著,值得临床推广.

对护士职业性肌肉骨骼损伤的影响因素及预防措施进行综述.总结归纳了影响护士职业性肌肉骨骼损伤的主要因素,包括年龄及工作年限、性别、文化程度、工作满意度、科室或工作场所、排班6个方面.探讨了护士职业性肌肉骨骼损伤的预防对策,包括体育锻炼、使用预防工具、完善医院制度和增加组织支持、加强护士职业性肌肉骨骼损伤的防护教育,并综合分析了这些预防对策的效果和局限性,为进一步制订预防护士职业性肌肉骨骼损伤方案提供参考.

Objective To analyze and assess the risk factors affecting acute lymphoblastic leukemia in children, then to improve survival and long-term quality of life using individual treatment programs for children. Method This article used retrospective study. 200 children with newly diagnosed acute lymphoblastic leukemia admitted into our hospital from May, 2012 to March, 2016 were selected as research objects. The clinical data were collected; and the association of various prognostic factors and changes of risk stratification were analyzed. Results The induction therapy complete remission rate of the 200 cases of acute lymphoblastic leukemia was 95.5％ after the stratification of risk and related treatment. WBC ≥ 50 × 109/L at initial treatment, prednisone-induced insensitivity, age > 9 years old and < 1 year old, bone marrow immature cells > 5％ on the 33rd day of induction, BCR/ABL and MLL/AF4 fusion gene positive were the risk factors increasing recurrence and mortality. Conclusion The age at initial treatment, peripheral white blood cell count, fusion gene, chromosomal abnormalities karyotype and translocation, CNS status, the treatment of morphological reactions, and minimal residual lesions are the long-term risk factors affecting the prognosis of children with acute lymphoblastic leukemia.

Mounting evidence has demonstrated that Bit1 has been investigated as an etiological factor for certain cancers, including esophageal squamous cell carcinoma reported in our previous study, but data regarding possible roles of Bit1 in esophageal squamous cell carcinoma and esophageal adenocarcinoma remain to be elucidated. The purpose of this study was to examine whether Bit1 can be a novel diagnostic marker for the patients with esophageal squamous cell carcinoma and esophageal adenocarcinoma. The results revealed that Bit1 level in esophageal squamous cell carcinoma was significantly higher than that in esophageal adenocarcinoma tissues ( p < 0.05); notably, Bit1 level in esophageal adenocarcinoma tissues was lower than that in paired normal tissues but no difference was found ( p > 0.05). Bit1 expression patterns were completely in accordance with matrix metalloproteinase 2 and Bcl-2 in esophageal squamous cell carcinoma and esophageal adenocarcinoma. In addition, Bit1, Bcl-2, and matrix metalloproteinase 2 expression patterns in different differentiated esophageal squamous cell carcinoma were higher than those in corresponding normal esophageal tissues. Bit1 expression in poorly differentiated esophageal squamous cell carcinoma was significantly higher than that in normal esophageal tissues ( p < 0.05) but not in moderately and well-differentiated esophageal squamous cell carcinoma. Matrix metalloproteinase 2 expression patterns in poorly and moderately differentiated esophageal squamous cell carcinoma were significantly higher than those in corresponding normal esophageal tissues ( p < 0.01) but not in well-differentiated esophageal squamous cell carcinoma tissue ( p > 0.05). Bcl-2 expression patterns in various differentiated esophageal squamous cell carcinoma were higher than those in corresponding normal esophageal tissues with no statistical differences ( p > 0.05). Importantly, Bit1 expression was positively correlated with both matrix metalloproteinase 2 and Bcl-2 expression in esophageal squamous cell carcinoma and esophageal adenocarcinoma tissues ( p < 0.05). Collectively, these preliminary data support further investigation of Bit1 as an important diagnostic factor for esophageal squamous cell carcinoma and esophageal adenocarcinoma.

孕妇这一特殊的群体，容易出现腰酸背痛、下肢水肿、不科学睡眠姿势、产后颈椎、腰椎疼痛等问题[1]。为了促进孕妇孕期的舒适、安全和健康以及缓解她们孕期的不适，市场上出现了 F 型孕妇抱枕。这种孕妇抱枕具有帮助孕妇保持科学的左侧睡姿、缓解下肢水肿、减少膨隆腹部不适的优点。但是，不足的是普通 F 型抱枕的连接带可伸展度有限、孕妇睡姿不能灵活调整、不能很好地缓解下肢水肿、使孕妇下肢压力太大。为了改善这些问题，更好地满足孕妇的需要，笔者通过多方面的资料和对调查结果的收集、统计与分析，针对有以上弊端的普通 F型抱枕做了进一步的改进，设计了一种多功能 F 型孕妇抱枕。现介绍如下。

目的：了解社区脑卒中主要照顾者的抑郁情况，并分析其影响因素。方法方便抽取146例脑卒中主要照顾者，使用抑郁自评量表（SDS）对其抑郁状况进行调查。结果脑卒中主要照顾者SDS平均分〔（51．42±13．63）分〕显著高于中国人群常模，抑郁发生率为45．9％。影响脑卒中主要照顾者抑郁状况的因素包括照顾者的年龄、每天照顾时间及脑卒中患者日常生活能力。结论脑卒中照顾者存在不同程度的抑郁状况，需引起社区护理人员的关注和重视，早期发现问题，及时疏导，预防抑郁及其他心理障碍的发生。

[目的]探讨认知-肌松干预方法对多发性骨髓瘤病人心理状态的影响。[方法]选择多发性骨髓瘤病人48例,随机分为观察组和对照组各24例。观察组实施认知-肌松干预方法,对照组给予常规心理护理。分别于干预前、干预结束后采用症状自评量表（SCL-90）、焦虑自评量表（SAS）和抑郁自评量表（SDS）对病人进行测评,观察两组心理干预效果。[结果]观察组干预前后病人SCL-90、SAS及SDS抑郁评分比较差异有统计学意义,干预后观察组负性情绪的改善优于对照组。[结论]多发性骨髓瘤病人可伴有多种负性情绪及心理障碍,认知-肌松干预方法可缓解其焦虑、抑郁等负性情绪,改善病人身心状态。

Aiming at the security pitfall of LBS applications in cloud environment in two aspects of sensitive identity information and realtime position information,we put forward a hybrid symmetrical and asymmetric encryption scheme,and establish the LBS security model based on the protection of that scheme.This model uses the pseudonym logo of IMSI as the only identity of a user,which avoids the transmission and storage of sensitive identity information in plain texts form.In the premise of not introducing the third party CA,both sides in communication take different encryption methods,this guarantees the safety of identity and location information transmitted in wireless network and stored on cloud.Finally,the feasibility and effectiveness of the method is validated through security analysis and scheme indexes comparison.

Objective To investigate the relationship between positive experience and social support of spouses' of community stroke patients.Methods 100 stroke patients and their spouses in two communities were conveniently selected and investigated about their positive experience and social support with General Information Questionnaire (GIQ),Modified Barthel Index(MBI),Positive Aspects of Caregiver (PAC),Perceived Social Support Scale (PSSS).Results The mean score of the spouses' positive experience was (22.74±5.85); the dimension of serf-affirmation was (15.82±3.84),higher than the dimension of life expectation(6.92±2.95).The scores of the spouses' positive experience were significantly different among age,gender,education of spouses and age and ability of daily life of stroke patients; the score of the spouses' positive experience was positively correlated with social support,subjective support,utility of support;multiple linear regression showed that age of spouses,ability of daily life of stroke patients and utility of support were influential important factors of spouses' positive experience.Conclusions The spouses' positive experience was below average level,we must pay more attention to improve it,utility of support can improve spouses' positive experience.

Although FPGA-based reconfiguration computing platform has been shown as a promising technique in high productivity computing field ,it may suffer security threats during its bitstream remote update process .A secure scheme is proposed in this paper to prevent tamper and replay attacks during the process of remote bitstream update on reconfigurable computing platform ,which encrypts the bitstream partially and calculates the value of MAC when making the configuration at the Remote Updating Configuration End .And then these data is sent to the distributed Control Units on reconfigurable computing platform via network . ,The encrypted bitstream will be put into security configurator after its integrity was verified by the value of MAC .At the end of the secure update process ,FPGAs will makes the requirements to its Control Unit and get the secure bitstream after it is restart . Analysis shows that the scheme proposed can guarantee the integrity and the confidentiality of the bitstream for remote updating and also has the ability of protecting the updating process from replay attacks .

Context awareness information,such as the operational,user's personal,spatial and environmental information,can provide users for the services they really needed without explicit requesting. We analyse users' call records,calendar,GPS and user installed applications provided by the mobile devices with the method of context awareness. After collecting the information,time and location factors are taken into consideration,which makes the whole authentication process more reliable. We also put forward the context awareness authentication architecture under the background of mobile cloud computing,and give detailed description of each component of the architecture and the algorithm model of the decision-making device as well as the communication protocol,so that the user will use the mobile cloud safer and more convenient.