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替罗非班在急性进展性脑梗死中应用

现代医学Modern Medical Journal2020，Aug ；48（8）：966-970［收稿日期］2020-03-23［修回日期］2020-08-11［作者简介］尹其舵（1982－），男，安徽巢湖人，主治医师。

E -mail ：Yqd19820815@163．com［通信作者］吴清阳E -mail ：qingyangwumd@163．com［引文格式］尹其舵，李正侠，耿万杰，等．替罗非班在急性进展性脑梗死中应用［J ］．现代医学，2020，48（8）：966-970．·论著·替罗非班在急性进展性脑梗死中应用尹其舵1，李正侠1，耿万杰1，吴清阳2（1．安徽省阜阳市太和县人民医院神经内科，安徽阜阳236600；2．南京医科大学附属无锡市人民医院影像科，江苏无锡214023）［摘要］目的：探讨替罗非班联合阿司匹林、氯吡格雷对急性进展性脑梗死患者的临床疗效、生活质量ADL 评分、神经功能缺损NIHSS 评分的影响。

方法：前瞻性分析90例急性进展性脑梗死患者，随机分为观察组和对照组，各45例。

对照组给予服用阿司匹林、氯吡格雷治疗，观察组在经替罗非班联合治疗（24 72）h 后贯续服用阿司匹林及氯吡格雷。

比较2组患者治疗后临床疗效、NIHSS 评分（24h 、72h 、7d 及14d ）、ADL 评分及不良反应发生率。

结果：观察组总有效率为88．99%，高于对照组的71．11%（P ＜0．05）；观察组治疗后NIHSS 评分低于对照组，且观察组治疗后与治疗前ADL 评分差值高于对照组（P ＜0．05）；不良反应发生率：观察组为13．85%，对照组为7．69%（P ＞0．05）。

结论：替罗非班联合阿司匹林、氯吡格雷能有效地改善急性进展性脑梗死患者脑组织血流，提高患者生活质量，改善神经功能，安全性较好。

［关键词］急性进展性脑梗死；替罗非班；NIHSS 评分；生活质量［中图分类号］Ｒ743．3［文献标识码］A［文章编号］1671-7562（2020）08-0966-05doi ：10．3969/j．issn．1671-7562．2020．08．006Effect of tirofiban in patients with acute cerebral infarctionYIN Qiduo 1，LI Zhengxia 1，GENG Wanjie 1，WU Qingyang 2（1．Department of Neurology ，Taihe County People ＇s Hospital ，Fuyang 236600，China ；2．Department of Ｒadiology ，the Affiliated Wuxi People ＇s Hospital of Nanjing Medical University ，Wuxi 214023，China ）［Abstract ］Objective ：To study the clinical efficacy of tirofiban combined with aspirin and clopidogrel on scores ofDaily Living Ability Scale （ADL ）and National Institute of Health Stroke Scale （NIHSS ）in patients with acute pro-gressive cerebral infarction．Methods ：90patients with acute progressive cerebral infarction admitted to our hospi-tal from July 2018to July 2019were randomly divided into observation group and control group （45cases ）．The control group was treated with aspirin and clopidogrel ，on top of which the observation group was given tirofiban．The clinical efficacy ，ADL ，NIHSS and adverse reactions between the two groups were statistically analyzed．Ｒesults ：The total effective rate was 88．89%in the observation group ，71．11%in the control group （P ＜0．05）．In the observation group ，the NIHSS were lower than those during the time of 24h ，72h ，7d and 14d ，respectively （P ＜0．05）and meanwhile ，the differentials of ADL between post treatment and prior treatment were high than those in the control group （P ＜0．05）．The incidence of adverse reactions was 13．85%in the observation group ，7．69%in the control group （P ＞0．05）．Conclusion ：Tirofiban combined with aspirin and clopidogrel has a cura-tive effect in acute progressive cerebral infarction ，improving the brain microcirculation blood flow and nerve func-tion ，enhancing life quality of patients ，and ensuring the safety of the therapy．［Key words ］acute progressive stroke ；tirofiban ；score of NIHSS ；quality of life·669·急性脑梗死是临床常见的一种脑血管疾病，病理生理学基础为脑血供突然中断，可导致脑组织坏死，神经元细胞、星形胶质细胞、胶质细胞不同程度损伤，是出现致残、致死的严重脑血管疾病之一。

米非司酮周期疗法治疗对围绝经期异常子宫出血患者的影响分析

药物与临床China &Foreign Medical Treatment 中外医疗米非司酮周期疗法治疗对围绝经期异常子宫出血患者的影响分析梅娟，戴淑婷，张雪芳漳州招商局经济技术开发区第一医院妇产科，福建漳州 353100［摘要］目的研讨米非司酮周期疗法治疗对围绝经期异常子宫出血（Abnormal Uterine Bleeding, AUB ）患者的影响。

方法随机选取2021年5月—2023年5月漳州招商局经济技术开发区第一医院确诊为AUB 的100例患者为研究对象，依据随机数表法分组，对照组（n =50）接受米非司酮持续口服，观察组（n =50）接受米非司酮周期疗法治疗，比较两组方案疗效、性激素水平、临床相关指标以及用药安全性。

结果观察组经3个周期用药后的疗效（96.00%）高于对照组（80.00%），差异有统计学意义（χ2=6.060，P <0.05）。

用药后，观察组各项性激素指标水平均低于对照组，差异有统计学意义（P 均<0.05）。

观察组用药后血红蛋白值高于对照组，子宫内膜厚度小于对照组，差异有统计学意义（P 均<0.05）。

两组间发生药物不良反应基本相当，差异无统计学意义（P >0.05）。

结论对围绝经期AUB 患者实施米非司酮周期疗法用药，能够明显提升用药效果，调节患者机体性激素水平，提高血红蛋白值，缩小子宫内膜厚度，同时保障用药安全。

［关键词］围绝经期异常子宫出血；米非司酮；周期疗法；性激素；子宫内膜厚度［中图分类号］ R5 ［文献标识码］ A ［文章编号］ 1674-0742（2024）02(a)-0103-04Analysis of the Effect of Mifepristone Cycle Therapy on Perimenopausal Abnormal Uterine Bleeding PatientsMEI Juan, DAI Shuting, ZHANG XuefangDepartment of Obstetrics and Gynecology, Zhangzhou China Merchants Economic and Technological Development Zone First Hospital, Zhangzhou, Fujian Province, 353100 China[Abstract] Objective To study the effect of mifepristone cycle therapy on patients with perimenopausal abnormal uter⁃ine bleeding (AUB). Methods 100 patients diagnosed as perimenopausal AUB by Zhangzhou China Merchants Eco⁃nomic and Technological Development Zone First Hospital from May 2021 to May 2023 were randomly selected as the study objects and the group design was completed based on the random number table method. 50 cases in the control group received continuous oral mifepristone, and 50 cases in the observation group were treated with mifepristonecycle therapy. The efficacy, sex hormone levels, clinical indexes and drug safety of the two groups were compared. Results After 3 cycles of treatment, the therapeutic effect of the regimen in the observation group (96.00%) was higherthan that in the control group (80.00%), and the difference was statistically significant (χ2=6.060, P <0.05). After treat⁃ment, the levels of various sex hormone indexes in the observation group were lower than those in the control group, and the differences were statistically significant (all P <0.05). The hemoglobin value of the observation group was higher than that of the control group, and the endometrial thickness was lower than that of the control group, the differ⁃ences were statistically significant (both P <0.05). The incidence of adverse drug reactions between the two groups wassimilar, and there was no statistical significance difference (P >0.05). Conclusion The implementation of mifepristonecycle therapy for perimenopausal AUB patients can significantly enhance the effect of medication, regulate the level ofsex hormones in the patient's body, increase hemoglobin value, and reduce the thickness of the endometrium, as well DOI ：10.16662/ki.1674-0742.2024.04.103[作者简介] 梅娟（1983-），女，本科，主治医师，研究方向为妇产科临床。

组织行为学文章英文版

An Examination of the Relationship Among Structure,Trust,and Conﬂict Management Styles in Virtual TeamsXiaojing Liu,Richard J.Magjuka,and Seung-hee Lee I n today’s competitive environment,successful organizations that are able to utilize advanced information technology to establish a dynamic form to adapt to the ever-changing landscape and customer requirements always gain a competitive advantage in global competition (Porter &Lilly,1996).The virtual team has become one of the building blocks of a successful organization.In this article,a virtual team is deﬁned as ‘‘a group of people with complementary competencies executing simul-taneous,collaborative work processes through elec-tronic media without regard to geographic location’’(Chinowsky &Rojas,2003,p.98).Virtual teams can offer a range of beneﬁts toorganizations,among them encouraging constructive dialogue and knowledge,nurturing a community of workers,triggering deeper processing of content through interaction,and offering ﬂexible adaptation to complex tasks (Duarte &Snyder,1999;Conrad &Donaldson,2004;Palloff &Pratt,2005;Lee,Bonk,Magjuka,Su,&Liu,2006).However,a virtual team can also face challenges and issues that must beaddressed for a successful team operation.Fromexisting telework research,Workman,Kahnweiler,and Bommer (2001)summarize three attributes of virtual environments that are barriers to successful virtual collaboration:elevated ambiguity,increased isolation,and a less-structured environment.For example,in virtual environments lack of informal interactions,the constraints of dispersed asynchronous communication context,and limited capabilities of transmittingsocial &2008International Society for Performance ImprovementThe emergence of new technolo-gies has made it increasingly easy for distributed collaboration in both edu-cational and noneducational settings.Although the effectiveness in tradi-tional settings of the dynamics of small group work has been widely researched,there is limited researchthat offers evidence on how teams can work effectively in a virtual environment.The purpose of this study is to examine the relationship among team structure,trust,andconﬂict management style,in addi-tion to their impact on teamwork effectiveness in a virtual environment.An experimental design was used toassess the effects of structure on team performance.Forty-four groups,di-vided into hierarchical and nonhier-archical groups,worked on an online simulation project in an online MBAcourse.The results suggest that team structure is strongly associated with team performance,whereas trust and a collaboration conﬂict manage-ment style contribute to teamworksatisfaction.cues may render an environment that is low in social presence and interactivity.Such an environment can create difﬁculties for effective communication and collaboration (Montoya-Weiss,Massey,&Song,2001).Thus it has been suggested that virtual teams may have to make extra efforts in communication and collaboration for a successful operation.Walther (1996)suggests that in some instances a level of interaction that surpasses face-to-face interaction could occur thanks to strong involvement,intense relationships,and reciprocation.Although the effectiveness of small group work in traditional settings has beenwidely researched,there is still limited researchwith evidence concerning how teams can work effectively in a virtual environment.In particular,there is a lack of research on linking the social,task,and technological dimensions to the entry,process,and outcome variables of the teamwork process (Carabajal,LaPointe,&Gunawardena,2003)in a virtual environment.Existing theory about team-work processes may not be transferable to a virtual setting because introduction of media technology may have changed or altered the dynamics of thegroup process.For example,conﬂict in a virtualteam may persist longer without being noticed (Grifﬁth,Mannix,&Neale,2003),or trust development—which is generally regarded as a prerequisite for developing shared commitment—may be undermined from the lack of a personal human touch (Crossman &Lee-Kelley,2004).The purpose of this study is to add to the existing knowledge about virtual teamwork by examining the roles of team structure,trust,and conﬂict variables in the effectiveness of virtual teamwork.This study intends to answer several research questions:(1)Would there be signiﬁcant differences in team performance or satisfaction if virtual teams were structured differently?(2)Are there any signiﬁcant relationships between trust and virtual team performance or satisfaction?(3)Are there any signiﬁcant relationships between team conﬂict management styles and virtual team performance or satisfaction?Literature ReviewTeam StructureIn this article,team structure refers to the division of a team’s work environment into subtasks assigned to individual members or subteams.Such division can dictate the distribution of information and responsi-bilities of each team member.In teamwork,two types of structures were usually studied to understand their effects on team performance (Moon et al.,2004;Urban,Bowers,Monday,&Morgan,1995).Hierarchical structure refers to those structures in which team members have specialized roles or hold information and capabilities that are unique toExisting theory about teamwork processes may not be transferable to a virtual setting because introduction of media technology may have changed or altered the dynamics of the group process.each other.Such division of roles results in high interdependency among team participants.Nonhierarchical structure refers to those structures in which team members have nonspecialized roles and have fewer interdependencies in accomplishing a common team goal(Urban et al., 1995).In general,team structure deﬁnes the nature and patterns of relationships and the division of work among individuals in groups(Wong &Burton,2000).Studies that examine the relationship between team structure and team performance in organization settings revealed diversiﬁed results. Researchers,for instance,have proposed that a high degree of group division can reinforce individual accountability,and therefore it can prevent participants from slacking off or freeloading,which commonly impairs group performance in a virtual environment(Lin&Hui,1999; Pugh et al.,1963;Lin,Yang,Arya,Huang,&Li,2005).In a study that compared the problem-solving performance in two types of structure,the group with hierarchical structure indicated higher perceptions of intersubjectivity—that is,a‘‘shared collective understanding’’—and deep processing in group learning during the initial weeks of activity.Over time,however,these levels equalized across group structures(Rose,2004). In another study,Joung and Keller(2004)evaluated two types of structure during online group debate.The results suggested that the group with hierarchical structure demonstrated greater use of critical thinking skills and revealed more critical and dynamic interaction patterns than the nonhierarchical group.Nevertheless,some studies also suggested that nonhierarchical structure seemed to have outperformed hierarchical structure(Urban et al.,1995;Bowers,Urban,&Morgan,1992;Kleinman&Serfaty,1989). For example,Urban et al.(1995)studied teams in the context of military training and found that those with nonhierarchical structures were associated with superior performance compared to hierarchical structures when working under a high workload.Team structures were associated with patterns of communication structures.The teams with hierarchical structures tended to rely on question-and-answer sequences to elicit information and resources more than nonhierarchical teams did.This communication pattern of hierarchical teams was less effective than that of nonhierarchical teams,which,because of their similar roles,could communicate more clearly or were able to anticipate each other’s needs rather than waiting on the others to ask for information.The contradictory results of the relationship between structure and performance in the extant literature may have reﬂected the effect of structure under different task environments.Structural contingency theory posits that no structure is better across teams in organizational settings.However,hierarchical structures may work better than nonhierarchical structures in less complex environments,while nonhier-archical structures may work better than hierarchical structures in complex environments(Moon et al.,2004).Research indicates that therules of structural contingency theory are equally applicable in a virtual organization whose members are bounded by a common goal and who ground their work in communications through information technology (Moon et al.,2004;Burns&Stalker,1961).In an unstable or dynamic environment,nonhierarchical,or informal, structure is argued to be an effective way of organizing virtual teams because it allowsﬂexibility for workers to communicate according to the changing demands of the task(Burns&Stalker,1961;Hinds&McGrath, 2006).Virtual environments are generally regarded to be associated with added complexity and uncertainty,though this is not always the case.In their study,Hinds and McGrath(2006)found that in a distributed virtual team environment,dividing tasks in a nonhierarchical,independent way (for example,reducing task interdependences between work sites)reduces the need for frequent communication and therefore minimizes the waiting time and miscommunications that are due to the nature of delayed feedback in virtual communications.In this study,following Hinds and McGrath’s study(2006)and Urban et al.(1995),we hypothesize that in virtual groups that engage in complex problem-solving tasks(such as ill-deﬁned problems with no clear-cut answers),teams with nonhierarchical structures may be able to communicate more efﬁciently(by minimizing waiting time)and more effectively(thanks to their shared knowledge, which allows them to anticipate each other’s needs and explain information more thoroughly).Hypothesis1.Nonhierarchical structures outperform hierarchical structures on their virtual team performance in complex task environments.TrustIn this article,trust is deﬁned as‘‘an emergent state comprising team member intentions to accept vulnerability based on positive expectations of the intentions or behavior of another’’(Rousseau,Sitkin,Burt,& Camerer,1998,p.395).The positive effect of trust on team outcomes is widely documented.For instance,trust can enhance collaboration among team members and reduce the cost of team operations by eliminating extra effort needed to monitor team members(Serva&Fuller,2004).In addition,studies have consistently found that trust can have an inﬂuence on team effectiveness by way of its impact on team processes such as problem solving,decision making,and communication(Kifﬁn-Petersen, 2004).For example,Zand(1972,as cited in Kifﬁn-Petersen,2004)found that teams with high trust demonstrated creative and diversiﬁed patterns of behavior that improved the team’s problem solving.In contrast,low-trust teams showed a defensive pattern of behaviors that interfered with informationﬂow within the team,thus negatively affecting the quality of problem ck of trust has proven to negatively inﬂuence team members’satisfaction with teamwork and their willingness to continue to work with the team(Golembiewski&McConkie,1975).A workrelationship characterized by trust tends to enhance open communication and collaboration,reconcile conﬂict,and increase commitment to a team (Smith&Barclay,1997).Although some claim that working in virtual teams can produce additional challenges owing to the absence of social cues that can transfer interpersonal affections,including trust,research actually suggests that such absence does not necessarily hinder development of trust in virtual teams but may merely prolong the process of trust building(Walther, 1996;Henttonen&Blomqvist,2005).Studies also suggest that trust can play the same important roles in the functioning of virtual teams as in traditional teams(Morris,Marshall,&Kelleyrainer,2002;Henttonen& Blomqvist,2005).A synthesis of existing research suggests that development of trust is associated with continuous interactions and communications and repeated interpersonal exchange(Wilson,Straus,&McEvily,2006;Crossman&Lee-Kelley,2004).As in traditional teams,social communications(greetings, exchanges of personal information)can play an important role in developing trust in virtual teams(Henttonen&Blomqvist,2005). Contemporary theory of‘‘swift trust’’(Jarvenpaa&Leidner,1999)posits that highly active,proactive,and enthusiastic actions can strengthen trust.Compared to nonhierarchical structures,we hypothesize that a hierarchically structured team whose members possess more specialized roles may have to engage in more frequent reciprocal information exchange and take a more active role in seeking information and providing responses to others;this is due to high interdependence among team members(Moon et al.,2004).Such actions may in fact expose team members to more communication and interactions and therefore foster the development of trust.Hypothesis2a.Trust will be positively associated with virtual team performance.Hypothesis2b.Trust will be positively associated with virtual team satisfaction.Hypothesis2c.Hierarchical teams have a higher level of trust than nonhierarchical teams.Conﬂict ManagementConﬂict is an inevitable part of working in teams.In general,conﬂict refers to differences or discrepancies in team members’ideas,opinions,or ways of doing things.Modern organizational theories no longer view conﬂict as a negative sign of organizational issues but tend to regard it as an intrinsic component in organizational dynamics(Medina,Munduate, Dorado,Martı´nez,&Cisneros,2004).A moderate amount of conﬂict is argued to be‘‘essential for attaining and maintaining an optimum level of organizational effectiveness’’(Rahim&Bonoma,1979,p.1325).Whether conﬂict can be used for effective performance relies on strategic conﬂict-handling styles.It has been suggested that how conﬂict is handled is more important to the success of teams than the conﬂict itself (Paul,Seetharaman,Samarah,&Mykytyn,2004).According to Rahim (1992)and Montoya-Weiss et al.(2001),there are various ways to manage conﬂict in a team:avoidance,accommodation,competition,collaboration, and compromise.An avoidance approach to conﬂict management is characterized by evasiveness and failure to directly address conﬂicting viewpoints.An accommodation conﬂict management style reﬂects obligations to others.A competition conﬂict management style is deﬁned as pursuit of one’s own interest without careful regard for others,while a collaboration management style attempts to identify and achieve outcomes for mutual beneﬁt.A compromise management style is characterized byﬁnding mutually accepted solutions through negotiating differences.Past small group research indicates that more cooperative conﬂict management styles are more likely to be associated with positive individual and team outcomes than less cooperative conﬂict management styles(Lin,2003;Paul et al.,2004).The same positive effects were also found in virtual teams.A study that examined a culturally diverse group supported by a groupware system concluded that the groups that lean toward a higher level of collaboration style of conﬂict management perceived higher quality in decision making.Integration of diverse views resulted in integrative decisions and thus improved group agreement (Paul et al.,2004).A competition management style is traditionally viewed as having a negative effect on team performance in that it can result in less social integration and team cohesion(Montoya-Weiss et al.,2001;Cohen &Bailey,1997).Montoya-Weiss et al.(2001)propose that conﬂict theory developed in face-to-face settings may not be fully applicable to asynchronous teams, owing to fundamental differences(communication protocols,reduced social presence,or media richness)in a virtual environment.For example, competition conﬂict management behaviors of a team member may not be conspicuous to other members of the team in an asynchronous virtual environment,and the negative effects may be mitigated in asynchronous virtual teams(Tan,Watson,Clapper,&McLean,1998).In fact,it is possible that competitive behaviors such as aggressive emotions or competitive dominance may not be interpreted as such,but rather be viewed as a means of achieving efﬁciency and effectiveness in a lean,asynchronous commu-nication environment(Montoya-Weiss et al.,2001;Lin,2003).Hypothesis3a.A collaboration conﬂict management style in virtual teams is positively associated with team performance.Hypothesis3b.A collaboration conﬂict management style in virtual teams is positively associated with virtual team satisfaction.Hypothesis3c.A collaboration conﬂict management style in virtual teams is positively associated with trust.Hypothesis3d.A competition conﬂict management style in virtual teams is not associated with virtual team performance.Hypothesis3e.A competition conﬂict management style in virtual teams is not associated with virtual team satisfaction. Research MethodologyResearch SettingThe present study was conducted in an online MBA program at a large midwestern university.The participants were enrolled in a capstone management course.Subjects were separated into project groups of four to six people to work on an online simulation project.Each team was asked to adopt the view of a senior manager responsible for running a business venture,assuming responsibility for a$100million company in the electronic sensor manufacturing industry.The simulations required management teams to evaluate situations and make decisions to stimulate their company’s growth.Teams set a strategy and applied strategic concepts and techniques in forming and implementing a business plan, and they were asked to integrate theﬁrm’s production,marketing,human resources,research and development,ﬁnancial,and pricing plans.The project lasted four weeks.InstrumentsThe22-item questionnaire contained three dimensions:trust,conﬂict management resolution,and teamwork satisfaction.Trust measured subjects’perceptions of trust between themselves and their teammates.Trust scales(10items)were adapted from Jarvenpaa and Leidner(1999)and Mayer,Davis,and Schoorman(1995).Sample items included‘‘I really wish I had a good way to oversee the work of other team members on the project’’and‘‘Overall,the people in my group are very trustworthy.’’Cronbach’s alpha for the trust dimension was.851.Conﬂict management resolution measured scores on two types of strategy used by a subject when working in a team:competition conﬂict management(ﬁve items)and collaboration conﬂict management(three items).Scales of conﬂict management solutions were adapted from previous research(Montoya-Weiss et al.,2001;Paul et al.,2004).Theﬁve items of the collaboration approach to conﬂict management measured the degree of team members’attempts to identify and achieve outcomes that integrated the interests of all parties involved.A sample item for the collaboration conﬂict management approach scale is‘‘Team members seek a resolution that will be good for all of us.’’Subjects were asked to rate on a5-point scale(15strongly agree,55strongly disagree)the degree to which team members agreed with theﬁve statements.For the competition approach to conﬂict management,there are three items measuring the degree to which the conﬂict was a win-lose situation and how each team member might pursue his or her own interest withoutregard for others(such as‘‘Team members treat conﬂict as a win-lose contest’’).The coefﬁcient alphas for the collaboration and competition scales were.826and.806,respectively.Both variables were used as continuous variables in this article.Aggregating individual scores of conﬂict management styles to the team level is logically justiﬁed because the question items were designed to measure the characteristics of the work team(Alper,Tjosvold,&Law, 2000).In addition,the James,Demaree,and Wolf TWG(J)procedure (1984)was used to estimate the interrater reliability of members within each team for the variables of competition and collaboration management conﬂict styles.The median TWG(J)for the two variables across the44 teams were.96,and.90respectively.Both are above.70,which is considered the indicator of sufﬁcient agreement within a group.These test results indicated that the ratings of group members are reasonably homogeneous and can be aggregated to the group level.Teamwork satisfaction included four items that measured subjects’degree of satisfaction with the teamwork process(‘‘Looking back on the whole course,I am satisﬁed with our teamwork project’’),team output(‘‘I think I learned many meaningful lessons throughout team projects’’), overall value(‘‘Overall,I believe that the whole teamwork process of our team is valuable to driving us toward team goals’’),and team decision-making quality(‘‘Overall,I believe that our team came up with the best solution as we expected’’).Team performance was measured by theﬁnal proﬁt score from team simulations.This score presented an objective measure of team performance,reﬂecting the ability of the team to use knowledge and skills learned from the curriculum to make judicious decisions for their simulated industry.Two kinds of team structure were used in the study:hierarchical and nonhierarchical.Teams that used hierarchical structure divided the individual work on the basis of the functionality of the company. Each member was responsible for one specialized area of the company, such as research and development,marketing,product development,ﬁnance,and so forth.Under this structure,each team member had a specialized role and needed to coordinate closely with other divisions to make a decision associated with a product.In a nonhier-archical structure,each team member was responsible for one product.Each member had to assume responsibility for all areas associated with that product.Under this structure,team members could make relatively independent decisions without consulting others but had to coordinate with others on the strategic goals of the company.Teams were randomly assigned to the two types of structure.Each team was asked to follow the instruction protocol of the structure assigned.The members of hierarchical teams were required to take specialized functional roles while those of nonhierarchical teams were asked to take a broader range of similar roles that covered several areas of a product.A dummy variable was used to code the structure;1referred tohierarchical structure,and0was used to refer to nonhierarchical structure.Data CollectionData were collected from all208members of44teams.Six teams’datawere later dropped from the study because the team did not followinstructions closely in structuring their teams.Seventeen teams usedhierarchical structure,while21used nonhierarchical structure.The22-item questionnaire that measured trust,conﬂict management resolution,and teamwork satisfaction was administrated during the midterm of thecourse.The return rate of the questionnaires was about95%.FindingsTable1shows correlations of all the variables measured ormanipulated in this experiment.As indicated in the table,team structurewas negatively correlated with team performance(r5À.323,p o.05).The nonhierarchical structure was associated with higher team performance.The trust level of the group was positively correlated with the collaboration conﬂict management style(r5.754,p o.01)and negativelyassociated with the competition conﬂict management style(r5À.561,p o.01).In addition,the level of trust had a positive relationship withteam satisfaction(r5.561,p o.01).The competition management stylewas negatively correlated with the collaboration management style(r5À.581,p o.01).In ourﬁrst hypothesis(H1),we proposed that a nonhierarchicalstructure would outperform a hierarchical structure in a virtual workingteam;the data supported this hypothesis.Table2contains the ANOVAresults that measured whether groups differed signiﬁcantly in their performance and other variables measured.The results revealed that the1M123451.Structure.5512.Trust 4.11.01713.Collaboration conﬂict4.28.129.754(ÃÃ)1management1.72.081À.561(ÃÃ)À.581(ÃÃ)1petition conﬂictmanagement5.Team performance$9,339À.323(Ã).216.195.00116.Team satisfaction 4.15À.057.561(ÃÃ).664(ÃÃ)À.310(Ã).493(ÃÃ)Ãp o0.05.ÃÃp o0.01.nonhierarchically structured groups had signiﬁcantly better performance than hierarchical groups (F 53.88,p o 0.05),thus supporting H1.Hierarchical regression analyses (Table 2)were conducted to examine the effect of structure,trust,and conﬂict management variables on team performance,as well as satisfaction with teamwork.The results demonstrated a statistically signiﬁcant effect of structure on team performance.The team structure variable accounted for an appreciable amount of total variance (R 25.105).However,structure did not have a signiﬁcant effect on overall team satisfaction.Our second hypothesis (H2a and H2b)focused on the relationship between trust and team effectiveness:performance and satisfaction.Table 3shows that there is no direct effect of trust on team performance.Although this result did not support H2a,it did show a statistically signiﬁcant effect of trust on team satisfaction (R 25.394),and trust accounted for a considerable amount of variance,thus supporting hypothesis H2b.From the correlation analysis (Table 1),a higher level of trust was associated with a collaboration conﬂict management style.This suggested that teams with a high level of trust and whose members placed high conﬁdence in their teammates’abilities and behaviors tended to lean toward a more collaborative approach to solving conﬂicts.Table 2suggests that the two groups did not differ signiﬁcantly in terms of trust level,conﬂict management styles,or team satisfaction.Therefore,H2c was not supported.Table 3indicated a signiﬁcant effect of the collaboration conﬂict management style on team satisfaction (R 25.227)but no signiﬁcant effect on team performance.Thus H3a was refuted,and H3b was supported.According to Table 1correlation results,the trust level of the group was positively correlated with its collaboration conﬂict manage-ment style (r 5.754,p o .01).This result supported by H3c.Table 3showed that the competition conﬂict management style had no signiﬁcant effect on either team performance or satisfaction,supporting H3d and H3e.Although a correlation analysis showed negative2Mean (SD )Dependent VariableHierarchical Group Nonhierarchical Group F ,df Signiﬁcance Level Trust4.134 4.142.011,1.917Collaboration conﬂict management4.268 4.351.661,1.440Competition conﬂict management1.646 1.69.237,1.629Team performance$10,971$7,498 4.204,1.048ÃTeam satisfaction4.15 4.12.115,1.736Ãp o 0.05.relationships between a competition conﬂict management style and team satisfaction,the regression analysis did not show a signiﬁcant effect. Discussion and ConclusionThere are several importantﬁndings of this study worthy of further discussion and investigation.StructureThe results of this study indicated a signiﬁcant effect of team structure on team performance.In the present study,the teams with a non-hierarchical structure outperformed those with a hierarchical structure,a ﬁnding consistent with Urban et al.(1995).Interpretation of thisﬁnding should not exclude considerations of the task environment.The teams worked in an asynchronous online environment,which is commonly believed to bring a higher degree of vagueness,complexity,and lack of structure(Workman,Kahnweiler,&Bommer,2001)into virtual team-work process than face-to-face settings.These attributes may increase the degree of difﬁculty of communication in virtual teamwork.For hierarchically structured teams,each person held a specialized role,and extensive communication was needed for team members to make decisions and maintain routine operations of the team in order to achieve the goal of accomplishing a complex task such as running a simulated industry.Effective communication may be disrupted by possible misunderstandings and disputes stemming from a lack of visual cues in asynchronous virtual teaming environments.Thus it was possible that team members had to spend extra resources on maintenance of the team’s daily communications that may not add to team performance.However, in nonhierarchical teams,each person had a higher degree of autonomy 3Team Performance Team SatisfactionR2b R2b Structure.105ÃÀ.042Ã.003À.149 Trust.046.030.394ÃÃ.105 Collaboration conﬂict management.049.431.227ÃÃ.709ÃÃCompetition conﬂict management.057.282.000À.009 R2Total.257.624F 2.837Ã13.742**df4,334,33Ãp o0.05.ÃÃp o0.01.。

非酒精性脂肪性肝病代谢组学研究进展

机制尚未完全明确，１９９８年Ｄａｙ等［１２］提出“二次打击”学说。开。同时ＮＡＦＬＤ肝硬化患者与酒精性肝硬化患者也可有效区
随后Ｔｉｌｇ等［１３－１４］提出“多重平行打击”理论，包括遗传因素、分开（ＡＵＣ＝０．８３）。他们认为此方法可作为区分ＮＡＦＬＤ纤维
ＩＲ、氧化应激、脂毒性、慢性炎症、纤维化、免疫和肠道菌群等，化程度及诊断的无创生物标志物，且可以显著减少对肝活检的
黄酯和１３－ｃｉｓＲＡ呈正相关。他们在人类组织中首次检测到验证；单不饱和ＴＡＧ的增加可能是ＮＡＦＬＤ和ＣＨＢ患者ＮＡＳＨ
ａｔＲＡ的活性代谢物４－ｏｘｏ－ａｔＲＡ，表明这种类维生素Ａ可能的特异性标志物。
有助于人体类维生素Ａ的信号传导。肝脏维生素Ａ的稳态平２．３代谢组学对ＮＡＦＬＤ药物作用与疗效研究的推动作用
录组学、蛋白质组学为代表的系统生物学技术提供了新的技术展的新学科，代谢组学较为全面的展示了机体的代谢结果，为
与思路。区别于其他组学技术，以内源性小分子代谢物为研究临床医学提供了新的技术和方法。
对象的代谢组学可以很好的揭示机体变化的最终代谢结果。因２非酒精性脂肪性肝病（ＮＡＦＬＤ）
收基作ＤＯ稿金者Ｉ：日项简１０期目介．３：：：９１２上栾研６７０９）２海究雨／０ｊ．中婷－ｉｓ医１ｓ（ｎ１药．１－１９大０９０００６学１—；修－附）５回，属２女５日第６，．期七主２０：人２要２１０民．２从００医４事－．院０１慢４２人７－性才１肝７培病养计的划基（础ＸＸ与２０临１９床－通信作者：顼志兵，ｘｚｂ６１６０＠１６３．ｃｏｍ
和遗传易感密切相关的代谢应激性肝损伤，包括非酒精性单纯１代谢组学概述
性肝脂肪变（ＮＡＦＬ）、非酒精性脂肪性肝炎（ＮＡＳＨ）、肝硬化和１．１代谢组学含义代谢组学最初于１９９９年由Ｎｉｃｈｏｌｓｏｎ

《现代分子生物学》期末考试试题库

1.简述转座子的发现过程和意义发现：转座子最初是Barbara McClintock 于1940年代在玉米的遗传学研究中发现的，当时称为控制元件。

McClintock 的发现并没有引起重视，直到20世纪60年代后期，Shapiro在大肠杆菌中发现一种由插入序列所引起的多效突变，之后又在不同实验室发现一系列可转移的抗药性转座子，才重新引起人们重视。

1983年McClintock被授予诺贝尔生理学与医学奖，距离她公布玉米调控因子的时间已有32年之久。

意义:2.请简述基因组DNA的半保留复制是如何证明的3.简述pull-down与co-IP的基本原理、应用和区别参见赵珊珊PPT区别：Co-IP和GST pull-down的区别Co-IP和GST pull-down都是用于检测蛋白相互作用的实验，两者有很多相似之处，如只能检测强相互作用、只能定量分析、不能检测瞬时相互作用等。

同时两者在原理及实验操作上也存在一定的区别，下文就Co-IP和GST pull-down在原理及操作流程上的区别做一简述。

Co-IP和GST pull-down原理区别GST pull-down方法的基本原理是：利用重组技术将探针蛋白与GST融合，融合蛋白通过GST与固相化的载体上的GTH亲和结合。

因此，当与融合蛋白有相互作用的蛋白通过层析柱时或与此固相复合物混合时就可被吸附而分离。

免疫共沉淀（Co-IP）原理为用某一蛋白的抗体，在细胞裂解液中与相应的蛋白（诱饵蛋白）结合，用Protein A/G将抗原抗体复合物拉下，最后在拉下的复合物中检测是否存在与诱饵蛋白相结合的目的蛋白。

Co-IP和GST pull-down实验操作区别Co-IP实验为体内实验条件，蛋白质的相互作用可以在天然状态下进行，其优点为可以避免人为影响，还可以分离得到天然状态下相互作用的蛋白复合体，缺点是无法证明两个蛋白之间是直接的相互作用还是间接的相互作用；GST pull-down实验为外实验条件，可以去除其它蛋白的影响，从而确定目的蛋白和待检测蛋白是否可以发生直接相互作用。

1.最新.The_effects_of___electromyographic_activity_on_the_accuracy

The effects of electromyographic activity on the accuracy of the NarcotrendÒmonitor compared with the Bispectral Index during combined anaesthesiaP.Panousis,1A.R.Heller,3M.Burghardt,1J.U.Bleyl2and T.Koch41Staff anaesthesiologist,2Consultant,3Senior Consultant,4Head of Department,Department of Anaesthesiology andIntensive Care Therapy,University Hospital,Fetscherstr.74,01307Dresden,GermanySummaryThe NarcotrendÒis a monitor system for the assessment of depth of anaesthesia.The objective ofthis trial was to investigate the susceptibility of the Narcotrend to electromyographic(EMG)activity when compared with the Bispectral Index(BIS).We enrolled33patients undergoingmajor urological procedures under combined anaesthesia(thoracic epidural analgesia and general anaesthesia).Anaesthetic depth was assessed simultaneously by the BIS XP and Narcotrend.Theintended anaesthetic depth ranged between40and55in the BIS and between D2and D0inthe Narcotrend.BIS,but not Narcotrend,values correlated signiﬁcantly(p<0.0001)with EMG.BIS values between70and80occurred intermittently above an EMG activity of35dB,whereasthe Narcotrend and the clinical signs remained unchanged during the period of elevated BIS values.None of the patients reported intra-operative awareness.Increased electromyographic activitydoes not affect Narcotrend values.Under combined anaesthesia,the Narcotrend monitor is morereliable when compared with the BIS regarding susceptibility to increased EMG activity........................................................................................................Correspondence to:P.PanousisE-mail:periklis.panousis@uniklinikum-dresden.deAccepted:18April2007Epidural administration of local anaesthetics during combined anaesthesia(thoracic epidural analgesia and general anaesthesia)reduces the amount of inhaled and intravenous anaesthetics required for maintenance of an adequate anaesthetic depth[1–3].To quantify the anaes-thetic depth and to avoid intra-operative awareness and recall,some investigators used Bispectral Index-guided administration of the anaesthetic agents.The individual adjustment of the anaesthetic depth to its actual demand led to a signiﬁcant decrease in the requirement for isoﬂurane[1],sevoﬂurane[2]and propofol[3]. However,an increasing number of case reports[4–6] and randomised controlled trials[7–10]have pointed out the inaccuracies of the BIS which result from warming devices,vasoactive drugs and,most of all,from increased electromyographic activity.A monitor system(BIS)that has been actually designed to optimise the dosage of anaesthetic agents,fails to assess the anaesthetic depth accurately when EMG activity increases as a sign of recovery from neuromuscular blockade.This may mislead the anaesthetist to increase the dosage of anaesthetics in an attempt to re-adjust the anaesthetic depth,resulting in a possible haemodynamic deterioration or a prolonged recovery due to inadequate deep anaesthesia and unnec-essary additional muscular paralysis.The NarcotrendÒ(MonitorTechnik,Bad Bramstedt, Germany)is an electroencephalographic device which has been commercially available in Europe since2000and recently received US Food and Drug Administration approval.Up to now,there is a lack of data regarding possible interactions between the Narcotrend and EMG activity. This is theﬁrst study designed to investigate the effects of EMG activity on the accuracy of the Narcotrend values under combined anaesthesia when compared to BIS. MethodsPatientsAfter institutional approval and written informed consent, 33consecutive patients,aged26–81years,ASA physical state II and III,scheduled for major urological surgeryAnaesthesia,2007,62,pages868–874doi:10.1111/j.1365-2044.2007.05145.x .....................................................................................................................................................................................................................(retropubic radical prostatectomy or nephrectomy)under a combination of thoracic epidural analgesia and general anaesthesia were enrolled in the investigation. Exclusion criteria were patient’s refusal for the peri-operative use of epidural analgesia,a history of drug and/or alcohol abuse,cerebrovascular and central nervous diseases,bleeding or coagulation disorders,concomitant antiplatelet therapy,known allergic diathesis to anaes-thetic drugs or pregnancy.Pre-operative arrangements/monitoringPatients received0.1mg.kg)1midazolam orally45min prior to induction of general anaesthesia.Concomitant medication was continued as indicated.Aﬁve-lead electrocardiogram(ECG)including measurement of segmental ST depression(II,aVF,V5),and pulse oximetry were recorded.Arterial pressure was monitored continuously in the left radial artery(CMS MonitorÒ, model M1092A,Hewlett-Packard GmbH,Bo¨blingen, Germany).A central venous catheter was placed in the internal jugular vein to obtain continuous monitoring of the central venous pressure.Anaesthetic depth was assessed simultaneously by the BIS XP monitor(BISÒsensor,Aspect Medical Systems Natick,MA)and the Narcotrend(version4.0).After careful preparation of the skin,three silver⁄silver-chloride gel-ﬁlled electrodes(Blue Sensor;Medicotest, Olstykke,Denmark)were placed on the forehead for Narcotrend recordings.The BIS XP compatible elec-trode,BIS-Quattro,containing four silver⁄silver-chloride gel-ﬁlled adhesive electrodes,was placed according to the instructions of the manufacturers.Electrode impedance of both monitor systems was kept below5k W.The smoothing rate for the BIS XP was15s.Thoracic epidural analgesiaBefore induction of anaesthesia,an epidural catheter was inserted through an18-gauge Tuohy needle(PerisafeÒPlus,BD,Bidford-on-Avon,UK)with the loss-of-resistance method in the sitting position at a midthoracic level with the bevel facing in a cephalad direction.The catheter was inserted3–4cm into the epidural space.After a negative aspiration test,a test dose of3ml of lidocaine2% was administered for detection of intrathecal misplacement of the catheter.Intra-operative analgesia was performed by application of10ml ropivacaine0.3%and1.0l g.ml)1 sufentanil via the epidural catheter every60min. General anaesthesiaAnaesthesia was induced with1.5mg.kg)1propofol and 0.5l g.kg)1sufentanil.Tracheal intubation was facilita-ted by0.5mg.kg)1rocuronium.General anaesthesia was maintained by desﬂurane in oxygen⁄nitrous oxide (35%⁄65%).Patients were mechanically ventilated to an end-tidal carbon dioxide of4.8–5.3kPa at a fresh gas ﬂow of1l.min)1.(Primus,Dra¨ger,Lu¨beck,Germany). Body temperature was maintained at a minimum of 36°C with warmed infusions.Study protocolElectromyographic activity was indicated continuously on the BIS XP platform and compared with electrical stimulation of the ulnar nerve at the wrist by the nerve stimulator(InnervatorÒNS252,Fisher&Paykel, Healthcare,Auckland,New Zealand)using the train-of-four stimuli(TOF,2Hz for2s).Anaesthetic depth, haemodynamic parameters(heart rate and mean arterial pressure)and clinical signs(lacrimation,diaphoresis and patient’s movements)were recorded continuously and documented at5-min intervals.Increases in the EEG values(BIS and⁄or Narcotrend),indicating an inadequate anaesthetic depth,were treated only if they were accompanied by simultaneous changes of the haemo-dynamic parameters for more than20%of baseline values and⁄or changes of the clinical signs.Insufﬁcient intra-operative analgesia was determined as increase of mean arterial pressure and⁄or heart rate for more than20% of baseline values following surgical stimulation in the presence of normovolaemia(central venous pressure 8–12mmHg).In the case of insufﬁcient intra-operative analgesia,continuous administration of remifentanil starting with0.2l g.kg)1.min)1was allowed.When haemodynamic measures returned to baseline values and clinical signs indicated sufﬁcient analgesia,remifentanil administration was tapered until it reached zero.Desﬂurane adjustment for maintenance of BIS and Narcotrend within the intended range was performed continuously during surgery with an allowed stabilisation phase of5min following changes in the desﬂurane administration.Postoperative follow-upAfter skin closure,the volatile anaesthetic was discontin-ued and following extubation of the trachea in the operating room,patients were monitored for at least 60min in the post anaesthesia care unit(PACU).To detect intra-operative awareness or recall,patients were interviewed immediately and2weeks after surgery using the Brice[11]questionnaire:1What is the last thing you remember,before you fell sleep?2What was theﬁrst thing you remember,waking up? 3Do you remember anything else between those two points?4Did you have dreams?5Were they pleasant or frightening?StatisticsLinear regression was used to assess the relation between EMG activity and EEG readings.For both BIS and Narcotrend,a linear model wasﬁtted with EMG as predictor variable.As the data come from repeated measurements of the same subjects,a random intercept term was included in the model.As the observations are taken longitudinally,within-subject errors are likely to be autocorrelated.Aﬁrst-order autoregressive process was employed to account for this special covariance structure. Because of different durations of anaesthesia,missing values occurred after the90th min in a number of subjects.Individual plots of observed andﬁtted values over time showed an increasing lack ofﬁt after that time. Therefore,analysis was restricted to theﬁrst90min. After allowing for different variances in each subject, normal probability plots(Q-Q-plots)approximated a straight line through the origin,thus indicating normal distribution of the residuals.p values were calculated for the effect of EMG.The goodness ofﬁt of the resulting models was evaluated by the squared correlation betweenﬁtted and observed values as a substitute for r-squared in linear models without repeated measures.The statistical analysis was performed using GNU R [12]with the NLME package[13].ResultsMeasurements could be performed in all33patients. None of the patients had to be removed from evaluation due to violations of the study protocol or inappropriate signal quality due to artefacts in both monitor systems. Patients’characteristics,type and duration of surgery are presented in Table1.Combined anaesthesia could be performed in all patients.Epidural administration of ropivacaine0.3%+ sufentanil1l g.ml)1led to sufﬁcient intra-operative analgesia,and additional remifentanil administration due to signs of inadequate intra-operative analgesia was not necessary.Neuromuscular blockade diminished within 40(±10)min after injection of rocuronium for facilitation of tracheal intubation as indicated by the EMG value on the BIS XP monitor and the stimulation of the ulnar nerve by means of the nerve stimulator(TOF=4).During the further course of surgery,no repeated administration of neuromuscular blocking agents was necessary.There were no intra-or postoperative complications related to the anaesthetic regimen.All epidural catheters were removed within a mean(SD)of5(1)days after surgery and all patients were discharged within15days after surgery.During the interviews(Brice questionnaire), no patient reported intra-operative awareness or recall. Mean(SD)duration of surgery was170(29)min without complications,such as extensive blood loss, haemodynamic deterioration,hypothermia,or prolonged neuromuscular blockade.End-tidal concentration of desﬂurane during surgery ranged between 2.7%and 2.3%,equal to1–0.8minimum alveolar concentration (MAC)in nitrous oxide,respectively.Of990possible measurements(33patients and30time points of documentation in5-min intervals),data of625 measurements could be obtained due to the shorter duration of surgery among some patients.For BIS,but not for Narcotrend,there was a strong positive correla-tion with EMG(p<0.0001).This correlation holds true for both subject means and individual mean centred readings with R2=0.385for the BIS and R2=0.008for the Narcotrend,respectively(Figs1and2).High BIS values(>70)occurred among16(48.4% of all cases)patients at EMG activity level>30dB as indicated by the BIS XP platform and veriﬁed by electrical stimulation of the ulnar nerve(TOF=4)Table1Patients’characteristics,duration and type of surgery.Age; year Sex;F/MHeight;cmWeight;kgDuration;minSurgery;typeMean(SD)65(10)4⁄29177(7)82(13)170(29)10NE⁄23RPE F,female;M,male;RPE,radical prostatectomy;NE,nephrectomy.without simultaneous increases in the Narcotrend values or changes in the clinical signs(Fig.3).During that period,patients were asked to squeeze the investigator’s hand to reproduce intra-operative consciousness,but none of the patients responded.Even after painful squeezing of the M.trapezius,there was no indication of inadequate anaesthetic depth.For these patients,the median BIS value was75and the median EMG activity 38dB.A regression model revealed an R2of0.179with p<0.001.In contrast to the BIS,there were no increases in the Narcotrend values throughout surgery due to interaction with increased EMG activity.DiscussionIn the present study,the BIS and Narcotrend monitor systems were evaluated regarding their susceptibility to electromyographic activity during major urological pro-cedures under the combination of thoracic epidural analgesia and general anaesthesia.Our results demonstrate a signiﬁcant correlation between EMG and BIS,but not between EMG and Narcotrend under constant anaes-thetic depth and sufﬁcient intra-operative analgesia,as indicated by the haemodynamic parameters,the clinical signs and the lack of patients’response to tactile and verbal stimuli during elevated BIS values.The development of the Narcotrend algorithm is based on descriptions of EEG pattern changes during human sleep,ﬁrst described by Loomis in1937[14].Loomis deﬁnedﬁve stages,A–E,to distinguish the different hypnotic stages.In the late1990s,Schultz developed the Narcotrend,a monitor device for the assessment of anaesthetic depth,using the Loomis classiﬁcation ofﬁve different hypnotic stages,adding15substages for a more precise classiﬁcation of the EEG(Table2).Brieﬂy,the signals are sampled at128samples per second with a 12-bit resolution,and are bandpassﬁltered to0.5–45Hz. The power spectrum is calculated by means of a Fast Fourier Transformation(FFT),allowing enormous visual compression of spectral data by stacking and thus simpliﬁed recognition of time-related changes in the EEG.Impedances and electrode potentials are continu-ously tested at deﬁned time intervals to ensure a high EEG signal quality.Trace segments with a length of20s, the so-called epochs,are the units of classiﬁcation. Followingﬁltering of artefacts,the EEG parameters that are relevant for the detection of suppression and that contribute to the discriminant functions are calculated and updated.Finally,a smoothing value of the Narcotrend classiﬁcation is calculated as a weighted mean(weights depending on the background parameters)[15].The BIS algorithm includes three EEG subparameters, depending on the depth of anaesthesia:‘Burst suppres-sion’,the‘SynchFastSlow’and the‘BetaRatio’.Burst suppression has a greater weight in the calculation of BIS values during general anaesthesia when compared to sedation.The SynchFastSlow is deﬁned as the logari-thm of the following ratio:the sum of bispectrum peaks in the0.5–47Hz range divided by the sum of the bispectrum peaks in the40–47Hz range.The weight of SynchFastSlow in the BIS index calculation relates to the degree of EEG activity during general anaesthesia. The weight of BetaRatio is greatest at light sedation. The BetaRatio is calculated as the log of the ratio of power in two empirically derived frequency bands: logðP30À40Hz=P11À20HzÞ[16].Both Narcotrend and BIS algorithms use frequencies between0.5and47Hz to compute the raw EEG into a narcotic stage.Regarding EMG activity creating frequen-cies from25to300Hz[17],this might be a source of interference between the two monitor systems and the muscle activity,due to an overlap between the frequencies generated by increased muscular activity and the frequen-cies originating from the EEG.The BIS XP platform contains an EMG activity bar that indicates the muscle activity throughout the measure,and the manufacturers point out the improvements in the software of the BIS in combination with the new BIS QuattroÒelectrode as regards indicating andﬁltering artefacts,like electromyo-graphic activity.However,the results of our investigation do not conﬁrm the expectations of these improvements.None of the Narcotrend versions contains an indicator about EMG activity.Considering that the Narcotrend algorithm includes frequencies between0.5and47Hz, one would assume that increased EMG activity would also interfere with the EEG recordings and thereby affect the accuracy of the values.However,during the measures in all our patients we did not observe an increase in the Narcotrend values similar to the BIS values during enhanced EMG activity.The exact algorithm of both monitor systems has not yet been published in detail.Regarding the BIS monitor,the possible explanation about sudden and⁄or periodical increases of the values in the presence of enhanced EMG activity could be the overlapping frequencies of EMG and EEG.Although the Narco-trend algorithm and EMG activity‘share’the same frequency band,increased EMG activity did not lead to any change in the Narcotrend values.A possible explanation of this observation could be that the Narcotrend algorithm does not process EMG activity. As long as the exact algorithm is not published,this explanation remains speculative.Recently,Schneider et al.[18]and Russell[19] presented challenging data about the accuracy of the Narcotrend.Schneider and colleagues investigated the reliability of the Narcotrend during induction of anaes-thesia regarding an adequate detection of the transition between awareness and unconsciousness.The Narcotrend failed to detect accurately changes in the consciousness of surgical patients during induction of general anaesthesia and regained consciousness after interruption of propofol administration following tracheal intubation.Russell used the isolated forearm technique to assess the reliability of the Narcotrend at a deﬁned anaesthetic depth and concluded that the Narcotrend is unable to detect consciousness during general anaesthesia due to the fact that patients responded to verbal commands.The main difference between our study design and that of Schneider et al.is that we performed our measures during a steady state.We evaluated the Narcotrend during surgery at a deﬁned anaesthetic depth,without changes in the administration of desﬂurane,to provoke transient awake phases.In contrast to the study of Russell,who examined12 patients,we did not observe any periods during our investigation in which the monitor of the Narcotrend was blank due to malfunction or inappropriate signal quality. Based on Russell’sﬁndings,we asked the patients to squeeze the anaesthesiologist’s hand at BIS values>60; none of the patients responded.Another contrast to the above-mentioned study was the fact that we targeted a ‘deeper’anaesthetic depth as indicated by the Narco-trend(D2-D0)in contrast to Russell who intended C-levels,which is comparable with deep sedation or light anaesthesia.Processed EEG monitors are applied increasingly in anaesthetic practice.Patients undergoing major abdom-inal or urological surgery in a combination of epidural analgesia and general anaesthesia may beneﬁt from the individual adjustment of the anaesthetic depth.The synergistic effects of these techniques decrease the requirement of inhaled and intravenous anaesthetic agents with consecutive faster emergence from anaesthesia and recovery from surgery[20].Epidural analgesia decreases not only the requirement of anaesthetic agents,but also reduces the amount of neuromuscular blocking agents (NMBA)required for an optimal surgicalﬁeld[3,21]. Patients require fewer NMBAs as the afferents from the surgicalﬁeld are blocked at spinal level.Conclusively, EMG activity is relatively high in the absence of NMBAs and this might be a source of interference with the p-EEG devices,affecting thereby their reliability in assessing accurately the anaesthetic depth.As shown for the BIS [4–10],EMG activity inﬂuences its accuracy,in the manner that adequately anaesthetised patients appear more awake than they in fact are.A possible(unnecessary) increase of the anaesthetic depth and a simultaneous administration of NMBAs with consecutive haemo-dynamic deterioration,or prolonged emergence may counterbalance the advantages of a p-EEG,individually adjusted administration of the anaesthetic agents.Ever since it was stated that p-EEG monitoring may inﬂuence patient outcome[22],clinicians expect p-EEGTable2Narcotrend stages and the respective Narcotrend index ranges(version4.0).Narcotrend stage Narcotrend indexAwakeA95–100B090–94SedatedB185–89B280–84Light anaesthesiaC075–79C170–74C265–69General anaesthesiaD057–64D147–56D237–46General anaesthesia with deep hypnosisE027–36E120–26E213–19General anaesthesia with increasing burst suppressionF05–12F11–4monitor systems to be robust against interferences throughout surgery and provide data which are reliable and comparable with the clinical signs.This is theﬁrst study investigating the effects of EMG activity on the accuracy of the Narcotrend during com-bined anaesthetic procedures.Among our33patients, unlike the BIS XP,the Narcotrend was not affected by enhanced electromyographic activity.References1Casati L,Ferna´ndez-Galinski S,Barrera E,Pol O,Puig MM.Isoflurane requirement during combined general⁄epidural anaesthesia for major abdominal surgery.Anesthesia andAnalgesia2002;94:1331–7.2Hodgson PS,Liu S.Epidural lidocaine decreases sevoflurane requirement for adequate depth of anaesthesia as measured by the Bispectral Index monitor.Anesthesiology2001;94: 799–803.3Agarwal A,Pandey R,Dhiraaj S,et al.The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by Bispectral Index)and maintenance doses of fentanyl and vecuronium.Anesthesia and Analgesia2004;99: 1684–8.4Bruhn J,Bouillon TW,Shafer SL.Electromyographicactivity falsely elevates the Bispectral Index.Anesthesiology 2000;92:1485–7.5Hemmerling TM,Fortier JD.Falsely increased Bispectral Index values in a series of patients undergoing cardiacsurgery using forced-air-warming therapy of the head.Anesthesia and Analgesia2002;95:322–3.6Panousis P,Koch T,Heller AR.The effects of electro-myographic activity on the Bispectral Index during com-bined anaesthesia.Anesthesia and Analgesia2006;103:1605. 7Ishiyama T,Oguchi T,Iijima T,Matsukawa T,Kashimoto S, Kumazawa T.Ephedrine,but not phenylephrine,increases Bispectral Index values during combined general and epidural anaesthesia.Anesthesia and Analgesia2003;97:780–4.8Vivien B,Di Maria S,Ouattara A,Langeron O,Coriat P, Riou B.Overestimation of Bispectral Index in sedatedintensive care unit patients revealed by administration ofmuscle relaxant.Anesthesiology2003;99:9–17.9Inoue S,Kawaguchi M,Sasaoka N,Hirai K,Furuya H.Effects of neuromuscular block on systemic and cerebralhaemodynamics and Bispectral index during moderate ordeep sedation in critically ill patients.Intensive Care Medicine 2006;32:391–7.10Liu N,Chazot T,Huybrechts I,Law-Koune JD,Barvais L, Fischler M.The influence of a muscle relaxant bolus onBispectral and Datex-Ohmeda entropy values duringpropofol-remifentanil induced loss of consciousness.Anesthesia and Analgesia2005;101:1713–8.11Brice DD,Hetherington RR,Utting JE.A simple study of awareness and dreaming during anaesthesia.British Journal of Anaesthesia1970,2005;42:535–42.12R Development Core Team.A Language and Environment for Statistical Computing.Vienna:R Foundation for Statistical Computing,2004.Available:. 13Pinheiro J,Bates D,DebRoy S,Sarkar D.NLME.Linear and Nonlinear Mixed Effects Models:R package version3.1-55, 2005.Available:.14Loomis AL,Harvey EN,Hobart CA.Cerebral states during sleep as studied by human brain potentials.Journal ofExperimental Psychology1937;21:127–44.15Kreuer S,Wilhelm W.The Narcotrend monitor.In: Best Practice&Research Clinical Anaesthesiology2006;20:111–9.16Rampil IJ.A primer for EEG signal processing in anesthesia.Anesthesiology1998;89:980–1002.17Jensen EW,Litvan H,Struys M,Martinez Vasquez P.Pitfalls and challenges when assessing the depth ofhypnosis during general anaesthesia by clinical signs and electronic indices.Acta Anaesthesiologica Scandinavica2004;48:1260–7.18Schneider G,Kochs EF,Horn B,Kreuzer M,Ningler M.NarcotrendÒdoes not adequately detect the transitionbetween awareness and unconsciousness in surgical patients.Anesthesiology2004;101:1105–11.19Russell IF.The Narcotrend‘depth of anaesthesia’monitor cannot reliably detect consciousness during general anaes-thesia:an investigation using the isolated forearm technique.British Journal of Anaesthesia2006;96:346–52.20Kehlet H,Dahl JB.The value of multi-modal or balanced analgesia in postoperative pain relief.Anesthesia and Analgesia 1993;77:1048–56.21Heller AR,Litz RJ,Djonlagic I,et al.Kombinierte Ana¨s-thesie mit Epiduralkatheter.Eine retrospektive Analyse des perioperativen Verlaufs bei Patienten nach radikalerProstatektomie.Anaesthesist2000;49:949–59.22Monk TG.Processed EEG and patient outcome.Best Practice &Research Clinical Anaesthesiology2006;20:221–8.。

半枝莲总黄酮提取工艺优化及抗氧化、抗肿瘤活性评价

郑沛，文敏，刘秋叶，等. 半枝莲总黄酮提取工艺优化及抗氧化、抗肿瘤活性评价[J]. 食品工业科技，2023，44（23）：194−202. doi:10.13386/j.issn1002-0306.2023020199ZHENG Pei, WEN Min, LIU Qiuye, et al. Optimization of Extraction Process and Evaluation of Antioxidant and Antitumor Activities of Total Flavonoids from Scutellaria barbata [J]. Science and Technology of Food Industry, 2023, 44(23): 194−202. (in Chinese with English abstract). doi: 10.13386/j.issn1002-0306.2023020199· 工艺技术 ·半枝莲总黄酮提取工艺优化及抗氧化、抗肿瘤活性评价郑　沛1,2，文　敏1，刘秋叶1，王　潇1,2，左亚杰1,2,*（1.湖南中医药大学第一附属医院，湖南长沙 410007；2.湖南中医药大学，湖南长沙 410208）摘　要：本实验旨在优化半枝莲总黄酮提取工艺，评价半枝莲总黄酮纯化物抗氧化、抗肿瘤活性。

采用单因素实验结合响应面Box-Behnken 设计对半枝莲总黄酮提取工艺进行研究，主要考察了提取时间、料液比、提取温度和乙醇体积分数对黄酮得率的影响，从而得出半枝莲总黄酮提取的最佳工艺；采用DPPH 、ABTS 法检测半枝莲总黄酮纯化物的抗氧化活性；采用MTT 法检测纯化物对NCI-H1299、HepG2、MHCC-97H 、HuH-7细胞增殖的影响。

结果表明，半枝莲总黄酮提取最佳工艺为提取时间93 min 、料液比1:41（g/mL ）、提取温度为68 ℃、乙醇体积分数为75%，该条件下半枝莲总黄酮得率为26.46 mg/g 。

广西省成人高等教育学士学位英语考试真题

广西省成人高等教育学士学位英语考试真题Adult Higher Education Bachelor's Degree English Exam Questions in Guangxi ProvincePart 1 Reading Comprehension (40 points)Directions: There are four passages in this part. Each passage is followed by some questions or unfinished statements. For each of them, there are four choices marked A, B, C and D. You should decide on the best choice and mark the corresponding letter on the Answer Sheet with a single line through the center.Passage 1Questions 1 to 5 are based on the passage below.In recent years, there has been a growing emphasis on the importance of environmental protection. The rapid development of technology and industry has brought about severe pollution problems that threaten the health of the planet and its inhabitants. As a result, many governments and organizations have started to take action to address these issues.1. What is the passage mainly about?A. The rapid development of technology and industryB. The importance of environmental protectionC. The health problems caused by pollutionD. Government policies on pollution control2. According to the passage, what is one consequence of technological and industrial development?A. Increased wealth for nationsB. Improved health for humansC. Pollution problems for the environmentD. Better communication between countries3. Which of the following is NOT mentioned as a reason for the emphasis on environmental protection?A. The threat to the health of the planet and its inhabitantsB. The rapid development of technology and industryC. The need for increased government regulationsD. The pollution problems caused by human activities4. What is the result of governments and organizations taking action on environmental issues?A. Increased pollution levelsB. Greater economic growthC. Improved environmental conditionsD. Higher rates of industrial development5. What can be inferred about the future of environmental protection efforts from the passage?A. They will continue to grow in importanceB. They will become less necessary over timeC. They will be abandoned due to political reasonsD. They will focus on economic growth rather than sustainabilityPassage 2Questions 6 to 10 are based on the passage below.It is well known that regular exercise has a positive impact on physical health, but recent research has also shown that it can have significant benefits for mental well-being. Exercise has been found to reduce stress, improve mood, and even enhance cognitive function. This suggests that physical activity is not only important for staying fit but also for staying mentally sharp.6. What is the main idea of the passage?A. Exercise is essential for physical healthB. Regular exercise can improve mental well-beingC. Research on exercise is well-knownD. The benefits of exercise are overstated7. According to recent research, what is one benefit of exercise mentioned in the passage?A. Increased risk of stressB. Improved moodC. Decline in cognitive functionD. Diminished physical health8. What is suggested by the passage about the relationship between physical and mental health?A. They are unrelated to each otherB. They are both improved by regular exerciseC. Mental health is more important than physical healthD. Exercise has no impact on cognitive function9. Why does the author mention the positive effects of exercise on cognitive function?A. To explain the benefits of physical activityB. To emphasize the importance of mental sharpnessC. To highlight the need for further researchD. To question the validity of previous studies10. Based on the information in the passage, which of the following is true?A. Exercise only benefits physical healthB. Cognitive function is not affected by exerciseC. Physical activity is crucial for overall well-beingD. Mental well-being is unaffected by physical health practicesPassage 3Questions 11 to 15 are based on the passage below.The age of technology has transformed many aspects of our lives, including the way we communicate, work, and learn. The internet has made information more accessible than ever before, allowing people to connect with others, conduct business, and access educational resources online. This has led to an increasein remote work and online education opportunities for individuals around the world.11. What is the main topic of the passage?A. Technological advances in the modern ageB. The transformation of communicationC. The benefits of remote workD. The impact of the internet on education12. According to the passage, what has the internet made more accessible to people?A. Personal relationshipsB. InformationC. Travel opportunitiesD. Job opportunities13. How has the internet impacted education, as mentioned in the passage?A. It has decreased access to educational resourcesB. It has shifted the focus to traditional learning methodsC. It has increased online education opportunitiesD. It has made learning more difficult for students14. Which of the following is NOT mentioned as a result of the age of technology?A. Increased accessibility to informationB. More remote work opportunitiesC. Less reliance on digital communicationD. Improved educational resources15. What can be inferred about the future of education from the passage?A. It will move away from online platformsB. It will become less accessible to peopleC. It will continue to be influenced by technologyD. It will rely more on traditional methodsPassage 4Questions 16 to 20 are based on the passage below.Traveling can be a transformative experience that allows individuals to explore new cultures, learn about different perspectives, and create lasting memories. Whether it'sbackpacking through Europe, studying abroad in Asia, or volunteering in Africa, travel provides opportunities for personal growth and self-discovery. By stepping outside of their comfort zones, travelers can develop a greater appreciation for the diversity and beauty of the world.16. What is the main idea of the passage?A. Traveling is an expensive hobbyB. Travel can change a person's perspectiveC. Personal growth is not possible through travelD. Exploring new cultures is unnecessary17. According to the passage, what can travel provide individuals with?A. Opportunities for personal growth and self-discoveryB. Monetary wealth and physical possessionsC. A sense of isolation and lonelinessD. A deeper understanding of their own culture18. How does the author suggest travelers can develop a greater appreciation for the world?A. By staying within their comfort zonesB. By avoiding interactions with localsC. By embracing diversity and beautyD. By experiencing isolation and loneliness19. What is mentioned as a possible outcome of traveling, as stated in the passage?A. Increased ignorance of other culturesB. Greater awareness of global issuesC. A disdain for personal growth and self-discoveryD. A decrease in appreciation for diversity20. Based on the information in the passage, which of the following is true?A. Traveling is a waste of time and moneyB. Personal growth is not possible through travelC. Exploring new cultures can be enrichingD. Developing an appreciation for diversity is unnecessaryPart 2 Vocabulary and Structure (40 points)Directions: There are 40 incomplete sentences in this part. For each of them, there are four choices marked A, B, C, and D.You should decide on the best choice and mark the corresponding letter on the Answer Sheet with a single line through the center.21. She has applied _____ the job and is confident that she will get it.A. aboutB. forC. afterD. at22. The meeting is scheduled _____ 10:00 AM and 12:00 PM.A. toB. onC. atD. by23. My boss is always _____ me with too much work.A. overloadB. overloadingC. overloadedD. overloads24. His business grew rapidly, _____ he decided to expand into new markets.A. asB. soC. howeverD. therefore25. We _____ our best to complete the project on time.A. will tryB. tryingC. tryD. tries26. John couldn't believe his eyes _____ he saw the final results of the exam.A. asB. whenC. butD. that27. The new marketing campaign _____ a lot of attention from potential customers.A. receivesB. has receivedC. receivingD. received28. I need to improve my time management skills _____ I can meet all my deadlines.A. in order toB. so thatC. becauseD. although29. Sarah's presentation was so _____ that everyone fell asleep during it.A. boringB. boredC. boredlyD. bore30. We _____ our flight because of the heavy snowstorm.A. missingB. will missC. missedD. are missing31. The museum is closed _____ Mondays for maintenance work.A. inB. byC. atD. on32. The car hit the tree _____ it swerved off the road.A. afterB. becauseC. soD. when33. Please make sure to _____ your valuables before you leave the hotel.A. take withB. take overC. take offD. take away34. I have been _____ to study Japanese for a long time.A. wantingB. wantedC. wanted toD. wants35. The doctor advised him to _____ smoking for his health.A. quitB. quittingC. quitsD. quitted36. Mary put on her raincoat _____ it was raining heavily outside.A. becauseB. soC. thereforeD. as37. I have never _____ such rudeness in my life.A. seesB. have seenC. sawD. seen38. The train was late, _____ we missed our connection.A. soB. butC. thereforeD. however39. Could you please _____ the window? It's getting cold in here.A. closeB. closedC. closingD. to close40. We have been waiting for the bus _____ over half an hour now.A. sinceB. duringC. forD. fromPart 3 Cloze Test (10 points)Directions: There are 10 blanks in the following passage. For each blank, there are four choices marked A, B, C, and D. You should decide on the best choice and mark the corresponding letter on the Answer Sheet with a single line through the center.Language is the ____41____ by which human beings communicate with each other. It is essential for everyday____42____, work, and relationships. Through language, we can ____43____ our thoughts, emotions, and ideas ____44____ others. ____45____ is an important tool for expressing our creativity, sharing knowledge, and ____46____ information. Without language, our interactions with ____47____ would be limited, andour ____48____ to express ourselves effectively would be____49____. In today's globalized world, the ability to ____50____ in multiple languages is a valuable skill that can open up new opportunities and ____51____ understanding between people from different cultures. Language ____52____ us to connect with others, ____53____ our experiences, and ____54____ new perspectives. By ____55____ our language skills, we can broaden our horizons and enrich our lives.41. A. mediumB. mediumC. mediaD. mediums42. A. communicateB. communicatesC. communicationD. communications43. A. expressB. expressesC. expressionD. expressed44. A. forB. withC. onD. to45. A. LanguagingB. LanguageC. LanguagesD. Langue46. A. exchangeB. exchangedC. exchanges47. A. otherB. anotherC. othersD. the other48. A. abilityB. abilitiesC. ableD. abilities49. A. limitedB. limitlessC. limitD. limitedly50. A. speakB. speakingC. spokenD. spoke51. A. promoteB. promotesC. promotingD. promotion52. A. allowsB. allowedC. allowD. allowing53. A. rely onB. relay onC. relay uponD. relay in54. A. gainB. gainsC. gainedD. gaining55. A. improvingB. improvedC. improveD. improvesPart 4 Writing (30 points)Directions: For this part, you are required to write an essay in about 150 words on the topic "The Importance of LifelongLearning." You should base your essay on the outline given below and you should indicate the advantages and abilities that lifelong learning can bring to individuals in various aspects of life.Outline:1. Introduction: Define lifelong learning and its significance.2. Body:- Advantages of lifelong learning in personal development- Benefits of continual education in career advancement- Importance of ongoing learning in improving quality of life3. Conclusion: Summarize the benefits of lifelong learning and encourage the readers to embrace continuous education.【Sample Essay】Lifelong learning, also known as continuous education, is the process of gaining knowledge and skills throughout one's life. This form of learning plays a crucial role in personal development, career advancement, and overall quality of life. Firstly, lifelong learning allows individuals to acquire new knowledge and skills, which can enhance personal growth and fulfillment. By engaging in continual education, people canexpand their horizons, improve their critical thinking abilities, and maintain a curious and open-minded attitude towards the world. Additionally, ongoing learning is essential for career advancement as it enables individuals to stay relevant in a rapidly changing job market. Continuous education provides the opportunity to develop new skills, adapt to technological advancements, and enhance job performance. Lastly, lifelong learning is vital for improving the quality of life by promoting mental stimulation, creativity, and overall well-being. By embracing continuous education, individuals can lead more fulfilling and satisfying lives as they continue to learn and grow throughout their lifespan.In conclusion, lifelong learning offers numerous advantages and abilities to individuals across various aspects of life. From personal development to career advancement and quality of life enhancement, continual education plays a significant role in empowering individuals to reach their full potential. Therefore, I encourage everyone to embrace continuous education and make lifelong learning a fundamental part of their personal and professional growth. By committing to lifelong learning, we can continue to evolve, adapt, and thrive in an ever-changing world.。

氨糖在骨关节炎中的应用

killer NSAIs cause serious gastrointestinal and cardiovascular
adverse events, especially with long term use Glucosamine was used to be thought as disease modifying
Effects of glucosamine in patients with osteoarthritis
2016级硕士研究生：
研究生导师：周宗科教授
June, 2018
Introduction
Osteoarthritis of hip and knee is increasing non-steroidal anti-inflammatory drugs was used as the pain
Method
Statistical analysis: multivariable Bayesian hierarchical random effects models
Significant difference: we back transformed effect sizes to differences on a 10 cm visual analogue scale on the basis of a median pooled SD of 2.5 cm found in large scale osteoarthritis trials that assessed pain on a 10 cm visual analogue scale.
Result
Result
Result
Result
tests for interaction were all negative (P≥0.20 for interaction)

2024上海静安区高三英语二模

静安区2023学年第二学期期中教学质量调研高三英语试卷(完卷时间：120分钟满分：140分)2024年4月考生注意：1. 试卷满分140分，完卷时间120分钟。

2. 本调研设试卷和答题纸两部分，全卷共12页。

所有答题必须涂(选择题)或写(非选择题)在答题纸上，做在试卷上一律不得分。

第I 卷(共100分)I. Listening ComprehensionSection ADirections: In Section A, you will hear ten short conversations between two speakers. At the end of each conversation,a question will be asked about what was said. The conversations and the questions will be spoken only once. After you hear a conversation and the question about it,read the four possible answers on your paper,and decide which one is the best answer to the question you have heard.1. A. At a grocery store. B. At a florist's stand.C. At a bank counter.D. At an electronic shop.2. A. Sign up for a fitness class. B. Shop for fitness equipment.C. Have a fitness test.D. Watch a fitness video.3. A. Pay the ticket right away. B. Challenge the ticket.C. Ignore the ticket.D. Apologize to the parking officer.4. A. She is available on Saturday. B. She will cancel her dentist appointment.C. She can not cover the man's shift.D. She forgot about the shift.5. A. The woman had better give him an extension on the deadline.B. The woman had better draft the proposal by herself.C. The woman had better approve the proposal.D. The woman had better give insights on the budget section.6. A. She doesn't like animals from the shelter.B. She prefers buying pets from breeders.C. She thinks adopting a pet is a bad idea.D. She supports the idea of adopting a pet.7. A. Either of them is an experienced chef.B. Both of them have experienced failures in the kitchen.C. Neither of them are fond of cooking.D. Both of them are concerned about the new recipe.8. A. Bungee jumping is safeB. Bungee jumping is thrilling.C. Bungee jumping might have risks.D. Bungee jumping is sure to be regrettable.9. A. The man should borrow the book several days later.B. The woman urgently needs the book back.C. The man does not need to return the book quickly.D. The woman is unwilling to lend the man the book.10. A. The woman's parents will not appreciate a surprise party.B. The woman should prioritize her parents' preferences for the party.C The man dislikes the idea of a surprise party.D. The woman should plan a party based on her own preferences.Section BDirections: In Section B,you will hear two short passages and one longer conversation. After each passage or conversation,you will be asked several questions. The passages and the conversation will be read twice,but the questions will be spoken only once. When you hear a question,read the four possible answers on your paper and decide which one would be the best answer to the question you have heard.Questions 11 through I3 are based on the following speech.11. A. A pupil in need of help. B. A person promising to donate money.C. A member from a charity.D. A teacher in the Semira Region.12. A. 10%. B. 35%. C. 50%. D. 65%.13. A. To train teachers for the disabled. B. To help a pupil with special needs.C. To pay for a walking holiday.D. To organize a charity club for the disabled.Questions 14 through 16 are based on the following passage.14. A. To distract other students from doing well.B. To impress his friends with the shining ring.C. To improve his chances in the exam.D. To honor his grandfather by wearing a ring.15. A. By having enough time for breaks.B. By breaking down learning into portions.C. By informing teachers of the study habits.D. By wearing lucky objects.16. A. Start revision ahead of time.B. Reward oneself during revision.C. Consider different learning styles.D. Stay up late for the exam.Questions 17 through 20 are based on the following conversation.17. A. To inquire about travel recommendations.B. To discuss cultural festivals in Southeast Asia.C. To plan a solo travel adventure to Thailand.D To learn about Mr. Patel's travel experiences.18. A. Europe and Africa. B. Thailand and VietnamC. South America and Australia.D. Japan and China.19. A. Solely cultural exploration.B. Primarily outdoor adventures.C. A mix of cultural and outdoor experiences.D. Luxurious and private accommodations.20. A. It is ideal for meeting fellow travelers.B. It offers exclusive travel experiences.C. It is a more comfortable and secure stay.D. It offers authentic cultural immersion.II. Grammar and VocabularySection ADirections:After reading the passage below,fill in the blanks to make the passages coherent and grammatically correct.For the blanks with a given word,fill in each blank with the proper form of the given word;for the other blanks,use one word that best fits each blank.Beethov-hen's first symphonyOn a grey Friday morning at a Hawke's Bay farm,members of New Zealand's symphony orchestra dressed in black to perform their latest composition in front of a large crowd.The music contained many marks of traditional classical music,but as it began,the instruments started to make loud,rough sounds more commonly __21__(hear)in chicken coops than in an auditorium.However,no feathers were angered by this departure from tradition, ___22__the audience that gathered to listen to the concert last week was,in fact,a couple of thousand chickens.The piece of music-Chook Symphony No. 1-__23__(create)specifically for the birds out of an unlikely partnership between the orchestra and an organic free-range chicken farm which wanted a piece of chicken-friendly music to enrich its flocks' lives.“We've been playing classical music for the chickens for some years now because ___24 ___ is well researched that the music can calm the chickens down,”says Ben Bostock,one of the two brothers who__25(own)the Bostock Brothers farm. Research has shown animals can respond positively to classical music,and chickens are particularly responsive to baroque(巴洛克格),according to some studies.The composer,Hamish Oliver,__26__used the baroque tradition as a starting point and drew inspiration from composers such as Corelli,Bach,and Schnitke,wanted the piece to be playful by including sounds from a chicken's world. “The trumpet imitates the c hicken …the woodwind instruments are the cluckiest,especially if you take the reeds off. ”The early stages of composition were spent _______(test)out which instruments and sounds the chickens responded to best.“They didn't like any big banging. ”Bostock said,adding that when the birds respond positively to themusic,they tend__28__(wander)farther among the trees. Bostock now hopes chicken farmers around the world will use the piece of music to calm their own birds.For Oliver,having input from the farmers about __ 29__the chickens were responding to particular sounds and instruments was a highlight of the project.The symphony has searched exhaustively __30__any other examples of orchestras making music specifically for chickens and believes this to be a world-first,says Peter Biggs,the orchestra's chief executive.Section BDirections :Complete the following passage by using the words in the box. Each word can only be used once. Note thatA new way to reduce poachingResearchers are working on a pilot program backed by Russia's Rosatom Corp to inject rhino horns(犀牛角)with radioactive material,a strategy that could discourage consumption and make it easier to detect illegal trade.Poachers(偷猎者)killed 394 rhinos in South Africa for their horns last year,government data shows,with public and private game __31__lacking the resources needed to monitor vast tracts of land and protect the animals that live there.While the toll was a third lower than in 2019 and the sixth __32_drop,illegal hunting remains the biggest threat to about 20,000 of the animals in the country —the world's biggest population.Thousands of__33__sensors along international borders could be used to detect a small quantity of radioactive material____34___into the horns,according to James Larkin,a professor at the University of Witswatersrand in Johannesburg,who has a background in radiation protection and nuclear security. “A whole new_35_of people could be able to detect the illegal movement of rhino horn,"he said. Some alternate methods of discouraging poaching,including poisoning, dyeing and removing the horns,have raised a variety of opinions as to their virtue and efficacy.Known as The Rhisotope Project,the new anti-poaching __36__started earlier this month with the injection of an amino acid(氨基酸)into two rhinos' horns in order to detect whether the compound will move into the animals' bodies. Also,__37__studies using computer modeling and a replica rhino head will be done to determine a safe dose of radioactive material. Rhino horn is used in traditional medicine,as it is believed to cure disease such as cancer,__38__as a show of wealth and given as gifts."If we make it radioactive, these people will be hesitant to buy it,"Larkin said. "We're pushing on the whole supply chain. "Besides Russia's state-owned nuclear company,the University of Witwatcrsrand. scientists and private rhino owners are involved in the project. If the method is ___39__feasible,it could also be used to curb illegal trade in elephant ivory.“Once we have developed the whole project and got to the poi nt where we completed the proof of concept,then we will be making this whole idea ____40_to whoever wants to use it. " Larkin said.III. Reading ComprehensionSection ADirections: For each blank in the following passages there are four words or phrases marked A, B. C and D. Fill in each blank with the word or phrase that best fits the context.City air is in a sorry state. It is dirty and hot. Outdoor pollution kills 4. 2m people a year, according to the World Health Organization. Concrete and tarmac meanwhile,absorb the sun's rays rather than reflecting them back into space,and also ___41 ___plants which would otherwise cool things down by evaporative transpiration(蒸腾作用). The never-ceasing__42_of buildings and roads thus tums urban areas into heat islands,discomforting residents and worsening dangerous heatwaves.A possible answer to the twin problems of pollution and heat is trees. Their leaves may destroy at least some chemical pollutants and they certainly __43__tiny particles floating in the air. which are then washed to the ground by rain. Besides transpiration,they provide __44___.To cool an area effectively, trees must be planted in quantity. Two years ago, researchers at the University of Wisconsin found that American cities need 40%tree___45___to cut urban heat back meaningfully. Unfortunately,not all cities —and especially not those now springing up in the world's poor and middle-income countries —are __46___with parks, private gardens or a sufficient number of street trees. And the problem is likely to get worse. At the moment,55%of people live in cities. By 2050 that share is expected to reach 68%.One group of botanists believe they have at least a partial ___47___to this lack of urban vegetation. It is to plant miniature simulacra(模拟物)of natural forests, ecologically engineered for rapid growth. Over the course of a career that began in the 1950s,their leader,Miyawaki Akira, a plant ecologist at Yokohama National University in Japan. has developed a way to do this starting with even the most___ 48___deserted areas. And the Miyawaki method is finding increasing___ 49___around the world.Dr Miyawaki's insight was to deconstruct and rebuild the process of ecological succession, by which ___50___land develops naturally into mature forest. Usually,the first arrival is grass, followed by small trees and,finally. larger ones.The Miyawaki method___51 ___some of the early phases and jumps directly to planting the kinds of species found in a mature wood.Dr Miyawaki has__52__the planting of more than 1,500 of these miniature forests,first in Japan,then in other parts of the world. Wherever they are planting,though,gardeners are not restricted to__53 __nature's recipe book to the letter. Miyawaki forests can be customized to local requirements. A popular choice__54__ is to include more fruit trees than a natural forest might support,thus creating an orchard that requires no maintenance.If your goal is to better your __55__surroundings,rather than to save the planet from global warming,then Dr Miyawaki might well be your man.41. A. thrive B. nourish C. displace D. raise42. A. assessment B. maintenance C. spread D. replacement43. A. release B. trap C. reflect D. dissolve44. A. attraction B. shadow C. interaction D. shade45. A. consumption B. coverage C. interval D. conservation46. A. blessed B. lined C. piled D. fascinated47. A. treatment B. obstacle C,warning D. solution48. A. unnoticed B. unpromising C. untested D. unfading49. A. criticism B. favor C. sponsor D. anxiety50. A. bare B. graceful C. faint D. mysterious51. A highlights B. skips C. improves D. pushes52. A. accessed B. spotted C. supervised D. ranked53. A. disturbing B. balancing C. following D. reducing54. A. for example B. in essence C. on the other hand D. after all55. A. suburban B. leisure C. scenic D. immediateSection BDirections: Read the following three passages. Each passage is followed by several questions or unfinished statements. For each of them there are four choices marked A,B,C and D. Choose the one that fits best according to the information given in the passage you have read.(A)From Marie Tussaud's Chamber of Horrors to Disneyland's Haunted Mansion(鬼屋)to horror-themed escape rooms,haunted house attractions have terrified and delighted audiences around the world for more than 200 years.These attractions turn out to be good places to study fear. They help scientists understand the body's response to fright and how we perceive some situations as enjoyably thrilling and others as truly terrible. One surprising finding;having friends close at hand in a haunted house might make you more jumpy,not less so.Psychologist and study co-author Sarah Tashjian,who is now at the University of Melbourne, and her team conducted their research with 156 adults,who each wore a wireless wrist sensor during their visit. The sensor measured skin responses linked to the body's reactions to stress and other situations. When the sensor picked up,for example,greater skin conductance —that is,the degree to which the skin can transmit an electric current —that was a sign that the body was more aroused and ready for fight or flight. In addition to this measure,people reported their expected fear (on a scale of 1 to 10)before entering the haunted house and their experienced fear (on the same scale)after completing the haunt.The scientists found that people who reported greater fear also showed heightened skin responses. Being with friends,Tashjian and her colleagues further found,increased physiological arousal during the experience,which was linked to stronger feelings of fright. In fact,the fear response was actually weaker when people went through the house in the presence of strangers.Other investigators have used haunted houses to understand how fear and enjoyment can coexist. In a 2020 study led by Marc Malmdorf Andersen,a member of the Recreational Fear Lab at Aarhus University in Denmark,scientists joined forces with Dystopia Haunted House. The Danish atraction includes such terrifying experiences as being chased by "Mr. Piggy",a large, chain-saw-wielding man wearing a bloody butcher's apron and pig mask. People between the ages of 12 and 57 were video recorded at peak moments during the attraction,wore heart-rate monitors throughout and reported on their experience. People's fright was tied to large-scale heart-rate fluctuations;their enjoyment was linked to small-scale ones. The results suggest that fear and enjoyment can happen together when physiological arousal is balanced "just right".56. Studing haunted house attractions helps scientists to learn about _____.A. the psychological effects of fear on individualsB. the history of horror-themed entertainmentC. the body's response to material rewardsD. the impact of technology on people's enjoyment57. How did Sarah Tashjian and her team conduct their research on haunted house experiences? A. By surveying participants.B. By analyzing historical records.C. By employing wireless wrist sensors.D. By using virtual reality simulations.58. What did Tashjian and her colleagues discover in their study?A. Being with fiends elevated level of physiological arousal.B. The fear reaction was stronger in the company of strangers.C. Psychological effect was unrelated to intensified feelings of fright.D. Those reporting lightened fear showed increased skin responses.59,It can be concluded from the 2020 study led by Marc Malmdorf Andersen that ____.A. fear and enjoyment can not happen at the same timeB. large-scale heart-rate fluctuations were linked to enjoymentC. the age of the participants was not related to the study's findingsD. fear and enjoyment can coexist under certain conditions(B)Is an electric vehicle right for you?Many people will ask themselvesthat question for the first time this year.Prices are falling,battery range is risingand mainstream brands are adding new EVs at a breakneck pace.Here are three things anybody seriously considering buying an EV should know:1. The price to install a 240v chargerAnybody who owns an electric vehicle needs a 240-volt charger at home. With one,you can recharge overnight,so you start every day with the equivalent of a full tank.Just a few years ago,home 240v EV chargers cost $2,500-$3,000,including installation,but prices have declined as competition grows with the number of EVs on the road.2. The time it takes to chargeAbout 80%of miles driven in EVs are powered by electricity charged at home,but you'll need to charge elsewhere occasionally. That's when charging time becomes a big deal,but how long it takes depends on a couple of factors.First,voltage from the charger. Getting 250 miles of range in seven hours from a 240v charger is fine when you're charging overnight at home,but it's a deal breaker if you're going 300 miles for a weekend getaway. In that case,you'll want to look for a 400v DC fast charger. They're not as common as 240v public chargers yet,but they're becoming more widespread.There's another factor:the on-board charger. It regulates how fast the battery can accept electricity. A vehicle with a higher-capacity on-board charger accepts electricity faster.3. Where to chargeGood route-planning apps will help you find chargers on a road trip.“Most people have no idea how many public charging stations are within,say,a 10-or 15- mile radius(半径)because they're small,people don't look for them or even don't know what to look for,and they're rarely signposted,"said journalist John Voelcker,who has studied EVs and charging exhaustively.4. On the horizonIf an EV doesn't meet your needs now, watch this space. They're coming closer,but large numbers of gasoline vehicles will remain in production for years. Beyond that,companies will keep making spare parts for oil-burners for decades.60. Which of the following statements is TRUE according to the passage?A. The price of installing a home EV charger has remained stable in the past few years.B. It's quite easy to identify the public charging stations with the help of striking signposts.C. Popular brands are introducing new EVs at an incredibly fast rate.D. An electric vehicle can't provide the same amount of energy as a completely filled fuel tank.61. The underlined phrase "watch this space" in the last paragraph probably means" _______ ”.A. give up the plan to purchase an EVB. make space for an EVC. find an alternative to EVD. keep an eye out for future developments62. This passage is mainly intended to _______ .A illustrate the factors charging time depends onB. offer advice on purchasing an electric vehicleC. look forward to the future of electric vehiclesL explain the reason for the falling prices of electric vehicles(C)Flinging brightly coloured objects around a screen at high speed is not what computers' central processing units were designed for. So manufacturers of arcade machines invented the graphics-processing unit (GPU),a set of circuits to handle video games' visuals in parallel to the work done by the central processor. The GPU's ability to speed up complex tasks has since found wider uses:video editing, cryptocurency mining and most recently,the training of artificial intelligence.AI is now disrupting the industry that helped bring it into being. Every part of entertainment stands to be affected by generative AI,which digests inputs of text,image,audio or video to create new outputs of the same. But the games business will change the most,argues Andreessen Horowitz,a venture-capital(VC)firm. Games interactivity requires them to be stuffed with laboriously designed content:consider the 30 square miles of landscape or 60 hours of music in “Red Dead Redemption 2”a recent cowboy adventure. Enlisting Al assistants to chum it out could drastically shrink timescales and budgets.AI represents an "explosion of opportunity"and could drastically change the landscape of game development. Making a game is already easier than it was:nearly 13,000 titles were published last year on Steam,a games platform,almostdouble the number in 2017. Gaming may soon resemble the music and video industries in which most new content on Spotify or YouTube is user-generated. One games executive predicts that small firms will be the quickest to work out what new genres are made possible by Al. Last month Raja Koduri,an executive at Intel,left the chip maker to found an Al-gaming startup.Don't count the big studios out,though. If they can release half a dozen high-quality titles a year instead of a couple,it might chip away at the hit-driven nature of their business,says Josh Chapman of Konvoy,a gaming focused VC firm. A world of more choices also favors those with big marketing budgets. And the giants may have better answers to the mounting copyright questions around Al. If generative models have to be trained on data to which the developer has the rights,those with big back-catalogues will be better placed than startups. Trent Kaniuga,an artist who has worked on games like "Fortnite",said last month that several clients had updated their contracts to ban Al-generated ant.If the lawyers don't intervene,unions might. Studios diplomatically refer to Al assistants as “co-pilots”,not replacements for humans.63. The original purpose behind the invention of the graphics-processing unit (GPU)was to______A. speedup complex tasks in video editing and cryptocurency miningB. assist in the developing and training of artificial intelligenceC. disrupt the industry and create new outputs using generative AID. offload game visual tasks from the central processor64. How might the rise of AI-gaming startups affect the development of the gaming industry?A. It contributes to the growth of user-generated content.B. It facilitates blockbuster dependency on big studios.C. It decreases collaboration between different stakeholders in the industry.D. It may help to consolidate the gaming market under major corporations.65. What can be inferred about the role of artificial intelligence in gaming?A. AI favors the businesses with small marketing budgets.B. AI is expected to simplify game development processes.C. AI allows startups to gain an edge over big firms with authorized data.D. AI assistants may serve as human substitutes for studios.66. What is this passage mainly about?A. The evolution of graphics-processing units (GPUs).B. The impact of generative AI on the gaming industry.C. The societal significance of graphics-processing units(GPUs).D. The challenges generative AI presents to gaming studios.Section CDirections: Read the following passage. Fill in each blank with a proper sentence given in the box. Each sentence can beTime to end Santa's 'naughty list'?Many of us have magical memories of Santa secretly bringing gifts and joy to our childhood homes —but is there a darker side to the beloved Christmas tradition?I was —and I'm happy to admit it —a loyal believer of Santa. I absolutely loved the magic of Christmas,especially Santa Claus,and my parents went above and beyond to encourage it. However,as I begin to construct my own Santa Claus myth for my daughter,I can't help but feel guilty. Could it undermine her trust in me?_____67______Backin1978,a study published in the American Journal of Orthopsychiatry(矫正精神医学)found that 85%of four-year-olds said they believed in Santa. In 2011,research published in the Journal of Cognition and Development found that 83%of 5-year-olds claimed to be true believers.I guess it's not all that surprising. _____68 _____He features in every Christmas TV show and movie. Each year the North American Aerospace Defence Command (NORAD)allows you to track Santa's journey on Christmas Eve. To reassure children during the pandemic in 2020,the World Health Organization issued a statement declaring that Santa was “immune”from Covid 19. And it's precisely this effort on behalf of parents,and society in general,to create such seemingly overwhelming evidence for the existence of Santa Claus that David Kyle Johnson,a professor of philosophy at King's College in Pennsylvania,describes as 'The Santa Lie' in his book The Myths That Stole Christmas. He highlights how we don't simply ask children to imagine Santa,but rather to actually believe in him. _____69 _____The 'Santa lie' can reduce trust between a parent and a child. _____70 _____It is the creation of false evidence and convincing kids that bad evidence is in fact good evidence that discourages the kind of critical thinking we should be encouraging in children in this era. “The ‘Santa lie' is part of a parenting practice that encourages people to believe what they want to believe,simply because of the psychological reward,”says Johnson. “That's really bad for society in general. ”IV. Summary WritingDirections: Read the following passage. Summarize the main idea and the main point(s)of the passage in no more than 60 words. Use your own words as far as possible.Exploring the Appeal of VintageToday,the term“vintage”applies to almost everything. Vintage is more recent than an antique (古董)which is defined as 100 years old or more. It basically means reviving something old- fashioned or filled with memories. For an object to be considered vintage,it must be unique and genuine enough to retain at least some of its original charm.We buy vintage because it creates a sense of personal connection for us:it speaks to our childhood memories and that feels good. We also buy vintage because we're rebels. Vintage is a protest against modern mainstream culture. In an age of technology,buying vintage is a refuge from our fast-paced,high-tech world. We want our children to make the most of their creativity and know how to entertain themselves without electronic gadgets. Ironically,early video games are now considered vintage.Of all the vintage objects,vintage toys are forever attractive for both adults and children. Although some toys have emotional value,others have high market value and are expensive to collect. Vintage toys that were made in small quantities often bring a higher value than those that were mass produced. That means,if you own one of the 2,000 “Peanuts”royal blue beanie baby elephants that were manufactured with a darker blue coat than originally intended,you might have something valuable on your hands. In fact,due to a manufacturer error,this is the most collectible beanie baby around —and worth about f3,000.If you're motivated and feeling lucky,you can find deals on vintage toys by browsing charity shops,secondhand stores,community centers,flea markets and garage sales. You never know what kind of treasures are hiding at the bottom of a mixed box in someone's basement,garage or attic.第Ⅱ卷(共40分)V. TranslationDirections: Translate the following sentences into English. using the words given in the brackets.72. 他在升旗仪式上的演讲得到了高声喝彩。

跨理论模型在健康行为管理中的应用研究进展

跨理论模型在健康行为管理中的应用研究进展【摘要】跨理论模型（the transtheoretical model of change，TTM）是近年来研究较热门的一种个体行为转变的心理研究方法，随着国内外对该模型研究的不断深入，已将其广泛应用于健康行为管理中，并取得一定成效。

本文综述了TTM的概念、主要内容以及近年来在健康行为管理中的应用研究进展，并对其发展趋势进行了展望。

【关键词】跨理论模型；健康行为；护理管理；综述【abstract】The transtheoretical model of change (TTM) is a popular psychological research method of inpidual behavior change in recent years. With the deepening of the research on TTM at home and abroad, it has been widely used in health behavior management and achieved some results. In this paper, the concept, main content and application of TTM in health behavior management in recent years were reviewed, and its development trend was prospected.【key words】cross theoretical model; health behavior; nursing management; review健康行为是个体或群体以预防疾病、保持和增进身心健康为目的而采取的一系列行动，如合理营养、规律作息、适当锻炼等[1]。

健康行为管理则是对健康相关行为进行监督、干预和改进的过程，良好的健康行为习惯是获得健康的重要保障[2]。

微创经皮空心螺钉闭合复位与切开复位内固定治疗踝关节骨折的临床比较

微创经皮空心螺钉闭合复位与切开复位内固定治疗踝关节骨折的临床比较发布时间：2023-02-15T09:13:37.226Z 来源：《医师在线》2022年3月6期作者：余斌[导读]余斌1，赵建国2，王成2，谢平2，祝春雷2，卢彬3（1.张家港澳洋医院有限公司港城康复医院骨关节康复科，江苏张家港 215600；2.张家港澳洋医院骨科，江苏张家港 215600；3.张家港澳洋医院手足外科，江苏张家港 215600）摘要：目的：探讨对踝关节骨折采用微创经皮空心螺钉闭合复位与切开复位内固定治疗的临床效果。

方法：选择张家港澳洋医院2015年1月至2020年12月收治踝关节骨折患者66例，以随机数表法将患者分为2组，对照组（n=33）予切开复位内固定术治疗，观察组（n=33）采用微创经皮空心螺钉闭合复位治疗，对比两组手术及预后指标，随访3月以AOFAS踝-后足评分评估患者关节功能，检测术前术后血清骨碱性磷酸酶（bone alkaline phosphatase，BALP）、骨钙素（bone γ-carboxyglutamic acid-containing protein，BGP）、I型前胶原氨基端延长肽（N-terminal?peptide?of?Type I procollagen，PINP）水平评估骨代谢状态，并统计两组并发症情况进行分析。

结果：观察组手术时间、骨痂形成时间、骨折愈合时间（40.08±8.62）min、（7.12±1.86）周、（10.12±1.46）周，短于对照组，出血量（12.41±4.35）ml，小于对照组，差异有统计学意义（P<0.05，t=3.114、6.537、10.421、19.977）。

术后观察组BALP、BGP、PINP水平分别为（19.55±1.72）U/L、（5.72±0.60）ug/L、（95.16±22.62）ug/L，均大于对照组，差异有统计学意义（P<0.05，t=3.882、5.301、3.982）。

镇痛分娩与自然分娩的临床效果观察

论著·临床论坛CHINESE COMMUNITY DOCTORS 中国社区医师2018年第34卷第14期镇痛分娩源于国外，在欧美国家已经得到了极其广泛的应用，目前在国内许多医院也开始应用镇痛分娩，且效果较为良好。

镇痛分娩的核心目的就是通过应用一些方法减轻或消除产妇分娩时的疼痛。

该方法可有效缓解产妇分娩时的疼痛和恐惧，在第一产程使产妇得到了一定的休息，为宫口全开后的分娩积蓄了力量[1]。

本次研究回顾性分析2016年6月-2017年8月于我院进行阴道分娩的218例产妇的临床资料，分析所有产妇的分娩结果，对比镇痛分娩和自然分娩的临床效果，现报告如下。

资料与方法2016年6月-2017年8月收治行阴道分娩孕妇218例，将其中130例自然分娩的产妇归为对照组，将88例镇痛分娩的产妇归为观察组。

对照组产妇年龄22～36岁，平均(27.3±2.18)岁；孕周37～42周，平均(39.6±1.18)周。

观察组产妇年龄22～35岁，平均(26.2±1.93)岁；孕周38～43周，平均(40.3±1.27)周。

本次研究所选产妇均为正常足月、身体健康、胎儿体位正常者，排除有胎儿窘迫状镇痛分娩与自然分娩的临床效果观察张秀英221600徐州矿务集团总院妇产科doi:10.3969/j.issn.1007-614x.2018.14.048摘要目的：探讨自然分娩和镇痛分娩的临床效果。

方法：收治阴道分娩孕妇218例，其中130例自然分娩产妇为对照组，88例镇痛分娩产妇为观察组。

结果：观察组产妇镇痛效果明显优于对照组(P ＜0.05)；观察组产妇第一产程时间显著短于对照组(P ＜0.05)。

结论：镇痛分娩具有确切的镇痛效果，能大大降低产妇分娩时的痛苦，可以有效缩短第一产程的时间，不增加产后出血量，对新生儿无影响，且对产妇的住院时间也无影响。

关键词镇痛分娩；镇痛效果；自然分娩Comparison and analysis on the clinicaleffectof analgesiclabor and natural childbirthZhang XiuyingDepartment of Gynaecology and Obstetrics,Mining Group General Hospital of Xuzhou City 221600Abstract Objective:To explore the clinical effects of natural and analgesic delivery.Methods:218cases of pregnant women withvaginal delivery were selected,in which 130cases of natural childbirth selected as the control group,and 88cases of analgesiadelivery as the observation group.Results:The analgesic effect of parturients in the observation group was significantly better thanthat of the control group(P ＜0.05),and the first time of labor in the observation group was significantly lower than that of thecontrol group(P ＜0.05).Conclusion:Analgesia delivery has the exact analgesic effect,can greatly reduce the pain of parturientdelivery,can effectively shorten the first stage of labor,do not increase the amount of postpartum hemorrhage.It has no effect on thenewborn,and has no effect on the length of stay of the puerpera.Key words Analgesia delivery;Analgesic effect;Natural childbirth80论著·临床论坛CHINESE COMMUNITY DOCTORS 于对照组的(12.1±2.2)h，第二产程及第三产程差异无统计学意义(P ＞0.05)，见表2。

振幅整合脑电图联合新生儿行为神经测定在早产儿脑损伤中的应用价值

国际医药卫生导报 2019年第25卷第20期　IMHGN，October 2019，Vol.25　No. 20振幅整合脑电图联合新生儿行为神经测定在早产儿脑损伤中的应用价值史学凯1　何潇1　吴华1　黄玉维1　曾贵祥2　潘新年3　蓝国锋11南宁市第二人民医院儿科　530031；2南宁市妇幼保健院儿科　530011；3广西壮族自治区妇幼保健院儿科，南宁　530000通信作者：蓝国锋，Email：317271689@ 【摘要】　目的　评价在对早产儿脑损伤的诊断中，利用振幅整合脑电图（amplitude integrated electroencephalography，aEEG）联合新生儿行为神经测定（Neonatal Behavioral Neurological Assessment，NBNA）的诊断效果和价值表现。

方法　把从2017年1月至2018年12月本院收入的早产儿218例（胎龄为28～36周），根据有无存在脑损伤因素分为脑损伤组102例，非脑损伤组116例，在早产儿出生后的6 h内，对期间进行aEEG描记的诊断方法，连续记录3 h，并于生后24 h内及第3天进行头颅B超检查，于出院前进行头颅核磁共振成像（Magnetic Resonance Imaging，MRI）检测，并且纠正胎龄40周，进行NBNA评分，并根据aEEG的特点及NBNA评分高低，来对两项评估在早产儿的脑损伤诊断中联合运用的价值和效果。

结果　临床应用表明，联合利用aEEG及NBNA评分对早产儿的脑损伤程度进行评估，其灵敏度可达91.87%，超过单独应用aEEG的86.31%和单独应用NBNA的76.32%，在特异度表现上，联合应用的特异度为67.53%，低于单独应用aEEG的75.42%和单独应用NBNA的83.67%，联合应用的情况下，ROC曲线下的面积达到0.856，超过独立应用aEEG、NBNA的0.813和0.754。

关节镜下两种缝合方案在冈上肌腱损伤患者中的应用效果对比

第24卷第11期中国内镜杂志 Vol. 24 No. 11 2018年11月 China Journal of Endoscopy Nov. 2018论著收稿日期：2018-05-11DOI: 10.3969/j.issn.1007-1989.2018.11.014文章编号： 1007-1989（2018）11-0067-06关节镜下两种缝合方案在冈上肌腱损伤患者中的应用效果对比江杨青1，姜滔2，王靖鹏1（1.浙江省温岭市中医院骨科，浙江温岭 317500；2.浙江省新华医院骨科，浙江杭州 310005）摘要：目的比较关节镜下两种缝合方案在冈上肌腱损伤患者中的应用效果。

方法选取2015年1月－2018年4月该院收治的136例冈上肌腱损伤患者为研究对象，将患者依据1∶1比例随机分为对照组（n =68）和观察组（n =68）。

对照组患者采用关节镜下单排改良Mason-Allen 缝合技术修复，观察组采用关节镜下改良缝合桥技术修复。

比较两组患者肩关节活动度、视觉模拟评分（VAS）、美国肩肘外科协会评分（ASES）和Constant 评分。

结果治疗前两组患者肩关节内旋、外旋、前屈和外展情况、静息VAS、活动VAS 评分、ASES 评分和Constant 评分比较均无明显差异（P >0.05）；治疗后两组患者的肩关节内旋、外旋、前屈和外展情况、静息VAS、活动VAS 评分、ASES 评分和Constant 评分较治疗前均明显改善，且观察组优于对照组，差异有统计学意义（P <0.05）。

结论冈上肌腱损伤患者经单排改良Mason-Allen 缝合技术修复及改良缝合桥技术修复均能够有效缓解疼痛，改善肩关节活动度和功能，且改良缝合桥技术修复效果更佳。

关键词：冈上肌腱损伤；关节镜；单排缝合；改良缝合桥技术中图分类号： R686.1 文献标识码： AComparison of the effect of arthroscopic sutures for supraspinatus tendon injuriesYang-qing Jiang 1, Tao Jiang 2, Jing-peng Wang1(1.Department of Orthopedics, Wenling Hospital of Traditional Chinese Medicine, Wenling, Zhejiang 317500, China; 2.Department of Orthopedics, Xinhua Hospital, Hangzhou, Zhejiang 310005, China)Abstract: Objective To compare the effect of two kinds of sutures under arthroscopy on patients with supraspinatus tendon injury. Methods 136 patients with suprascapal tendon injuries treated from January 2015 to April 2018 were selected. The patients were randomly divided into control group (n = 68) and observation group (n = 68). The control group was treated with single-row modified Mason-Allen suture under arthroscopy, and the observation group was repaired with an arthroscopic modified suture bridge technique. The shoulder joint activity, visual analogue scale (VAS) score, ASES score and Constant score were compared between the two groups. Results There was no significant difference in internal rotation, external rotation, flexion and abduction, resting V AS, activity V AS score, ASES score and Constant score between the two groups before treatment (P > 0.05). Internal rotation, external rotation, flexion and abduction of shoulder joints, resting V AS, active V AS score, ASES score, and Constant score were all significantly improved before treatment, and the observation group was superior to the control group. The difference was statistically significant (P < 0.05). Conclusion The repair of supraspinatus tendon injury by modified suture bridge technique can effectively relieve pain and improve shoulder motion and function.Keywords: supraspinal tendon injury; arthroscopy; single suture; modified suture bridge technique中国内镜杂志第24卷冈上肌腱损伤是临床常见的肩关节退行性病变，主要因撞击机制联合退变及外伤性机制所致，具有较高的致残性[1]。

Effects of Side - Stick Controllers

EFFECTS OF SIDE-STICK CONTROLLERS ON ROTOR CRAFT HANDLING QUALITIES FOR TERRAIN FLIGHT Edwin W. Aiken Aeromechanics Laboratory, U.S. Army Research and Technology Laboratories - AVSCOM NASA Ames Research Center Moffett Field, California 94035 U.S.A. Abstract Pertinent fixed- and rotary-wing feasibility studies and handling-qualities research programs are reviewed and the effects of certain controller characteristics on handling qualities for specific rotorcraft flight tasks are summarized. In particular, the effects of the controller for<:edeflection relationship and the number of controlled axes that are integrated in a single controller are examined. Simulation stUdies conducted as part of the Army's Advanced Digital/ Optical Control System (ADOCS) program and flight research program3 performed by the National Aeronautical Establi3hment of Canada provide a significant part of the available handling qualities data. These stu,l1es demonstrate the feasibility of using a single, properly designed, limiteddisplacement, multi-axis controller for certain relatively routi1e fl~ght tasks in a two-crew rotorcraft with nominal levels of stability and control augmentation. However, for the more demanding terrain flight tasks, unless high levels of stability and control augmentation with a high degree of reliability are incorporated, separated three- or two-axis controller configurations are required for acceptable handling qualities. Introduction Advanced flight control systems which employ fly-by-wire or fiberoptic technology provide the control system designer with the flexibility to synthesize the system based upon pilot-oriented design criteria. In addition to multimode control laws which vary as a function of mission task and flight condition, these systems will include advanced pilots' controllers with designs that are no longer constrained by the characteristics of a mechanical flight control system. One particularly appealing design concept is the replacement of the conventional set of primary controllers by a single side-stick controller. This appro~ch to controller design provIdes sIgnIfIcant benerits to the cockp1t designer by increasing the available cockpit space, by a savings in weight, and by Presented at the International Conrerence on Rotorcraft Basic Research, Research Triangle Park, North Carolina, February 19-21, 1985.

The Effects of organizational learning culture and job

Although organizational learning theory and practice have been clariﬁed by practitioners and scholars over the past several years, there is much to be explored regarding interactions between organizational learning culture and employee learning and performance outcomes. This study examined the relationship of organizational learning culture, job satisfaction, and organizational outcome variables with a sample of information technology (IT) employees in the United States. It found that learning organizational culture is associated with IT employee job satisfaction and motivation to transfer learning. Turnover intention was found to be negatively inﬂuenced by organizational learning culture and job satisfaction. Suggestions for future study of learning organizational culture in association with job satisfaction and performance-related outcomes are discussed. With the current expansion of the global economy and the fast-changing evolution of technology and innovation, organizations are facing an ongoing need for employee learning and development. As knowledge increasingly becomes a key factor for productivity, it has also become a currency for competitive success. Understanding factors that contribute to organizational learning and the transfer of knowledge to the workplace environment are essential to

写一篇关于合作与冲突在团队绩效中的作用的论证的英文文章

冲突与团队绩效的关系Conflict is an inevitable behavior in the development of enterprise organizations, and its occurrence is the result of some uncoordinated relationships inside and outside the enterprise organization, which is mainly manifested in the intensification of contradictions and behavioral confrontations between conflict actors. At present, organizational conflicts have become more and more intense due to the scarcity of resources and the competitiveness of resource allocation, the intensification of the contradiction between the dependence of work content and the dispersion of work sites, and the emergence of cross-functional task teams and product organizations. Practice has proved that the existence of organizational conflicts has a certain impact on the operation and development of enterprise organizations. Some of the effects are positive and constructive, while others are clearly destructive. How to play a constructive role in conflict depends on the effective choice of conflict management strategies. Surveys have shown that business managers already spend 20 percent of their day-to-day working hours resolving conflicts. It can be seen that how to effectively manage conflicts has become an important issue for enterprise managers to improve organizational performance, achieve organizational goals, and even relate to the survival of enterprises. Therefore, how to carry out effective conflict management in the enterprise is a very worthy of research.。

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