嵌合基因是指由两个或多个原本不连续的基因片段重组而成的新基因,它们可以通过基因组重排、转录诱导等机制产生。嵌合基因在正常生理和发育过程中具有重要的功能和调控作用。嵌合基因可以改变原有基因的表达水平、编码蛋白质的结构和功能、信号通路的激活和抑制等,从而促进肿瘤细胞的增殖、侵袭、转移和耐药性。近年来,随着高通量测序技术的发展和应用,越来越多的嵌合基因被发现和鉴定,它们在不同类型的肿瘤中具有不同的表达模式和功能作用,为肿瘤的分子诊断、预后评估和靶向治疗提供了新的机会和挑战。本文旨在对嵌合基因产生的机制、检测方法和在肿瘤中的功能和应用等方面进行综述,为进一步认识嵌合基因在肿瘤进展中的功能机制及其精准化治疗提供参考。
Chimeric genes refer to novel genes formed by the recombination of two or more originally non-contiguous gene fragments through mechanisms like genomic rearrangement and transcriptional induction．They play important roles in physiological and developmental regulation．Chimeric genes can alter the expression,structure and function of original genes,modulate signaling pathway activation and inhibition,and thereby promote tumor cell proliferation,invasion,metastasis and drug resistance．In recent years,with the development and application of high-throughput sequencing technologies,increasing numbers of chimeric genes have been discovered and identified．They demonstrate different expression patterns and functional roles in various tumor types,providing new opportunities and challenges for molecular diagnosis,prognostic assessment and targeted therapy of cancers．This review summarizes the mechanisms of chimeric gene formation,detection methods and their functions and applications in tumors,to provide insights into the functional mechanisms of chimeric genes in tumor progression and their implications for precision treatment．
受试者招募工作关乎临床研究质量与进度。无法按计划招募到合适的受试者,一直是研究者发起的临床研究（IIT）开展过程中面临的主要挑战之一。本文分析影响IIT项目受试者招募进度的常见因素,并借鉴国内外经验,从提高受试者认知度与信任度、拓宽招募渠道、加强人文关怀、建立多中心伦理协作审查机制等方面探讨推进受试者招募的具体措施,以期为IIT研究者及科研管理部门提供参考。
Recruitment of subjects is crucial to the quality and progress of clinical research．However,the inability to recruit suitable subjects according to the plan has been one of the major challenges faced by investigators in the process of conducting investigator-initiated trial（IIT）．This article analyzes the common factors that affect the recruitment progress of IIT projects,draws on domestic and international experiences,and explores specific measures to promote subject recruitment,including improving subject awareness and trust,expanding recruitment channels,enhancing humanistic care and establishing a multi-center ethical collaboration review mechanism,in order to provide reference for IIT researchers and research management departments．
目的 探讨多参数磁共振成像对T1高信号间隔与非T1高信号间隔的原发性鼻腔鼻窦黑色素瘤（PSM）的鉴别价值。方法 回顾性分析经病理证实的 PSM 44例,术前均接受常规,DWI 和DCE-MRI检查。通过单因素和多因素Logistic分析评估T1高信号间隔与非T1高信号间隔PSM各MRI参数的差异。结果 44例PSMs 中,T1高信号间隔PSMs 25例,非T1高信号间隔PSMs 19例。两者在多参数MRI中,仅T2低信号间隔,ADC值、达峰时间（Tp）及最大相对增强率（MRER）在单变量分析中差异存在统计学意义（均P<0.05）,在多因素Logistic分析中差异均无统计学意义（P均>0.05）。结论 多参数MRI对区分T1高信号间隔与非T1高信号间隔的PSM具有一定的指导价值,但并不能作为区分两者的独立预测指标。
Objective To evaluate the diagnostic value of multi-parameter MRI in differential diagnosis of primary sinonasal melanoma（PSM）with high- and non-high-T1 signal septa．Methods Forty-four patients pathologically confirmed with PSMs underwent conventional,DWI and DCE-MRI examinations before operation．Univariate and multivariate Logistic analyses were used to evaluate the differences of MRI parameters between high- and non-high-T1 signal septa in PSMs．Results Among 44 PSMs,25 cases had high T1 signal septa and 19 cases had non-T1 high signal septa．In multi-parameter MRI,only T2 low signal septa,the value of ADC,peak time（TP）and maximum relative enhancement rate（MRER）were significantly different in univariate analysis（P<0.05）,but not in multivariate Logistic analysis（P>0.05）．Conclusions Multi-parameter MRI has some value in differentiating PSM with high-T1 and non-high-T1 signal septa,but it can not be used as an independent predictor to distinguish them．
目的 探讨与分析高频超声联合超微血流成像对肱三头肌肌腱断裂伴骨化性肌炎的诊断价值。方法 选择2020年7月—2022年5月在本院诊治的84例肱三头肌肌腱断裂患者作为研究对象,所有患者均行关节镜及超声检查,超声检查包括高频超声、超微血流成像,记录超声特征并判断诊断价值,根据关节镜检查结果分为骨化性肌炎组和非骨化性肌炎组。结果 84例患者中,经关节镜检查判断为合并骨化性肌炎24例（骨化性肌炎组）,占比28.6%。骨化性肌炎组超声表现为肱三头肌肌腱纤维呈连续性中断,含稍强回声的非均质等回声,近侧断端肌腱有回缩并增厚。非骨化性肌炎组（60例）超声表现为肱三头肌肌腱纤维呈连续性中断,局限性边界清晰非均质性稍低回声,两断端中间呈不均质低回声。骨化性肌炎组的骨质破坏、软组织肿胀与关节积液等占比分别为75.0%、79.2%、79.2%,均高于非骨化性肌炎组的20.0%、25.0%、35.0%（P<0.05）。骨化性肌炎组的肌腱面积、肌腱厚度、血管条数均比非骨化性肌炎组更高（P<0.05）。84例患者中,高频超声、超微血流成像与两者联合诊断为肱三头肌肌腱断裂伴骨化性肌炎分别为18例、23例、24例,高频超声、超微血流成像与两者联合诊断肱三头肌肌腱断裂伴骨化性肌炎的灵敏度为70.8%（17/24）、91.7%（22/24）、100.0%（24/24）,特异度为98.3%（59/60）、98.3%（59/60）、100.0%（60/60）。结论 肱三头肌肌腱断裂伴骨化性肌炎比较常见,高频超声联合超微血流成像在肱三头肌肌腱断裂伴骨化性肌炎的应用可有效反映病灶形态特征与血流特征,在诊断上具有很高的灵敏度与特异度。
Objective To explore and analyze the diagnostic values of high-frequency ultrasound combined with superb microvascular imaging（SMI）in triceps brachii tendon rupture with ossifying myositis．Methods From July 2020 to May 2022,84 cases of patients with triceps brachii tendon rupture who were diagnosed and treated in our hospital were selected as research subjects．All patients underwent arthroscopy and ultrasonography,ultrasonography including high-frequency ultrasound and SMI,to record ultrasound characteristics and determine diagnostic value,and patients were divided into ossifying myositis group and non-ossifying myositis group according to the results of the arthroscopic examination．Results In 84 patients,there were 24 patients（28.6%）diagnosed as ossifying myositis by arthroscopy（ossifying myositis group）．The ultrasound findings of the ossifying myositis group were interruption of the triceps brachii muscle tendon fibers with slightly strong echogenicity and heterogeneous isoechogenicity．The proximal severed tendon had retraction and thickening．In the non-ossifying myositis group（n=60）,the ultrasound findings showed a interruption of the triceps brachii muscle tendon fibers,with clear localized boundaries and slightly heterogeneous hypoechogenicity,and there was an uneven hypoechogenicity between the two broken ends．The proportions of bone destruction,soft tissue swelling and joint effusion in the myositis group were 75.0%,79.2% and 79.2%,which were significantly increased compared to 20.0%,25.0% and 35.0% in the non-ossifying myositis group（P<0.05）．The tendon area,tendon thickness and vascular number in the ossifying myositis group were significantly higher than those in the non-ossifying myositis group（P<0.05）．In the 84 patients,there were 18 cases,23 cases and 24 cases diagnosed of triceps tendon rupture with ossifying myositis by high-frequency ultrasound,SMI and their combination．The sensitivity of high-frequency ultrasound,SMI and their combination in the diagnosis of triceps tendon rupture with ossifying myositis were 70.8%（17/24）,91.7%（22/24） and 100.0%（24/24）,with specificity of 98.3%（59/60）,98.3%（59/60） and 100.0%（60/60）．Conclusions Triceps brachii tendon rupture with ossifying myositis is relatively common．The application of high-frequency ultrasound combined with SMI in triceps brachii tendon rupture with ossifying myositis can effectively reflect the morphological and blood flow characteristics of the lesion,with high sensitivity and specificity in diagnosis．
目的 探讨接受冠状动脉造影患者的中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和单核细胞-淋巴细胞比值（MLR）与冠状动脉疾病（CAD）严重程度的关系。方法 收集2021年1月—2021年12月在六安市人民医院接受冠状动脉造影的150例急性冠脉综合征（ACS）患者。CAD的严重程度通过Gensini评分进行评估,150例ACS患者根据评分被分为轻度病变组（≤14分,41例）、中度病变组（15~47分,69例）和重度病变组（≥48分,40例）。比较3组的临床指标,采用相关统计学分析NLR、PLR、MLR与CAD严重性（Gensini评分）的相关性。结果 纳入研究的150例患者的平均年龄为（66.49±11.43）岁,男性占67.3%。在重度病变组,NLR和PLR值高于其他两组。在Pearson相关性检验中,Gensini评分与NLR呈正相关（r=0.319,P<0.001）,然而,Gensini评分与MLR、PLR之间无相关性（P>0.05）。在Logistic回归分析中,NLR（OR：1.306,95%CI：0.107~0.427）是CAD的独立危险因素。在ROC曲线分析中,发现NLR的曲线下面积最高,为0.723（95%CI：0.629~0.817,P<0.001）,NLR≥0.25为识别CAD存在的最佳临界值,灵敏度为78.49%,特异度为60.26%。结论 根据Gensini评分,NLR与CAD的严重程度呈正相关,而研究中未观察到MLR、PLR与CAD严重程度之间的关联。
Objective To explore the correlation of neutrophil-to-lymphocyte ratio（NLR）,platelet-to-lymphocyte ratio（PLR）,monocyte-to-lymphocyte ratio（MLR）with coronary artery disease（CAD）severity in patients undergoing coronary angiography．Methods A total of 150 patients with acute coronary syndrome（ACS）who underwent coronary angiography in Lu'an People's Hospital from January 2021 to December 2021 were enrolled．The severity of CAD was assessed by Gensini score,according to the score,150 patients with ACS were divided into mild disease group（≤14 points,41 cases）,moderate disease group（15-47 points,69 cases）and severe disease group（≥48 points,40 cases）．Clinical indicators of the three groups were compared,and related statistics were used to analyze the correlation between NLR,PLR,MLR and the severity of coronary artery lesions（Gensini score）．Results The average age of selected 150 patients was（66.49±11.43）,67.3% were male．In the severe disease group,NLR,PLR values were higher than the other two groups．A positive significant correlation was found between Gensini score and NLR（r=0.319,P<0.001）by Pearson's correlation test．However,no correlation was found between Gensini score and MLR and PLR（P>0.05）．In the Logistic regression analysis,NLR（OR：1.306,95% CI：0.107-0.427）was the independent risk factor of CAD．In receiver operating characteristic curve analysis,NLR was found to have highest area under the curve at 0.723（95% CI：0.629-0.817,P<0.001）,with an optimal cut-off value of 0.25,predicting the severe coronary lesion with a sensitivity of 60.26% and specificity of 78.49%．Conclusions The NLR is positively correlated with the severity of CAD．No correlation between MLR,PLR and severity of CAD in the cohort were observed．
目的 分析单核细胞-淋巴细胞比率（MLR）联合游离三碘甲腺原氨酸（FT3）对乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者生存状况的预测效果。方法 纳入我院在2019年1月—2022年1月期间收治的HBV-ACLF患者共187例进行研究,随访患者90 d的生存状况,其中69例死亡患者设为死亡组,其余118存活患者设为存活组。对2组患者的各项资料进行单因素分析,对差异有统计学意义的因素行Logistic多因素分析,分析HBV-ACLF患者死亡的危险因素,并分析MLR联合FT3对HBV-ACLF死亡的预测效果。结果 死亡组患者的年龄、肝硬化发生率、原发性腹膜炎发生率、肝肾综合征发生率、电解质紊乱发生率、终末期肝病模型、MLR、中性粒细胞与淋巴细胞计数比值、国际标准化比值、肌酐、白细胞计数、总胆红素水平均高于B组,血钠、FT3、总血清胆固醇水平均低于存活组,差异有统计学意义（P<0.05）。MLR≥0.60、FT3≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）。MLR、FT3、MLR+FT3对HBV-ACLF患者死亡均有一定的预测价值,但MLR+FT3的预测价值高于其他单项预测。结论 MLR≥0.60、FT3≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）,且二者联合应用对HBV-ACLF患者死亡有较佳的预测价值。
Objective To analyze the predictive effect of mononuclear-lymphocyte ratio（MLR）combined with free triiodothyronine（FT3）on the survival of patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）．Methods In the study,187 patients with HBV-ACLF from January 2019 to January 2022 in our hospital were included,and the survival status of the patients was followed up for 90 days．Among them,69 patients were included in the death group and the rest 118 patients were included in the survival group．The data of the two groups of patients were analyzed by univariate analysis,and the statistically significant factors were analyzed by Logistic multifactor analysis．The risk factors of death in patients with HBV-ACLF were analyzed,and the predictive effect of MLR combined with FT3 on the death of HBV-ACLF was analyzed．Results The age,incidence of cirrhosis,primary peritonitis,hepatorenal syndrome,electrolyte disturbance,ratio of neutrophil to lymphocyte count,international standardized ratio,model for end stage liver disease,MLR,creatinine,white blood cell count and total bilirubin of the patients in the death group were higher than those in survival group,and the levels of serum sodium,FT3 and total cholesterol were lower than those in survival group,the differences were significant（P<0.05）．The results showed that MLR≥0.60,FT3≤2.50 pmol/L were risk factors for death of HBV-ACLF patients（P<0.05）．MLR,FT3,MLR+FT3 had certain predictive value for the death of HBV-ACLF patients,but the predictive value of MLR+FT3 was higher than other single prediction．Conclusions MLR≥0.60 and FT3≤2.50 pmol/L are risk factors for death of patients with HBV-ACLF（P<0.05）,and the combination of the two has a better predictive value for death of patients with HBV-ACLF．
目的 探讨功能性消化不良（FD）患者应用乳果糖联合莫沙必利治疗的临床疗效及药物对肠道菌群的影响。方法 选取2019年1月—2021年12月来院诊治的180例FD患者作为研究对象,随机分为2组,每组90例,对照组口服莫沙必利片,观察组服用莫沙必利片+乳果糖口服液,4周后观察2组患者治疗后临床症状改善率及肠道菌群数量的情况。结果 治疗4周后,观察组的总有效率（86.67%）高于对照组（72.22%）,P<0.05;观察组的乳杆菌菌群数多于对照组,肠球菌、肠杆菌菌群数少于对照组,P<0.05。结论 乳果糖联合莫沙必利用于FD患者临床治疗,总有效率高于单用莫沙必利,患者症状获得有效改善,明显改善FD患者肠道菌群水平。
Objective To explore the clinical efficacy and effect on intestinal flora of lactulose combined with mosapride in patients with functional dyspepsia（FD）．Methods A total of 180 FD patients admitted to the hospital in January 2019 and December 2021 were selected as the study subjects and randomly divided into two groups,90 cases in each group．The control group took oxapride orally and the observation group took lactulose oral solution additionally．After 4 weeks,the improvement rate of clinical symptoms and the number of intestinal flora of patients were observed．Results After 4 weeks of treatment,the total effective rate of the observation group（86.67%）was obviously higher than that of the control group（76.67%）,P<0.05;the number of Lactobacillus in the observation group was higher than that of the control group,and the numbers of Enterococcus and Enterobacteria were less than that of the control group,P<0.05．Conclusions The total effective rate of lactulose combined with mosalabin for FD patients is higher than that of mossalapride alone．The symptoms are effectively improved,and the intestinal flora level of FD patients is significantly improved．
目的 探究精神分裂症患者应用帕利哌酮后剂量校正浓度（C/D）的影响因素,旨在为精神分裂症患者的临床用药提供参考。方法 选择2021年9月–2022年5月在我院择期接受帕利哌酮治疗的122例精神分裂症患者作为研究对象,收集患者的年龄、性别、给药剂量、给药频次以及合并用药等状况。结果 不同性别间帕利哌酮C/D存在差异,其中女性的C/D明显比男性的C/D更高。在关于年龄、性别、给药剂量、给药频次以及合并用药对帕利哌酮C/D的影响分析中,合并用药阿立哌唑、性别对帕利哌酮C/D有影响。结论 帕利哌酮应用在精神分裂症患者治疗中,性别、合并应用阿立哌唑会对帕利哌酮C/D产生显著影响。
Objective To explore the influencing factors of dose-corrected through concentration（C / D）of paliperidone in patients with schizophrenia,in order to provide reference for clinical medication of patients with schizophrenia．Methods A total of 122 patients with schizophrenia treated with paliperidone in our hospital from September 2021 to May 2022 were selected as the research objects．The patient's age,gender,dosage,frequency of administration and combined medication were collected．Results There were differences in the C / D of paliperidone between different genders,and the C / D of women was significantly higher than that of men．In the analysis of the effects of age,gender,dosage,frequency of administration and combined medication on the C / D of paliperidone,the combined medication of aripiprazole and gender had effect on the C / D．Conclusions The application of paliperidone in the treatment of patients with schizophrenia,gender and combined application of aripiprazole can have significant impact on C / D．
目的 通过关注追踪中老年人口腔健康问题对生活质量的影响,系统梳理中老年人口腔健康的相关影响因素及其关系,为此类人群的口腔健康及其相关生活质量的活动开展提供调研依据。方法 随机抽取2022年10月—2023年5月之间的266名中老年人参与调查,按照“病因链”收集该类人群的社会学特征、日常口腔保健行为、身体健康状况,分析评价中老年人口腔健康相关生活质量。结果 266名中老年人口腔健康常识和行为得分平均为（30.69±8.98）分,口腔健康评估平均为（8.59±3.68）分,口腔健康相关生活质量GOHAI总分为（25.65±8.10）分。单因素分析显示,人口学特征与一般身体健康状况、口腔健康常识和行为以及口腔健康情况与中老年人的口腔健康相关生活质量的GOHAI得分密切相关（P<0.05）。多因素分析显示,女性、年龄>45岁、患慢性病、日常生活习惯是影响中老年口腔健康和生活质量的独立危险因素（P<0.05或P<0.01）。结论 口腔健康作为全身健康的基础,其影响因素多种多样,通过控制干预主要影响因素来提高社区口腔健康和相关生活质量,以改善社区居民生活幸福值。
Objective By focusing on and tracking the impact of oral health problems of middle-aged and elderly people on the quality of life,the relevant influencing factors and relationships of oral health were systematically sorted out to provide a research basis for the development of oral health and related quality of life of such people．Methods A total of 266 middle-aged and elderly people were randomly selected from October 2022 to May 2023 to participate in the survey,and the sociological characteristics,daily oral health care behaviors and physical health status of this population were collected according to the “etiological chain”,so as to analyze and evaluate the quality of life related to the oral health of middle-aged and elderly people．Results The 266 middle-aged and elderly people had a mean score of（30.69±8.98）for general knowledge and behavioral scores of oral health,a mean score of（8.59±3.68）for oral health assessment,a total score of（25.65±8.10）for oral health-related quality of life GOHAI．The univariate analysis showed that demographic characteristics,general body health state,oral health cognition and behavior and oral health state were closely associated with the GOHAI score related to the oral health associated quality of life in the middle-aged and elderly people（P<0.05）．The multivariate analysis indicated that female,age >45 years old,presence of chronic diseases and daily living habits were indepdent risk factors of the oral health and quality of life of the middle-aged and elderly（P<0.05）．Conclusions Oral health,as the basis of systemic health,has various influencing factors,by controlling the main influencing factors can improve the community oral health and related quality of life,and improve the happiness of community residents．
目的 分析医用几丁糖治疗不可复性关节盘前移位患者的临床疗效及其对患者生活质量、恐惧疾病进展的影响。方法 将200例确诊为不可复性关节盘前移位患者分为2组,实验组以颞下颌关节微创灌洗术联合几丁糖治疗,对照组采用单一颞下颌关节微创灌洗术治疗,分别于治疗前和治疗后1、3、6、12个月采用一般资料调查表、口腔健康影响程度量表（OHIP）-14中文版、恐惧疾病进展简化量表（FoP-Q-SF）、视觉疼痛模拟量表等进行问卷调查并进行统计学分析。结果 治疗后,2组患者最大张口度、疼痛评分、生活质量及恐惧疾病进展水平较治疗前明显改善（P>0.05）,且2组间比较,颞下颌关节微创灌洗术联合医用几丁糖在临床效果、生活质量及恐惧疾病进展水平长期效果明显优于单一颞下颌关节微创灌洗术（P>0.05）。结论 颞下颌关节微创灌洗术单一应用或联合医用几丁糖均对不可复性关节盘前移位患者疗效良好,对提升患者生活质量和缓解恐惧心理方面也有着重要意义,其中不可复性关节盘前移位联合应用几丁糖的长期疗效优于其单一应用。
Objective To analyze the efficacy of medical chitosan and its effect on the quality of life and fear of disease progression of patients with anterior disc displacement without reduction．Methods A total of 200 patients with anterior disc displacement without reduction were selected and divided into two groups,the experimental group was treated with temporomandibular joint lavage and medical chitosan,the control group was treated with temporomandibular joint lavage only．Before and after treatment with 1 month,3 months,6 months and 12 months,general data questionnaire,OHIP-14 Chinese version,FoP-Q-SF and visual analogue scale were used to investigate and the data were analyzed statistically．Results After treatment,the maximum mouth opening degree,pain score,quality of life and fear of disease progression were significantly improved compared with those before treatment,the differences were statistically significant（P>0.05）．The long-term curative effect of the temporomandibular joint lavage and medical chitosan was better than that of the temporomandibular joint lavage only in clinical outcome,quality of life and fear of disease progression（P>0.05）．Conclusions Temporomandibular joint lavage combined with medical chitosan and temporomandibular joint lavage only are effective in the treating anterior disc displacement without reduction,and can improve the quality of life and fear of disease progression,while the combined treatment has better long-term effect．
目的 了解广州市社区居民对中医“治未病”的认知现状,分析其影响因素,并为中医“治未病”的进一步发展提出可行建议。方法 采用多阶段整群抽样法,对广州市不同区域的652名居民进行问卷调查,通过描述性分析和χ2检验分别对基本认知情况与影响因素进行阐述。结果 广州市居民对“治未病”服务了解情况不太理想（67.80%）,接受“治未病”服务的意愿情况较好（77.91%）,对于中医“治未病”服务的认知还比较片面,主要通过手机、网络、社区等方式了解相关内容。影响居民接受意愿的因素主要是年龄、学历、户口、职业类型等。结论 目前广州市社区中医“治未病”服务具有一定群众基础和发展潜力,但是还存在居民认知不足、宣传力度不够、服务能力不足等问题,应当着重从这些方面进行改进。
Objective To understand the current cognitive status of community residents in Guangzhou regarding traditional Chinese medicine（TCM）pre-treatment,analyze its influencing factors,and provide feasible suggestions for the further development of TCM pre-treatment．Methods By multi-stage cluster sampling method,a questionnaire survey was conducted on 652 residents in different regions of Guangzhou．Descriptive analysis and chi-square test were used to elucidate the basic cognitive situation and influencing factors．Results The understanding of TCM pre-treatment services among residents in Guangzhou was not ideal（67.8%）,and their willingness to receive TCM pre-treatment services was good（77.91%）．Their understanding of TCM pre-treatment services was quite one-sided,mainly through mobile phones,internet,communities and other means．The main factors affecting residents' willingness to accept this service were age,education level,household registration and occupation．Conclusions At present,the TCM pre-treatment service in the community of Guangzhou has a certain mass basis and development potential．However,there are still problems such as insufficient residents' awareness,insufficient publicity,and insufficient service capabilities,which should be improved in the future．
目的 了解越秀区助产机构医务人员对艾滋病母婴阻断知识及患者相关权益知识掌握情况,为更好地贯彻落实消除艾滋病母婴传播工作提供下一步工作策略和措施依据。方法 于2022年7月—8月,对广州市越秀区5家助产机构妇产科、保健科和医务科的医务人员进行艾滋病母婴阻断知识政策及HIV感染孕产妇相关权益知识的问卷调查。结果 465名医务人员对个别艾滋病母婴阻断政策了解不足,包括“人类免疫缺陷病毒（HIV）感染孕产妇到定点医疗机构终止妊娠或住院分娩时可以获得一定的减免”（知晓率79.78%）、“HIV感染孕产妇的宝宝可以免费领取一定数量的奶粉”（知晓率66.88%）;医务人员对HIV感染孕产妇的生育相关权益认识严重不足,对HIV感染孕产妇生育权益认识正确的仅有45.59%。临床护士群体对上述艾滋病母婴阻断政策及HIV感染孕产妇相关权益的知晓率低于临床医生及其他医务人员,组间比较差异有统计学意义（P<0.05）。结论 越秀区助产机构医务人员对艾滋病母婴阻断知识有一定的了解,但掌握不够完整、全面,对HIV感染患者的生育权认识严重不足,应进一步加强对助产机构医务人员、尤其是护士群体关于艾滋病母婴阻断政策知识及患者相关权益的培训,以更好地贯彻落实消除艾滋病母婴传播工作,保障HIV感染患者的权益。
Objective To understand the knowledge of medical staff of midwifery institutions in Yuexiu District about AIDS prevention of mother-to-children transmission（PMTCT）and patients' rights and interests,in order to provide the basis for the following work strategy and measures for better implementation of the elimination of mother-to-child transmission of HIV．Methods From July to August in 2022,a questionnaire survey about knowledge and policies of AIDS PMTCT and rights of HIV infected pregnant women was conducted among the medical staff of obstetrics and gynecology department,health care department and medical department in five midwifery institutions in Yuexiu District of Guangzhou City．Results A total of 465 medical workers had insufficient understanding of some policies on PMTCT of AIDS,including HIV-infected pregnant women can obtain certain fee waiver when they go to designated medical institutions to terminate pregnancy or hospitalized deliver（awareness rate of 79.78%）,HIV-infected pregnant women's babies can receive a certain amount of free milk powder（awareness rate of 66.88%）．There was a serious lack of awareness of reproductive rights of HIV-infected pregnant women among medical staff,and only 45.59% of them had correct understanding．The awareness rate of the PMTCT and the rights and interests of HIV-infected pregnant women among clinical nurses was significantly lower than that among clinicians and other medical staff．Conclusions The medical staff of midwifery institutions in Yuexiu District have some knowledge about the PMTCT of AIDS,but their knowledge is not complete and comprehensive,and their understanding of the reproductive rights of HIV-infected patients is seriously inadequate,so it is necessary to further strengthen the training of medical staff in midwifery institutions,especially nurses,on the policy knowledge of PMTCT of AIDS and the related rights and interests of patients,in order to better implement the elimination of mother-to-child transmission of AIDS and protect the rights and interests of infected patients．
目的 调查非重症监护室护士对住院卧床老年患者肺康复的知信行现状,探讨其影响因素。方法 采用自行设计的卧床老年患者肺康复知信行现状调查问卷,对广州市第一人民医院的555 名非重症监护室护理人员进行调查。结果 共回收有效问卷513份。调查对象肺康复知信行总分为（76.01±12.27）分,知识维度、态度维度、行为维度得分分别为（14.09±3.25）、（21.89±3.38）、（40.03±9.87）分。多元回归分析显示,主要影响护士对住院老年卧床患者实施肺康复知信行的因素为护龄、是否参加过肺康复相关培训及科室是否已开展肺康复（P<0.05）。结论 非重症监护室护士对卧床老年患者肺康复的态度积极,行为良好,但知识有待提升。建议开展卧床老年人相关肺康复培训,激励护士主动学习肺康复新理念的积极性和主动性,强化理论联系临床实践,从而提高临床护理质量。
Objective To investigate the knowledge,attitude and practice of non-intensive care unit（ICU）nurses about pulmonary rehabilitation of hospitalized bedridden elderly patients,and to explore the influencing factors．Methods A self-designed questionnaire on the status of knowledge,attitude and practice about pulmonary rehabilitation of bedridden elderly patients was used to investigate 555 non-ICU nurses in our hospital．Results A total of 513 valid questionnaires were collected．The total score of pulmonary rehabilitation was（76.01±12.27）,and the scores of knowledge,attitude and practice were（14.09±3.25）,（21.89±3.38）and（40.03±9.87）,respectively．Multiple regression analysis showed that the main factors affecting nurses' knowledge,attitude and practice in implementing pulmonary rehabilitation for hospitalized elderly bedridden patients were nursing age,whether they had participated in training related to pulmonary rehabilitation and whether pulmonary rehabilitation had been carried out in the unit（P<0.05）．Conclusions Non-ICU nurses have positive attitudes and good practice toward pulmonary rehabilitation for bedridden elderly patients,but their knowledge needs to be improved．It is recommended that training on pulmonary rehabilitation for the bedridden elderly be carried out to motivate nurses to learn new concepts of pulmonary rehabilitation,strengthen the link between theory and clinical practice,and improve the quality of clinical care．
目的 探讨老年髋部骨折（GHF）患者围术期隐性失血的影响因素及护理措施。方法 回顾性分析2020年3月—2023年3月我院收治的86例老年GHF患者,所有患者均采取手术治疗,计算所有患者围术期失血量,并收集所有患者的一般资料及围术期相关治疗情况,分析不同一般资料患者围术期隐性失血情况,不同手术方式及麻醉方式围术期隐性失血情况,不同术后处理方式围术期隐性失血情况,随后采取Logistic回归分析老年GHF患者围术期隐性失血的影响因素,最后针对结果制定老年GHF隐性失血的护理措施。结果 不同性别和是否合并冠状动脉粥样硬化、高血压患者围术期隐性失血量比较差异无统计学意义（P>0.05）,不同年龄、合并糖尿病、骨折类型患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同手术方式、麻醉方式患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同术后引流、使用肝素情况患者围术期隐性失血量比较差异有统计学意义（P<0.05）;Logistic回归分析结果表明：年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素都是造成GHF老年患者围术期隐性失血的影响因素（P<0.05）。患者经相关护理后,恢复较佳。结论 老年GHF患者围术期会存在大量隐性失血情况,同时年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素与围术期隐性失血量密切相关,临床上可采取针对性措施减少GHF患者隐性失血。
Objective To explore the influencing factors and nursing measures of perioperative hidden blood loss in elderly patients with geriatric hip fractures（GHF）．Methods From March 2020 to March 2023,86 elderly patients with GHF admitted to our hospital were selected as the study objects for retrospective analysis．All patients were treated with surgery．The perioperative blood loss of all patients was calculated,general information and perioperative treatment status of all patients were collected,the hidden blood loss of patients with different general information,different surgical and anesthesia methods and different postoperative treatment methods were analyzed．Logistic regression analysis was used to analyze the influencing factors of hidden blood loss of elderly GHF patients during the perioperative period．Nursing measures for hidden blood loss in elderly hip fractures were developed based on the results．Results There was no statistical difference in the amount of perioperative hidden blood loss among patients with different gender,complicated with coronary heart disease and hypertension or not（P>0.05）,but there was statistical difference in the amount of perioperative hidden blood loss among patients with different ages,complicated with diabetes and fracture types（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different surgical and anesthesia methods（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different postoperative drainage and use of heparin（P<0.05）．The results of Logistic regression analysis showed that age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use were independent risk factors for perioperative hidden blood loss in elderly patients with GHF（P<0.05）．Conclusions There will be a lot of hidden blood loss in the perioperative period of elderly patients with GHF．At the same time,age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use are closely related to the amount of hidden blood loss in the perioperative period．Targeted measures can be taken clinically to reduce the hidden blood loss in patients with GHF．
目的 探讨癫痫患者疾病进展恐惧水平的影响因素。方法 选取2021年1月—2022年8月本院收治的82例癫痫患者,评估所有患者的疾病进展恐惧水平,设计基线资料调查表,详细统计所有患者的基线资料,比较不同资料特征癫痫患者的恐惧疾病进展简化量表（FoP-Q-SF）评分,重点分析癫痫患者疾病进展恐惧水平的影响因素。结果 经评估,82例癫痫患者的FoP-Q-SF评分为（34.73±5.16）分;不同年龄、社会支持、希望水平、发作频率及受教育程度癫痫患者的FoP-Q-SF评分比较差异有统计学意义（均P<0.05）,其他不同资料特征癫痫患者的FoP-Q-SF评分比较,差异无统计学意义（P>0.05）;多元线性回归分析结果显示,低龄、发作频率高、低希望水平、社会支持低下及受教育程度低均为癫痫患者疾病进展恐惧水平的影响因素（P<0.05）。结论 癫痫患者疾病进展恐惧呈中高水平,低龄、发作频率高、低希望水平、社会支持低下及受教育程度低均为癫痫患者疾病进展恐惧水平的影响因素。
目的 对老年心血管疾病患者膳食行为改善情况进行综合调查,并分析其相关影响因素。方法 通过随机抽样的方法,抽取2021年10月—2022年10月桥南街社区卫生服务中心≥65岁心血管疾病患者570例为本次研究样本,通过调查问卷的方式,收集其一般资料、对健康膳食知识与态度及膳食行为改善情况进行全面调查,根据膳食行为改善情况分为改善良好组及改善差组,并分析其膳食行为改善的相关影响因素。结果 570例患者,膳食行为改善良好480例（84.21%）,膳食行为改善差90例（15.79%）。其中近一年中日常增加果蔬摄入489例（85.79%）,增加奶类摄入355例（62.28%）,增加豆类摄入312例（54.74%）,减少食用盐摄入452例（79.30%）,减少油脂摄入415例（72.81%）,减少糖类摄入378例（66.32%）;2组患者在文化程度、居住方式、人均月收入、合并疾病种类、健康膳食知识知晓、健康膳食态度、社会环境支持等方面差异有统计学意义（P<0.05）;Logistic线性回归分析显示,文化程度、居住方式、合并疾病种类、健康膳食知识知晓、健康膳食态度、社会环境支持等为影响老年心血管疾病患者膳食行为改善的主要因素（P<0.05）。结论 该地区老年心血管疾病患者的膳食行为改善较好,但还有一定进步空间,目前存在知行不一致的情况,因此当地相关部门要加强宣教力度,促使其养成健康的膳食态度,共建健康的社会环境,使其膳食行为得以更好改善。
目的 探究血清神经元特异性烯醇化酶（NSE）、振幅整合脑电图（aEEG）动态变化对早期预测窒息新生儿脑损伤的临床意义。方法 选择2022年3月–2023年3月在我院新生儿重症监护室接受治疗的窒息新生儿作为研究对象。按窒息程度分组：轻度窒息30例为A组,重度窒息30例为B组,无窒息的30例足月儿为C组。记录A、B、C组患儿出生后的血清NSE及aEEG,包括出生后24 h、3 d、7 d的血清NSE,出生后6 h、3 d、7 d的aEEG,了解血清NSE及aEEG变化。结果 B组在出生后24 h、3 d、7 d的血清NSE高于A组、C组,组间比较差异有统计学意义（P<0.05）。出生后6 h、3 d、7 d,aEEG背景活动、睡眠觉醒周期、痫性活动和窒息程度紧密相关。结论 血清NSE、aEEG可作为窒息新生儿脑损伤的监测,对于早期预测脑损伤极具临床应用价值。
目的 探讨2型糖尿病（T2DM）患者慢性肾脏病（CKD）发生的危险因素以及其与肥胖之间的相关性。方法 选择2019年3月—2021年12月我院收治的552例T2DM患者作为研究对象,根据是否发生CKD进行分组,其中合并CKD患者136例、未合并CKD患者416例,对2组患者的一般资料及实验室指标进行单因素回归分析比较;对于未合并CKD的T2DM患者进行为期1年的随访,统计T2DM患者CKD的发生率,并针对随访群体的一般资料及实验室指标进行对比分析,通过单因素Logistic回归分析患者发生CKD的影响因素,了解T2DM患者CKD的发生与肥胖之间的关系。结果 合并CKD和未合并CKD的T2DM患者间的年龄、病程、肝功能指标、血脂指标中的低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、肾功能指标中的尿酸、肾小球滤过率（eGFR）比较差异均无统计学意义（均P>0.05）,组间在性别构成、BMI、血压、白蛋白、血红蛋白、血脂指标中的总胆固醇（TC）及甘油三酯（TG）、血糖及肾功能指标中尿白蛋白/肌酐比（UACR）比较差异均有统计学意义（均P<0.05）。396例未合并CKD的T2DM患者随访结果显示,随访期间发生CKD患者123例、未发生CKD患者293例,组间的性别构成、BMI、舒张压、血红蛋白、丙氨酸氨基转移酶、白蛋白、总胆红素、TC、LDL-C、HDL-C、尿酸、糖化血红蛋白及eGFR比较差异均无统计学意义（均P>0.05）,而组间年龄、病程、收缩压、天冬氨酸氨基转移酶、TG、空腹血糖（FPG）及UACR比较差异均有统计学意义（均P<0.05）。单因素Logistic回归分析结果显示,T2DM患者发生CDK的独立危险因素包括肥胖和收缩压、TG及FPG等指标升高（P<0.05）。T2DM患者的BMI与CKD的发生有关,当患者的BMI在28~31 kg/m2之间时,其CKD的发生率明显增加。结论 T2DM患者的CKD发生与肥胖因素有一定相关性,危险因素包括肥胖、血脂血压血糖异常等,T2DM患者的BMI在28~31 kg/m2之间时,其发生CKD的风险会有所增加,故需要对患者的BMI进行有效控制,降低CKD发生率,以避免病情恶化。
目的 探究连续性静脉-静脉血液滤过（CVVH）联合HA330血液灌流在改善创伤脓毒症急性肾损伤患者肾功能及炎症反应中的应用效果。方法 选择我院2021年1月—2023年1月期间接诊的98例创伤脓毒症急性肾损伤患者开展研究,随机抽签法分为观察组（联合CVVH、HA330血液灌流治疗）、对照组（予以CVVH治疗）,各49例,对比临床疗效,包括肾功能、炎症反应、不良反应、预后情况。结果 治疗5 d后,观察组临床总有效率为93.84%,高于对照组73.47%（P<0.05）;观察组血清肌酐、尿素氮较对照组明显改善（P<0.05）;观察组IL-6、hs-CRP水平低于对照组（P<0.05）;观察组不良反应总发生率低于对照组（P<0.05）;观察组序贯器官衰竭估计评分、急性生理与慢性健康评分系统评分较对照组低（P<0.05）。结论 CVVH联合HA330血液灌流在改善创伤脓毒症急性肾损伤患者肾功能及炎症反应中的疗效良好,且安全性高,有利于减轻患者炎症反应,控制病情进展,从而改善肾功能及预后。
