德州地区进展性缺血性脑卒中相关危险因素的研究

探讨进展性缺血性脑卒中(SIP)的相关危险因素.选择德州市人民医院1999年～2009年163例SIP患者,首先对18个变量行单因素分析,然后对阳性变量行多因素Logistic逐步回归分析,筛选SIP发生的相关危险因素.高血压史、感染、加拿大卒中量表(CNS)评分、高血糖、TG、纤维蛋白原、脑水肿、颈动脉粥样硬化性狭窄、同型半胱氨酸和D-二聚体10个变量与SIP发生显著相关(P<0.05);脑水肿、颈动脉粥样硬化性狭窄、高血糖、感染、高纤维蛋白原水平和同型半胱氨酸6个因素是SIP发生的危险因素.脑水肿、颈动脉粥样硬化性狭窄,高血糖、感染、高纤维蛋白原在SIP发生中具有重要作用,为临床治疗提供了理论依据.     

用SIP合成分数研究儿童在两类假设情境中的社会信息加工特点

用假设情境问卷测量亲社会、一般、攻击性三组儿童在两类假设情境中的社会信息加工（SIP）特点,用累加法形成“SIP合成分数”作为儿童在假设情境中社会信息加工特点的综合指标,用2×3两因素方差分析研究分组和情境对儿童SIP的影响。研究表明“SIP合成分数”作为假设情境中一组SIP变量的综合指标具有良好的鉴别力和适用性,分组和情境对儿童SIP适应性的影响具有交互性。     

亲社会与攻击性儿童在两类假设情境中的社会信息加工特点

采用问卷调查法,分别测查、比较了亲社会儿童、攻击性儿童与一般儿童的社会信息加工(SIP)特点,目的是探讨三类儿童在SIP上是否存在差异。结果表明,在假设分享情境中,攻击性与一般儿童SIP的整体差异不显著,但在对不分享策略的他人情绪预期和关系预期2个变量上差异显著。亲社会与一般儿童、与攻击性儿童SIP的整体差异显著;在假设挑衅情境中,攻击性与一般儿童在对不同策略的自我效能感、选择频率、策略评价等7个变量上差异显著。亲社会与一般儿童在对不同策略的自我效能感、选择频率、策略评价等9个变量上差异显著;亲社会儿童与一般儿童SIP的整体不存在显著差异。     

糖尿病伴发脑卒中病例临床特点分析

探讨2型糖尿病患者伴发脑卒中的发生率及相关危险因素,采用头CT扫描,化验血糖、胆固醇、甘油三酯、高密度脂蛋白、纤维蛋白原。对我院自2005年7月-2007年7月间收治的2型糖尿病合并脑卒中患者与非糖尿病发生脑卒中患者进行比较分析。200例患者中糖尿病88例,患病率44％,两组患者比较糖尿病并发脑卒中发生多灶性梗死（P〈0．01）,血流变学分析（P〈0．01）其差异有统计学意义。糖尿病合并脑卒中的患者与多种危险因素有关,必须及早控制,防止脑卒中发生、发展,减少致残率。     

体外循环术后患者延迟撤机的危险因素分析

为了探讨ICU内体外循环术后患者延迟撤机的危险因素,收集了2005年5月～2007年10月我院体外循环术后患者共305例,根据患者机械通气时间分为延迟撤机组（机械通气时间≥24h）和早期撤机组（机械通气时间〈24h）,对患者术前基础血糖、白蛋白、肌酐及射血分数（EF）,术中是否应用球囊反搏术、转机时间（CPB）、主动脉阻断时间（ACC）及输血量,术后生命体征、肾功能、24h引流量、APACHEⅡ评分及机械通气时间等围手术期临床指标进行回顾性分析。结果显示,患者年龄、术前白蛋白和EF,CPB、ACC、是否行球囊反搏术,术后APACHEⅡ评分、血糖、肌酐、血小板、APTT、氧合指数、是否再次行开胸探查术等围手术期参数差异有显著性（P〈0．05）;Logistic多元回归分析显示低EF（EF〈40％,OR=6．07）、CPB（〉234min,OR=4．69）及ACC时间（〉172min,OR=4．32）延长、术后高APACHEⅡ评分（〉16,OR=5．36）是体外循环术后延迟撤机患者预后的主要影响因素。提示体外循环术后患者EF低、CPB（〉234min,OR=4．69）及ACC时间延长、术后APACHEⅡ评分高是延迟撤机的主要危险因素。     

《中小学生注意力测验》全国常模制定报告

《中小学生注意力测验》在全国范围对约２０００名被试试测后,本研究对所获数据进行了初步分析,得到：（１）各变量原始数据的均数和标准差;（２）对各变量进行因素分析的结果表明：可以认为该测验测出注意的稳定性、广度、转移、持续性和集中性;（３）各变量原始数据有显著年龄差异,但无性别差异。（４）信效度检验结果基本符合心理测量学要求。（５）制定了全国常模。     

车辆追随条件下驾驶员知觉行人危险的经验优势

危险知觉是指驾驶员在交通情境中对明显危险和潜在危险的识别、预测和反应的认知加工过程,是驾驶员对当前交通情境形成的连续而富于变化的复合认知表征。以往研究表明,对于行人过马路这类明显危险,新手和经验驾驶员危险知觉表现都非常出色。但是当明显危险（行人）和潜在危险（前车制动）并存时,经验驾驶员对明显危险的知觉反应是否会突显出优势呢？本研究通过设置两种交通场景：行人单一危险条件和行人-前车双重危险条件,考察不同经验人群对行人危险的反应及眼动特点。在第一个研究中,使用Tobii T120型眼动仪,通过反应时和眼动结合的方法,考察不同危险场景中,不同驾驶经验对驾驶员知觉行人危险的行为反应数据（反应时和正确率）及眼动指标（平均注视时间和水平搜索广度）的影响。采用2（交通场景：行人场景、行人-前车场景）×3（组别：无驾照组、新手组、经验组）两因素混合实验设计,其中交通场景是组内变量,组别为组间变量。因变量为驾驶员对行人危险进行反应的行为数据（反应时和正确率）及眼动数据（平均注视时间和水平搜索广度）。实验要求被试观看交通场景视频,当发现危险时,立刻按键反应。实验结果表明：在有前车条件下,经验组被试的反应时快于新手组（p=.039）和无驾照组（p=.013）,F(2,30)=3.98,p=.029。无驾照组被试对行人的平均注视时间长于经验组（p=.043）和新手组（p=.024）,F(2,30)=3.39,p=.047,ηp2= .18。无驾照组被试对场景的水平搜索广度均小于经验组（p=.006）和新手组（p=.016）,F(2,30)=5.17,p=.012,ηp2= .26。在第二个研究中,对研究一的数据进行了深入分析,考察双重危险场景中驾驶经验对驾驶员知觉行人危险及信息加工效率的影响。采用2（兴趣区类型：行人、前车）×3（组别：无驾照组、新手组、经验组）两因素混合实验设计,其中兴趣区类型是组内变量,组别为组间变量。因变量为搜索行人和前车时的眼动数据（总注视时间、搜索次数和平均搜索时间）。研究结果表明：经验组驾驶员对前车的总注视时间显著短于新手组（p=.014）和无驾照组（p=.003）,F(2,30)=5.99,p=.006。经验组驾驶员对前车的平均搜索视时间显著短于新手组（p=.014）和无驾照组（p=.004）,F(2,30)=5.50,p=.009。在有前车条件下,控制了性别、年龄后,驾驶员对前车的平均搜索时间越长,对行人的危险反应时越长（β=.393,p＜0.05,R2=.308）。这些结果说明：无经验和新手驾驶员糟糕的搜索行为不仅仅是由于操作抢夺认知资源或者情绪紧张导致的。危险的信息加工效率更低,搜索模式不够灵活,也是导致新手驾驶员行人碰撞事故率更高的原因之一。驾驶员培训有助于提高驾驶员对明显危险的信息加工效率和搜索模式灵活性。积累更多的驾驶经验可以提升驾驶员对潜在危险的的视觉搜索和注意资源分配效率,从而加快危险反应时间。未来的驾驶员培训应加强对新手驾驶员搜索技能的培训,并持续提供更多的驾驶员继续教育机会。     

急性心肌梗死患者小动脉弹性指数水平与各项危险因素的关系

探讨急性心肌梗死（AMI）患者小动脉弹性指数（C2）水平与各项风险因素的关系。纳入我院心血管内科于2010年1月～2013年7月间收治的AMI患者,并纳入同期入院的不稳定心绞痛（UA）患者作为对照组,收集相关临床资料,比较不同C2水平与相关指标的关联性发现：C2等11项危险因素存在显著差异,经多因素Logistic回归...     

大学教师职业生涯管理因素结构研究

在文献研究、结构化访谈和半开放式问卷调查的基础上,采用因素分析方法对大学教师职业生涯管理的因素结构及其与人口统计学变量之间内在关系进行了实证研究,结果显示（1）大学教师自我职业生涯管理是由教书育人、科研创新、明确目标、沟通协调、认识自我和了解组织等六因素结构构成,大学教师组织职业生涯管理是由专业支持、职业通道、科研激励和组织公平等四因素结构构成;（2）大学教师自我职业生涯管理与组织职业生涯管理显著相关;（3）大学教师自我职业生涯管理与性别、婚姻、教龄、学历、职称等人口统计学变量显著相关。研究结果对高校人力资源管理有启示意义。     

心理契约破坏研究现状与展望

心理契约破坏（psychologicalcontractbreach）是雇员对于组织未能充分履行心理契约中承诺责任的主观感知。文章阐述了心理契约破坏的概念界定、它产生的主要原因及其后果,以及相关的跨文化研究,并重点介绍了心理契约破坏对员工工作态度和行为产生影响过程中的相关权变因素（中介变量和缓冲变量）。在此基础上进一步提出未来研究应着重以下几方面：（1）心理契约破坏的心理机制及干预措施研究;（2）跨文化比较研究;（3）个体间差异的研究;（4）研究方法的改进     

Diagnosis and prevention of atherosclerotic cerebral infarction

Atherosclerotic disease accounts for approximately 25% of ischemic strokes. Atherosclerotic stroke is caused mainly by embolic events from the carotid artery bifurcation or the aortic arch, although intracranial thrombosis can occur, more often in African Americans, Asians, and diabetes patients. Primary prevention of stroke is critical for patients with risk factors for atherosclerosis, including hypertension, diabetes, smoking and hypercholesterolemia. Stroke can be prevented in patients with established atherosclerotic disease by identification and management of patients with carotid artery stenosis by non-invasive testing. Particular attention must be paid to patients with transient symptoms of brain ischemia.     

Stroke risk factors

Despite advances in the treatment of acute cerebral infarction, the most effective method of reducing stroke morbidity and mortality is the identification and modification of stroke risk factors. Modifiable stroke risk factors include hypertension, atrial fibrillation, hypercholesterolemia, cigarette smoking, hyperhomocystinemia, and carotid stenosis. Improved identification of individuals at increased stroke risk due to these factors can reduce individual risk and the cost to society of the consequences of stroke.     

阿司匹林在缺血性脑卒中二级预防应用的现况调查

调查缺血性脑卒中患者二级预防中阿司匹林的使用情况,并初步分析其影响因素。本研究为现况调查,调查对象为神经内科门诊与病房就诊既往诊断明确的脑梗死或短暂性脑缺血发作患者,调查其近两周内的阿司匹林使用情况及相关影响因素。经过调查初步得出缺血性脑卒中幸存者应该给予抗血小板药物,除非预计患者不久将死亡或有严重的禁忌证,阿斯匹林应用比例少,剂量不足,应引起患者及医务人员的重视,临床医师应遵循临床指南给与正确的指导。     

症状性颈动脉狭窄CEA治疗时机的Meta分析

评估症状性颈动脉狭窄（SCAS）患者颈动脉内膜剥脱术（CEA）手术时机选择及伴发症状对预后的影响.通过相关检索策略查找探讨CEA手术时机选择对于患者预后影响的随机对照试验.所有数据均采用Revman5.0分析软件进行Meta分析.纳入22篇文献,总计9 037名患者.Meta分析结果显示：SCAS患者4w、2w、1w 前后行CEA术后卒中再发率或死亡率组间无统计学差异.合并脑卒中的患者4w、2w 前后及合并短暂性脑缺血发作（TIA）或心肌梗死（MI）的患者4w前后行CEA术后卒中再发率或死亡率无统计学差异.症状稳定的SCAS患者应尽早行CEA术,伴发症状脑卒中、TIA 和MI不影响手术预后.     

Risk factors for arterial ischemic stroke in childhood

Stroke affects up to 13 of 100,000 children, is more common in boys and African Americans, and is associated with considerable cognitive and psychiatric morbidity, as well as motor disability. Around half are hemorrhagic and half are ischemic. Underlying conditions include sickle cell disease, cardiac abnormalities, chromosomal abnormalities (eg, Down syndrome), and neurocutaneous conditions (eg, neurofibromatosis), but up to half the patients with ischemic stroke have no previously diagnosed condition. Although there is almost certainly an important genetic component to stroke risk, head trauma, infections, drugs and radiation appear to play an etiological role in some patients. The majority of the patients with infarction in an arterial distribution have associated cerebrovascular disease. Vascular pathologies include carotid or vertebrobasilar dissection, intracranial vasculopathy affecting the middle and anterior cerebral arteries, which is often transient, and moyamoya. Intermediate risk factors may include hypertension, hypoxia, and poor nutrition leading, for example, to iron deficiency and hyperhomocysteinemia. Some chronic conditions may directly influence the child's behavior and stroke recurrence risk, although large cohorts and randomized controlled trials will be needed before strategies for modification can be evidence-based.     

Global cognitive function before,surrounding, and after ischemic stroke: the role of risk and protective factors varies with time among ischemic stroke survivors

An estimated 65% of individuals demonstrate multidomain cognitive impairment poststroke, although little is known about the varying role of cognitive risk and protective factors in preischemic, peri-ischemic, and postischemic stroke phases. Longitudinal changes in global cognitive function after ischemic stroke are not well characterized, especially in older adults over age 80. We examined global cognitive function trajectories in these three phases across a mean follow-up of 8.12 (2.30) years in 159 female stroke survivors aged 65–79 at baseline using linear mixed models with change points. In separate models controlling for demographic variables, we tested the interaction of baseline risk and protective factors with stroke phase on global cognitive function. None of the prestroke global cognitive function means or trajectories differed significantly. At the time of ischemic stroke, higher body mass index (BMI), the presence of hypertension (HTN), low optimism, and higher physical function were all associated with significantly greater mean decreases in global cognition (all p’s <.0.0001), but were not significantly different from the contrasting level (all p’s >0.05). Higher BMI, the presence of HTN, low optimism, and higher physical function were in turn protective of global cognitive decline postischemic stroke (all contrasting p values <.01). Baseline factors may play either a risk or a protective role in global cognitive function depending on the phase of ischemic stroke.     

The Effect of Non-Stroke Cardiovascular Disease States on Risk for Cognitive Decline and Dementia: A Systematic and Meta-Analytic Review

Cardiovascular disease is associated with increased risk for cognitive decline and dementia, but it is unclear whether this risk varies across disease states or occurs in the absence of symptomatic stroke. To examine the evidence of increased risk for cognitive decline and dementia following non-stroke cardiovascular disease we conducted two independent meta-analyses in accordance with PRISMA guidelines. The first review examined cardiovascular diagnoses (atrial fibrillation, congestive heart failure, periphery artery disease and myocardial infarction) while the second review assessed the impact of atherosclerotic burden (as indicated by degree of stenosis, calcification score, plaque morphology or number of plaques). Studies eligible for review longitudinally assessed risk for clinically significant cognitive decline and/or dementia and excluded stroke and cognitive impairment at baseline. Summary statistics were computed via the inverse variance weighted method, utilising Cox Proportional Hazards data (Hazard Ratios, HR). Both atrial fibrillation (n = 5, HR = 1.26, 95% CI [1.12, 1.43]) and severe atherosclerosis (n = 4, HR = 1.59, 95% CI [1.12, 2.26]) emerged as significant risk factors for cognitive decline and/or dementia. A small set of studies reviewed, insufficient for meta-analysis, examining congestive heart failure, peripheral artery disease and myocardial infarction suggested that these conditions may also be associated with an increased risk of cognitive decline/dementia. In the absence of stroke, patients with atrial fibrillation or generalised atherosclerosis are at heightened risk for cognitive deterioration. Nonetheless, this paper highlights the need for methodologically rigorous and prospective investigation of the relationship between CVD and dementia.     

Pregnancy and stroke

The risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.     

脑梗死不同病因亚型同血浆同型半胱氨酸浓度的关系研究

为探讨脑梗死患者血浆同型半胱氨酸（HCY）水平同病因分型及疾病严重程度的关系,选择首发脑梗死急性期患者73例,对照组30例,进行TOAST病因分型、NIHSS神经功能缺损评分、血浆HCY检测。结果显示,病例组血浆HCY升高率、水平比对照组显著增高;大动脉粥样硬化亚型病例组血浆HCY水平比对照组明显增高;病例组血浆HCY水平同NIHSS评分呈正相关,提示高HCY血症是脑梗死发病及大动脉粥样硬化亚型脑梗死发病的高危因素,血浆HCY水平同神经功能缺损程度正相关。