目的   探讨剖宫产后再次分娩阴道试产失败的影响因素。方法   选取2021年5月—2024年5月在枣庄市妇幼保健院分娩的138例有剖宫产手术史的足月妊娠产妇进行回顾性分析。所有产妇依照其阴道试产结果将成功阴道分娩的35例产妇分为成功组，将阴道试产失败中转剖宫产的103例产妇分为失败组。对比两组产妇的妊娠结局、孕期情况及围产期情况，最后采用多因素Logistic回归分析法分析剖宫产后再次分娩阴道试产失败的影响因素。结果   两组产妇子宫破裂、胎儿窘迫、产褥感染及产后出血等妊娠不良结局总发生率对比差异无统计学意义（11.43% vs 6.80%，χ ² =0.760，P=0.382 ＞0.05）；通过对比两组产妇孕期情况发现，失败组与成功组孕妇年龄、孕次、身高、孕前体质量、妊娠期合并症、分娩前体质量指数（BMI）比较差异无统计学意义（P＞0.05），失败组与成功组孕妇孕期体质量增长［（4.56±2.56）kg vs（12.45±3.24）kg］、分娩孕周［（39.46±1.25）周 vs（37.95±1.37）周］、阴道分娩史（8.57% vs 26.21%）、妊娠间隔时间［（2.74±0.35）年 vs（3.37±0.57）年］及瘢痕厚度［（4.51±0.56）mm vs（5.42±0.38）mm］，对比差异有统计学意义（t=3.497，P＜0.001；t=5.755，P＜0.001；χ ² =4.780，P=0.029；t=6.148，P＜0.001；t=10.764，P＜0.001）；通过对比两组产妇围产期情况发现，失败组与成功组新生儿性别、是否镇痛比例比较差异无统计学意义（P＞0.05），失败组与成功组孕妇产前新生儿估重［（3352.31±153.67）g vs（3046.25±141.68）g］、是否引产［60.00% vs 52.43%］、胎膜早破［11.43% vs 35.92%］、入院时是否临产［857% vs 27.18%］，对比差异有统计学意义（t=10.805，P＜0.001；χ ² =7.330，P=0.007；χ ² =7.500，P=0.006；χ ² =5.200，P=0.023）；以阴道试产情况作为因变量（失败=1，成功=0）纳入Logistic回归模型，结果显示，分娩孕周过晚、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的影响因素（P＜0.05）。结论   分娩孕周过高、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的独立影响因素，需针对分娩孕周、产前新生儿估重过高的剖宫产后再次分娩阴道试产产妇给予高度关注并采取相应措施进行干预，同时自然临产能够降低阴道试产失败风险，但针对具有引产指征的产妇，依然需要及时引产。

       Objective   To explore the influencing factors of vaginal trial delivery failure after cesarean section．Methods   A retrospective analysis was conducted on 138 full-term pregnant women with a history of cesarean section who gave birth in our hospital from May 2021 to May 2024．All women were divided into two groups according to the  results of their vaginal trial delivery．Based on their vaginal trial results，35 parturients who successfully delivered were divided into the successful group，and 103 parturients who failed vaginal trial delivery and transitioned to cesarean section were divided into the failed group．The pregnancy outcomes of postpartum women and the pregnancy and perinatal conditions were compared between the two groups，and multivariate Logistic  regression analysis was used to analyze the independent influencing factors of vaginal trial delivery failure after cesarean section．Results   There was no significant difference in the total incidence of adverse pregnancy outcomes such as uterine rupture，fetal distress，postpartum infection，and postpartum hemorrhage between the two groups of parturients （P＞0.05）．By comparing the pregnancy status of two groups of  pregnant women，it was found that there was no difference （P＞0.05）．The average weight gain during pregnancy of failure and successful group，gestational age，cases with vaginal delivery history，intervalbetween pregnancy and scar thickness，the contrast difference was significant （all P＜0.05） ．By comparing the perinatal situation of the two groups，there was no difference in the sex of fetus and analgesia receiving of parturients between the failed group and the successful group （P＞0.05），while there is difference in weight estimation，whether induced labour，premature  rupture of fetal membrane，whether admitted to hospital （all P＜0.05）．Vaginal trial delivery was set as the dependent variable （failure=1，success=0） and it was incorporated into the Logistic regression model．The results showed that high gestational age during delivery，high estimated weight of fetus before delivery，induction of labor，and non-labor upon admission were independent influencing factors for vaginal trial delivery failure after cesarean section （P＜0.05）．Conclusions  Excessive gestational age，high estimated weight of fetus before delivery，induced labor，and non-labor upon admission were independent influencing factors for the failure of vaginal trial delivery after cesarean section．It is necessary to pay high attention and take corresponding measures to intervene in women who have undergone vaginal trial delivery after cesarean section due to excessive gestational age and high estimated weight of fetus before delivery．At the same time，spontaneous labour can reduce the risk of vaginal trial delivery failure．However，for women with indications for induced labor，timely induction is still necessary．

       目的   探讨非肌层浸润性膀胱癌患者初次经尿道膀胱肿瘤电切术的复发情况及危险因素。方法   以93例非肌层浸润性膀胱癌患者进行研究，2018年1月至2022年1月西藏自治区人民政府驻成都办事处医院泌尿外科医院收治采取经尿道膀胱肿瘤电切术，术后随访24个月，复发22例，未复发71例，比较复发与未复发基础情况、不同肿瘤直径、不同肿瘤分期、分级、数量、是否带蒂、灌注化疗方式等特征患者的复发情况，对具有统计学意义的因素，采取非条件Logistic多因素回归分析，明确术后复发的危险因素。结果   肿瘤分期T1期者的复发率为32.08%，高于Ta期者15.50%，肿瘤分级为高级别者的复发率为53.33%，高于低级别者17.95%，肿瘤多发者的复发率为35.71%，高于单发者的13.73%，肿瘤不带蒂者的复发率为38.71%，高于肿瘤带蒂者的16.13%，常规灌注化疗患者的复发率为29.85%，高于术后即刻+灌注化疗患者的7.69%，比较差异均有统计学意义（χ ² 分别为6.648、4.836、6.872、6.166、5.834、5.902，P分别为0.010、0.027、0.008、0.013、0.015、0.024）。肿瘤分期T1期、肿瘤分级为高级别、肿瘤多发、常规灌注化疗为非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发的危险因素（P＜0.05）。结论   非肌层浸润性膀胱癌患者初次采取经尿道膀胱肿瘤电切术容易因为临床分期为T1期、肿瘤分级为高级别、肿瘤多发及常规灌注等出现复发，应采取针对性干预措施，改进灌注化疗方式，降低复发率。

       Objective  To investigate the  relapse and  risk factors of non-muscular invasive bladder cancer after primary transurethral resection．Methods  A total of 93 patients with non-muscular invasive bladder cancer were selected for study．They were received by the hospital from January 2018 to January 2022 and underwent transurethral resection．After 24 months of follow-up，22 patients recurred，and 71 patients did not recur．The recurrence of patients with different tumor diameter，tumor stage，grade，numbers，pedicel or not，and infusion chemotherapy methods were compared．For the statistically significant factors，unconditional logistic regression analysis was used to determine the independent risk factors for recurrence．Results  The recurrence rate in T1 stage of tumor was 32.08% higher than that in Ta stage，which was 15.50%．The recurrence rate in high stage was 53.33% higher than that in low stage，which was 17.95%．The recurrence rate in multiple tumor patients was 35.71% higher than that in single tumor patients，which was 13.73%．The no-pedicle tumor recurrence rate was 38.71% higher than that with pedicle，which was 16.13%．The recurrence rate in patients receiving conventional infusion chemotherapy was 29.85% higher than that in patients receiving immediate postoperative infusion chemotherapy，which was 7.69%．The differences were statistically significant（χ ² =6.648、4.836、6.872、6.166、5.834、5.902，P=0.010、0.027、0.008、0.013、0.015、0.024）．The independent  risk factors of recurrence after primary transurethral resection were tumor stage T1，high grade tumors，multiple tumors，routine perfusion chemotherapy as non-muscular invasive bladder cancer（P＜0.05）．Conclusions  The  patients with  non-muscular invasive bladder cancer taking transurethral resection for the first time are prone to recurrence because of the clinical stage of T1，tumor grade of high grade，multiple tumors and routine perfusion．Targeted intervention measures  should be taken to improve the perfusion chemotherapy method to reduce the recurrence rate．

       目的   分析类风湿因子（RF）、T淋巴细胞亚群（CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ ）与类风湿关节炎病情程度的关系。方法   选取2023年1月—2024年4月收治的90例类风湿关节炎患者作为观察组，同期到院的90例健康体检者为对照组，均接受RF、CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 检测，并按照类风湿关节炎患者病情评价（DAS28）判定观察组患者病情的严重程度，应用Pearson相关性分析RF、CD3⁺ 、CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 与患者病情严重程度的关系。结果   与对照组比较，观察组RF及CD8⁺ 水平较高，CD3⁺ 、CD4⁺ 及CD4⁺ /CD8⁺ 水平较低（P＜0.05）；不同病情的RF及CD8⁺ 水平比较，重度患者最高，其次为中度、轻度，而CD3⁺ 、CD4⁺ 及CD4⁺ /CD8⁺ 水平比较，轻度患者最高，其次为中度、重度，两两比较均有差异统计学意义（P＜0.05）；经Pearson相关性分析，RF及CD8⁺ 水平与病情程度呈正相关，CD3⁺ 、CD4⁺ 及CD4⁺ /CD8⁺ 水平与病情程度呈负相关（P＜0.05）。结论  RF、T淋巴细胞亚群指标与类风湿关节炎发生、发展有密切关系，可为医师准确评估患者病情严重程度提供可靠参考。

       Objective  To analyze the relationship between rheumatoid factor（RF），T lymphocyte subsets（CD3⁺ ，CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺ ）and the severity of rheumatoid arthritis．Methods  A total of 90 patients with rheumatoid arthritis from January 2023 to April 2024 were selected as the observation group，and 90 healthy checkup individuals who came to the hospital during the same period were selected as the control group．All patients underwent RF，CD3⁺ ，CD4⁺ ，CD8⁺ ，and CD4⁺ /CD8⁺  tests，and the severity of their condition was determined based on the evaluation of rheumatoid arthritis patient condition（DAS28）．Pearson Correlation analysis was used to analyze the relationship between RF，CD3⁺ ，CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺  and the disease severity of the patients．Results  Compared with the control group，RF and CD8⁺  levels in the observation group were higher，while the levels of CD3⁺ ，CD4⁺  and CD4⁺ /CD8⁺  were low（P＜0.05）．Comparison of RF and CD8⁺  levels for different conditions，the RF and CD8⁺  levels of the severe patients was highest，followed by moderate and mild．However，the CD3⁺ ，CD4⁺  and CD4⁺ /CD8⁺levels were highest in mild patients，followed by the moderate and sereve patients．Statistical significance was found in both pairwise comparisons（P＜0.05）．After the Pearson correlation analysis，RF and CD8⁺  levels were positively correlated with the degree of disease，while CD3⁺ ，CD4⁺ ，and CD4⁺ /CD8⁺  levels were inversely associated with the degree of disease condition（P＜0.05）．Conclusions  RF and T lymphocyte subsets are closely related to the occurrence and development of rheumatoid arthritis，and can provide reliable references for physicians to accurately evaluate the severity of patients’ conditions．

       目的   探讨阴道分娩后尿失禁患者疾病应对方式的影响因素。方法   选取2022年1月—2023年1月医院收治的阴道分娩后尿失禁患者78例，评估所有患者的应对方式，根据结果分为积极应对组与消极应对组，设计基线资料调查表，详细统计两组患者的基线资料并比较，重点分析阴道分娩后尿失禁患者疾病应对方式的影响因素。结果   经评估，78例阴道分娩后尿失禁患者疾病消极应对有40例，占比51.28%；积极应对组与消极应对组患者的产次（χ ² =4.110，P=0.043）、文化水平（Z=2.094，P=0.036）、家庭关怀度（Z=2.069，P=0.040）与自我效能（Z=2.249，P=0.025）比较差异有统计学意义，组间年龄（t=0.096，P=0.924）、孕次（t=1.257，P=0.212）、体质指数（BMI）（t=0.125，P=0.901）、工作（χ ² =0.778，P=0.378）、家庭月人均收入（χ ² =0.044，P=0.834）、漏尿（χ ² =0.040，P=0.842）比较差异无统计学意义；经回归分析发现，家庭关怀度低（OR=1.799，P=0.041）、自我效能低（OR=1.942，P=0.026）、经产妇（OR=2.554，P=0.045）及文化水平低（OR=1.837，P=0.038）均是阴道分娩后尿失禁患者疾病应对方式的影响因素。结论   阴道分娩后尿失禁患者疾病消极应对风险高，可能与产次、文化水平、家庭关怀度及自我效能有关。

       Objective To explore the influencing factors of disease coping strategies in patients with urinary incontinence after vaginal delivery．Methods A total of 78 patients with urinary incontinence after vaginal delivery admitted to the hospital from January 2022 to January 2023 were selected．The coping strategies of all patients were evaluated，and they were divided into a positive coping group and a negative coping group based on the results．A baseline data questionnaire was designed，and the baseline data of the two groups of patients were compared in detail．The focus was on analyzing the factors influencing the disease coping strategies of patients with urinary incontinence after vaginal delivery．Results After evaluation，40 out of 78 patients with urinary incontinence after vaginal delivery had negative coping strategies，accounting for 51.28%．The parity of patients in the positive and negative coping groups（χ ² =4.110，P=0.043），educational level（Z=2.094，P=0.036），family care（Z=2.069，P=0.040），and self-efficacy（Z=2.249，P=0.025）among the groups were different．Age between groups（t=0.096，P=0.924），gestational age（t=1.257，P=0.212），body mass index（t=0.125，P=0.901），and work experience（χ ² =0.778，P=0.378），monthly per capita income of households（χ ² =0.044，P=0.834），urinary leakage（χ 2 =0.040，P=0.842）had no statistically significant difference in comparison．Through regression analysis，it was found that low family care（OR=1.799，P=0.041），low self-efficacy（OR=1.942，P=0.026），postpartum women（OR=2.554，P=0.045），and low educational level（OR=1.837，P=0.038）were all influencing factors on the disease coping strategies of patients with urinary incontinence after vaginal delivery．Conclusions  Patients with urinary incontinence after vaginal delivery have a higher risk of negative coping with the disease，which may be related to parity，educational level，family care and self-efficacy．

      近视是一种常见的屈光不正状态，也是全球范围内普遍存在的视觉健康问题，其特征是在眼部调节放松的状态下，平行光线经眼的屈光系统折射后聚焦在视网膜前，导致视远模糊。近视通常在儿童期发生和发展，但在成年期仍可继续发生和发展。本综述对已发表的关于成年人近视发生和进展的文献进行总结，描述成年人近视的流行病学特征，包括近视率、近视发病率、近视进展率及其近视特征（屈光度及眼轴），总结成年人近视发病和进展的危险因素。了解成年人近视的发展特点和管理方式对于近视防控实践具有重要意义。

   Myopia is a common refractive error and a universal visual health problem in the world. It is characterized by the fact that parallel light rays refract through the refractive system of the eye and focus in front of the retina when the eye accommodatior is relaxed, resulting in distant blurred vision. Myopia usually occurs and develops in childhood, but can continue to occur and develop in adulthood. This review summarizes the published literature on the occurrence and progression of myopia in adults, describes the epidemiological characteristics of myopia in adults, including myopia rate, myopia incidence rate, myopia progression rate, and myopia characteristics（diopter and ocular axis） ; and summarizes the  risk factors for the occurrence and progression of myopia in adults. Understanding the developmental characteristics and management methods of adult myopia is of great significance for myopia prevention and control practice.