肿瘤相关巨噬细胞（TAMs）是肿瘤微环境中最丰富的免疫细胞之一,M2-TAMs在肿瘤发生、发展、转移和治疗过程中发挥重要作用,被认为是肿瘤治疗中的重要靶点。已有的研究表明,通过将促肿瘤的M2-TAMs重编程为促炎的M1-TAMs可实现抑制肿瘤生长和转移。本综述在介绍TAMs与肿瘤治疗相关背景的基础上,重点关注纳米药物重编程TAMs增强抗肿瘤的研究进展。本文将从TAMs靶向递送各种活性物质进行重编程TAMs和纳米药物介导的异常肿瘤微环境调节的间接重编程TAMs两种方式,综述近年来基于纳米药物递送系统的调控策略及典型例子。
Tumor associated macrophages（TAMs）is one of the most abundant immune cells in the tumor microenvironment．M2-TAMs play an important role in tumor genesis,progression,metastasis and treatment,and is additionally a very important target in tumor therapy．Previous studies have shown that inhibition of tumor growth and metastasis can be achieved by reprogramming M2-TAMs to M1-TAMs．On the basis,this review focuses on the analysis progress of nano-drug reprogramming TAMs to boost anti-tumor．In this paper,we reviewed two methods of reprogramming TAMs for targeted delivery of various active substances and indirect reprogramming TAMs for abnormal tumor microenvironment regulation mediated by nanomedicine．The regulatory strategies and typical samples of nanomedicine delivery systems in recent years were summarized.
目的 观察电子束照射对体外培养的细粒棘球蚴形态结构、死亡率及其p38 mRNA表达的影响。方法 采集自然感染的绵羊肝中的细粒棘球蚴原头蚴,随机分成3组,分别用0 Gy、30 Gy、60 Gy的不同剂量的6 MeV电子束各照射1次,照射后连续培养3 d、14 d,光镜观察虫体的大体变化及死亡率,qRT-PCR法测定p38基因的表达水平。结果 60 Gy组较0 Gy、30 Gy组原头蚴变性坏死数目明显增多,死亡率有差异（P<0.0125）,连续培养天数（3 d、14 d）对虫体死亡率无影响。经电子束照射后,30 Gy、60 Gy组原头蚴p38 mRNA表达水平较0 Gy组升高（P<0.05）。结论 体外培养的原头蚴经电子束照射后大体形态结构发生明显变化、死亡率升高,且与电子束的剂量存在量效关系;p38 mRNA的表达量随着电子束的剂量的增加而升高,p38基因可能参与电子束所致体外杀伤棘球蚴的作用机制。
Objective To observe the effect of 6 MeV electron beam on the morphological structure,mortality rate and expression of p38 mRNA and in Echinococcus granulosus．Methods Einococcus granulosus was collected from natural infected sheep liver and divided into 3 groups randomly,then irradiated by 6 MeV electron beam of 0 Gy,30 Gy and 60 Gy,respectively．After culturing for 3 and 14 days,the gross change and mortality of worms were observed by light microscopy and the expression level of p38 gene was determined by qRT-PCR．Results In 60 Gy group,compared with 0 Gy and 30 Gy group,the gross morphology and structure have changed significantly,the mortality rate was significantly different（P <0.0125）．Days of culture（3 days,14 days）had no obvious effect on mortality,and the p38 mRNA expression levels in 30 Gy and 60 Gy group were significantly higher than 0 Gy group（P <0.05）．Conclusions The gross morphology,structure changes and mortality of Einococcus granulosus increases significantly after electron beam irradiation and has obvious quantitative and effective relationship with the electron beam dose,the p38 gene may be involved in the mechanism of in vitro killing by electron beam.
目的 探讨尿液前列腺特异性抗原（u-PSA）预测老年良性前列腺增生（BPH）发生急性尿潴留（AUR）的价值。方法 选取东莞市中医院100例老年BPH患者（2020年1月—2021年4月）进行回顾性研究,均口服盐酸坦索罗辛+非那雄胺片治疗,随访1年,记录AUR发生情况,据此分为AUR组、非AUR组。比较2组一般资料,Logistic回归模型分析老年BPH发生AUR的危险因素,受试者工作特征（ROC）分析前列腺体积（PV）、u-PSA对老年BPH发生AUR的预测价值。结果 100例老年BPH患者AUR发生率为26%;AUR组u-PSA水平高于非AUR组,PV大于非AUR组（P<0.05）;Logistic回归模型分析,u-PSA水平及PV增高是老年BPH患者发生AUR的独立危险因素（P<0.05）;ROC曲线分析,u-PSA预测AUR的AUC=0.897,高于AUCPV（P<0.05）。结论 u-PSA可作为老年BPH继发AUR的量化评估指标,有利于临床早期筛查、诊断,采取针对性干预措施,改善预后。
Objective To investigate the value of urinary prostate-specific antigen（u-PSA）in predicting acute urinary retention（AUR）in elderly patients with benign prostatic hyperplasia（BPH）．Methods A total of 100 elderly patients with BPH in our hospital（from January 2020 to April 2021）were selected for a retrospective study,all of whom were treated with oral tamsulosin hydrochloride + finasteride tablets,followed up for 1 year,and the occurrence of AUR was recorded．The patients were divided into AUR group and non-AUR group．The general data of the two groups were compared．Logistic regression model was used to analyze the risk factors of AUR in elderly BPH patients,and receiver operating characteristic（ROC）was used to analyze the predictive value of prostate volume（PV）and u-PSA for AUR occurrence．Results The incidence of AUR in 100 elderly patients with BPH was 26%;the level of u-PSA in the AUR group was higher than that in the non-AUR group,and the PV was greater than that in the non-AUR group（P<0.05）．Increased PV was an independent risk factor for AUR in elderly patients with BPH（P<0.05）．ROC curve analysis showed that the AUC of u-PSA for predicting AUR was 0.897,which was higher than that of PV（P<0.05）．Conclusions u-PSA can be used as a quantitative evaluation index for AUR secondary to BPH in the elderly,which is conducive to early clinical screening and diagnosing,and taking targeted intervention measures to improve prognosis.
目的 观察帕立骨化醇治疗维持性血液透析并发继发性甲状旁腺功能亢进（SHPT）患者6个月的疗效。方法 选取40例血液透析合并 SHPT的患者,分成观察组和对照组,分别使用帕立骨化醇和骨化三醇治疗6个月,监测治疗前、治疗后血清全段甲状旁腺素（iPTH）、血钙、血磷水平。比较2组患者治疗6个月后iPTH、血钙、血磷变化情况。结果 治疗6个月后,观察组iPTH水平较对照组下降,观察组血钙水平较对照组上升幅度小,观察组血磷水平较对照组下降。结论 帕立骨化醇治疗6个月能显著降低血透并发SHPT患者的iPTH水平,治疗效果显著,且不会增加高钙、高磷血症风险,药物安全性好。
Objective To observe the effectiveness of paricalcitol in the 6-month treatment of maintenance hemodialysis patients with secondary hyperparathyroidism（SHPT）．Methods Forty maintenance hemodialysis patients with SHPT were selected and divided into observation group and control group．They were treated with paricalcitol or calcitriol for 6 months,respectively．Serum levels of intact parathyroid hormone（iPTH）,calcium and phosphorus were monitored before and after treatment．The changes of iPTH,calcium and phosphorus were compared between the two groups after 6 months of treatment．Results After 6 months of treatment,the level of iPTH in the observation group decreased significantly compared with the control group,the level of calcium in the observation group increased slightly compared with the control group,and the level of phosphorus in the observation group decreased significantly compared with the control group．Conclusions This observational study shows that paricalcitol can significantly reduce the iPTH level in hemodialysis patients with SHPT after treatment for 6 months,without increasing the risk of hypercalcemia and hyperphosphatemia.
目的 为寻找治疗盆腔炎性疾病（PID）的有效治疗方案,对比分析头孢哌酮舒巴坦钠+吗啉硝唑、康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑两种用药方案治疗PID的效果差异,期望为今后临床中合理选择PID药物治疗方案提供参考依据。方法 选取2019年1月—12月期间在我院接受治疗的104例急性PID患者（湿毒壅盛证）作为研究对象,用随机信封分为参照组、研究组,各52例。予以参照组患者头孢哌酮舒巴坦钠+吗啉硝唑静脉滴注治疗,研究组患者在参照组基础上口服康妇炎胶囊,均持续治疗14 d。观察2组患者近期疗效、炎性因子、盆腔炎性疾病包块、远期复发率（6个月、1年）、远期生活质量,综合评价两种用药方案应用效果。结果 治疗14 d后,研究组总有效率96.00%,高于参照组的80.39%,差异显著（P<0.05）;WBC、CRP、IL-2、TNF-α四项炎性因子水平均低于参照组,差异显著（P<0.05）;腔包块直径、疼痛评分均低于参照组,差异显著（P<0.05）。随访6个月、1年,研究组患者PID复发率分别为4.00%、10.00%,均低于参照组的15.69%、29.41%,差异显著（P<0.05）。结论 以康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑治疗PID,能够提升患者的近期治疗效果,改善炎性反应、盆腔炎性疾病包块,降低远期复发风险,改善远期生活质量,而且能够保证用药安全性,具有推广使用价值。
Objective To find an effective treatment for pelvic inflammatory disease（PID）,and to compare and analyze the difference of efficacy of cefoperazone and sulbactam sodium + molinidazole,Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,in order to provide reference for rational selection of PID drug treatment in future clinical practice．Methods A total of 104 patients with acute PID（excessive wet toxin accumulation syndrome）who received treatment in our hospital from January to December 2019 were selected as the research objects．They were randomly divided into the control group and the research group with 52 cases in each group．Patients in the control group were given intravenous infusion of cefoperazone and sulbactam sodium + morinidazole,and patients in the research group were given Kangfuyan capsule orally on the basis of the control group,all treated for 14 days．The short-term efficacy,inflammatory factors,pelvic inflammatory mass and pain improvement,adverse reactions,long-term recurrence rate（6 months,1 year）,long-term quality of life in two groups were observed,and the application effect of the two drug regimens was comprehensively evaluated．Results After 14 days of treatment,the total effective rate of the research group was 96.00%,which was higher than that of the control group（80.39%）,with significant difference（P<0.05）．After treatment,the levels of WBC,CRP,IL-2 and TNF-α were lower than those of the control group,and the differences were significant（P<0.05）．After treatment,lumen mass diameter and pain score were lower than the control group,the differences were significant（P<0.05）．After 6 months and 1 year follow-up,the PID recurrence rate of the research group was 4.00% and 10.00% respectively,both lower than that of the control group（15.69% and 29.41%）,with significant difference（P<0.05）．Conclusions Using Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,can improve the patient's recent treatment effect,improve the inflammatory reaction,pelvic inflammation mass, lower long-term risk of recurrence,improve the long-term quality of life,and can ensure medication safety,with promotion value.
目的 调查儿科急诊非急诊手术患儿输血后红细胞恢复的影响因素。方法 回顾2020年1月—2020年12月期间广州市妇女儿童医疗中心珠江新城院区儿科急诊1月~18岁患儿的输血情况,其中分为Hb提升达预期组（n=93）,Hb提升未达预期组（n=156）,根据年龄、性别、体质量、是否恶性肿瘤、是否发热、有无延迟输血、输血前血红蛋白水平、输注红细胞类型情况,分析输血疗效及影响因素。结果 2组患儿的性别、年龄、体质量、有无恶性肿瘤、是否发热、输血等待时间、输血前后血红蛋白值、输注红细胞悬液量以及有无及时输血均无统计学差异;输注红细胞类型组间存在显著差异,Hb提升未达预期组更多输注了洗涤红细胞悬液（13.5% vs 5.4%,P=0.044）,输血后 Hb 值较低（中位数,73 g/L vs 84 g/L,P<0.001）,变化 Hb 值较小（中位数,18 g/L vs 30 g/L,P<0.001）,归因分析未发现影响因素。结论 输注洗涤红细胞可能是降低输血后红细胞提升的影响因素,输注洗涤红细胞时需严格输血指征同时注意红细胞提高预值的设定。
Objective To investigate the influencing factors of blood transfusion efficacy in patients without emergency operations in pediatric emergency．Methods A retrospective analysis of the blood transfusion of pediatric emergency children（1 month~ 18 year of age）in Zhujiang New Town Branch of Guangzhou Women and Children's Medical Center from January 2020 to December 2020 was carried out,patients were divided into Hb elevation up to expectation group（n=93）and Hb elevation not up to expectation group（n=156）．The efficacy of blood transfusion and the factors affecting it were analyzed according to age,gender,body mass,with or without malignant tumor,whether fever was present,whether there was delayed transfusion,pre-transfusion hemoglobin level,and the type of red blood cells transfused．Results There were no significant differences in gender,age,weight,malignant tumor,fever,waiting time for blood transfusion,hemoglobin level before and after blood transfusion,infusion volume of red blood cell suspension and whether had timely blood transfusion between the two groups．Significant differences were found between groups of transfused red blood cell types,with more washed red blood cell suspensions transfused in the Hb elevation not meeting expectations group（13.5% vs 5.4%,P=0.044）,which had lower post-transfusion Hb values（median,73 g/L vs 84 g/L,P<0.001）,and smaller change Hb values（median,18 g/L vs 30 g/L,P<0.001）,and attribution analysis did not reveal influencing factors．Conclusions Transfusion of washed red blood cell may be an influencing factor that reduces the RBCs elevation after transfusion．Attention should be paid to strict indications for washed red blood cell transfusion and setting the expected Hb level.
目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。
Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.
目的 从社会组织网络嵌入性的角度,探讨公立医院医务人员工作内外匹配（包括组织匹配和区域匹配）在人际信任与隐性医学知识共享行为之间的中介效应,完善公立医院医务人员隐性医学知识共享机制的研究。方法 采用问卷调查方式对公立医院医务人员进行调查,运用SPSS 17.0软件进行数据分析,采用AMOS 22.0建立公立医院医务人员工作内外匹配在人际信任与隐性医学知识共享行为之间的中介效应回归方程。结果 公立医院医务人员人际信任与隐性医学知识共享行为之间有显著的正相关关系,标准化回归系数为0.446（P <0.001）。加入工作内外匹配变量后,公立医务人员人际信任对隐性医学知识共享行为的标准化回归系数由0.446（P <0.001）降到0.189（P<0.01）。结论 公立医务人员人际信任正向预测隐性医学知识共享行为;组织匹配、区域匹配在公立医务人员人际信任与隐性医学知识共享行为之间具有部分中介效应。
Objective To explore a new path of interpersonal trust impact on knowledge sharing behavior-being from the perspective of job embeddedness．Methods Questionnaire survey was used to investigate the medical staff in public hospitals．SPSS 17.0 software was used to analyze the data．AMOS 22.0 was used to establish the regression equation of intermediary effect between interpersonal trust and tacit medical knowledge sharing behavior of medical staff in public hospitals．Results There was a significant positive correlation between interpersonal trust and tacit medical knowledge sharing behavior．The standardized regression coefficient was 0.446（P <0.001）．When added the fitting to organization and community,the standardized regression coefficient decreased from 0.446（P <0.001）to 0.189（P <0.01）．Conclusions The interpersonal trust of public medical staffs positively predicts the tacit medical knowledge sharing behavior．Organizational matching and regional matching have partial mediating effect between interpersonal trust and tacit medical knowledge sharing behavior of public medical staff.
目的 探讨妇科肿瘤围手术期发生静脉血栓栓塞症（VTE）的高危因素及预防措施。方法 回顾性分析2018年1月—2021年5月于中山市人民医院妇科收治的围手术期VTE患者38例（9例术前发生血栓、29例术后发生血栓）的临床特征、诊疗过程,并根据高危因素提出针对性的预防措施。结果 9例术前血栓的患者,其中恶性肿瘤、血浆D-二聚体阳性（>500 mg/L）与对照组比较差异有统计学意义（P<0.05）,而年龄、BMI、合并内科疾病与对照组比较,差异无统计学意义（P>0.05）;29例术后血栓的患者,BMI>25 kg/m2、恶性肿瘤、合并内科疾病、手术时间大于3小时、术后使用止血药物与对照组比较差异有统计学意义（P<0.05）;而年龄与手术方式与对照组比较差异无统计学意义（P>0.05）。结论 恶性肿瘤、血浆-D二聚体阳性、手术时间大于3小时、术后使用止血药物均为妇科围手术期血栓发生的高危因素,针对上述高危因素积极预防可显著降低VTE的发生。
Objective To study the high-risk factors and preventive measures of venous thromboembolism in gynecological periopreative surgery．Methods The clinical characteristics and the diagnosis and treatment of thirty-eight cases with perioperative deep venous thrombosis（nine cases with preoperative deep venous thrombosis and twenty-nine cases with postoperative deep venous thrombosis）in the department of gynecology of Zhongshan People's Hospital were analyzed retrospectively．Targeted preventive measures were put forward according to high risk factors．Results Compared with the control group,there were significance differences in malignant tumor,positive D-dimer（>500 mg/L）in nine cases with preoperative thrombosis（P<0.05）,but no significance differences in age,body mass index（BMI）,complicated with internal diseases（P>0.05）．BMI>25,malignant tumor,complicated with internal diseases,operation time more than 3 hours,postoperative usage of hemostatics in twenty-nine cases with postoperative deep venous thrombosis had statistical significance compared with the control group（P<0.05）．But age and surgery method had no statistical significance（P>0.05）between the two groups．Conclusions Malignant tumor,positive D-dimer（>500 mg/L）,operation time more than 3 hours,postoperative usage of hemostatics were the high-risk factors in gynecological periopreative surgery,active prevention against these high-risk factors can significantly reduce the incidence of venous thromboembolism.
目的 研究CXC趋化因子配体4（CXCL4）、基质金属蛋白酶-9（MMP-9）、微小RNA-24（miR-24）对急性脑梗死（ACI）早期神经功能恶化（END）的预测价值。方法 分别选择2020年1月—2021年6月我院收治的30例ACI早期END患者（ACI+END组）,30例单纯ACI患者（ACI组）,同时期30例健康人群作为对照组,检测受试者CXCL4、MMP-9、miR-24表达情况及存在的相关性,分析血清CXCL4、MMP-9、miR-24表达情况与ACI早期发生END的关系。结果 CXCL4、MMP-9水平在对照组、ACI组、ACI+END组中依次升高,miR-24相对表达量依次降低（P<0.05）。血清CXCL4、MMP-9、miR-24水平在轻度、重度患者中呈升高趋势,miR-24相对表达呈降低趋势（P<0.05）。Logistic回归分析血清CXCL4、MMP-9、miR-24表达异常与ACI早期发生END独立相关（P<0.05）。经Pearson相关性分析发现,CXCL4与MMP-9之间呈正相关（r=0.584,P=0.001）;CXCL4、miR-24之间呈负相关（r=-0.569,P=0.001）,MMP-9、miR-24之间呈负相关（r=-0.567,P=0.001）。ROC曲线显示,与CXCL4、MMP-9、miR-24单项预测相比,三项联合对ACI的关系及对早期END的预测价值较高（P<0.05）。结论 CXCL4、MMP-9、miR-24在ACI发生END时出现异常表达,检测CXCL4、MMP-9、miR-24水平对ACI早期END具有一定预测价值,可尽早制定相关措施干预,提高治疗效率。
Objective To study the predictive value of CXC chemokine ligand 4（CXCL4）,matrix metalloproteinase-9（MMP-9）,microRNA-24（miR-24）in early neurological deterioration（END）of acute cerebral infarction（ACI）．Methods A total of 30 patients with ACI early END（ACI+END group）and 30 patients with ACI only（ACI group）who were admitted to our hospital from January 2020 to June 2021 were selected,and 30 healthy people（control group）who underwent physical examination in our hospital during the same period were selected．Expressions of CXCL4,MMP-9,and miR-24 were detected and their correlations were analyzed,and the relationship between the expressions of serum CXCL4,MMP-9,miR-24 and the early occurrence of END in ACI were analyzed．Results The levels of CXCL4 and MMP-9 were increased in the control group,ACI group and ACI+END group in turn,and the relative expression of miR-24 was decreased in turn,and the differences among the groups were statistically significant（P<0.05）．The levels of serum CXCL4,MMP-9,and miR-24 increased in mild and severe patients,while the relative expression of miR-24 decreased,and the differences between groups were statistically significant（P<0.05）．Logistic regression analysis showed that abnormal expressions of serum CXCL4,MMP-9 and miR-24 were independently correlated with the early occurrence of END in ACI（P<0.05）．After Pearson correlation analysis,it was found that there was a positive correlation between CXCL4 and MMP-9（r=0.584,P=0.001）,a negative correlation between CXCL4 and miR-24（r=-0.569,P=0.001）;a negative correlation between MMP-9 and miR-24（r=-0.567,P=0.001）．The ROC curve showed that compared with the single prediction of CXCL4,MMP-9 and miR-24,the predictive value of the combined prediction on ACI and early END were higher（P<0.05）．Conclusions CXCL4,MMP-9,and miR-24 are abnormally expressed in ACI when END occurs．Detection of CXCL4,MMP-9,and miR-24 levels has certain predictive value for early END of ACI,and relevant measures can be formulated as soon as possible to improve treatment efficiency．
目的 探讨医院消毒供应中心清洗全程质量控制用于院内感染风险预防价值。方法 选取2019年1月—2021年6月期间医院消毒供应中心待清洗消毒的1 000件手术器械（观察组）,采用全程质量控制;另选取1 000件手术器械（对照组）,常规流程清洗;比较2组患者器械清洗质量,统计清洗后因术中器械的院内感染率。结果 观察组清洗消毒后器械血渍、污垢、锈斑总发生率0.20%,低于对照组的1.50%,器械清洗、消毒、灭菌合格率高于对照组（P<0.05）。观察组器械操作流程与标准、科室管理、安全管理、综合质量管理高于对照组,院内感染率0.10%低于对照组的1.00%,医护人员满意度95.00%高于对照组的75.00%（P<0.05）。结论 医院消毒供应中心清洗质量控制,可增加手术器械清洗质量,减少院内感染的发生。
Objective To explore the value of whole process cleaning quality control in hospital disinfection supply center for risk prevention of hospital infection．Methods From January 2019 to June 2021,1000 surgical instruments to be cleaned and disinfected in the hospital disinfection supply center（observation group）were selected,and the whole process quality control was applied;another 1000 surgical instruments（control group）were selected for routine cleaning．The quality of instrument cleaning in the two groups was compared,and the hospital infection rate after the application of cleaned instrument was calculated．Results After cleaning and disinfecting instruments,the total incidence of blood stains,dirt and rust was 0.20% in the observation group,lower than that in the control group,which was 1.50%,and the qualified rate of instrument cleaning,disinfecting and sterilizing was higher than that in the control group（P<0.05）．The equipment operation procedures and standards,department management,safety management,and comprehensive quality management of the observation group were higher than those of the control group,the hospital infection rate was 0.10%,lower than that of the control group（1.00%）,and the satisfaction rate of medical staff was 95.00% in the observation group,higher than that of the control group（75.00%,P<0.05）．Conclusions The cleaning quality control of hospital disinfection supply center can improve the cleaning quality of surgical instruments and reduce the occurrence of hospital infection.
目的 探讨容积调强（VMAT）在全脊柱骨多发转移瘤放疗中的运用,观察疗效及安全性。方法 选取 2018年1月—2021年1月本科室收治的50例全脊柱骨多发转移瘤姑息止痛放疗的临床资料,分别对全脊柱靶区设计适形放疗（CRT）和VMAT多中心计划,运用剂量体积直方图及所对应的统计表评估靶区及危及器官剂量覆盖情况,放疗结束后通过1-8周视觉模拟评分法评价近期疗效,每3个月复查全脊柱MRI观察放疗不良反应。结果 采用VMAT技术放疗靶区剂量覆盖度、靶区适形指数和剂量均匀指数均优于CRT技术（P<0.01）,照射野重叠区未见明显剂量热点和冷点。采用VMAT技术危及器官V5 Gy受照体积高于CRT（P<0.01）,除了胃、胰腺和小肠,危及器官V10 Gy受照体积高于CRT（P<0.01或P<0.05）,危及器官V20 Gy受照体积则低于CRT（P<0.01）,除了肾,危及器官V30 Gy受照体积也低于CRT（P<0.01）。采用VMAT技术时危及器官的最大受照量低于CRT（P<0.01或P<0.05）,但除了心脏、胰腺和小肠,VMAT技术的危及器官平均受照量高于CRT（P<0.01或P<0.05）。采用VMAT技术较CRT出束时间增加（P<0.01）,采用CRT时技师摆位时间较VMAT增加（P<0.05）,对于总治疗时间VMAT较CRT增加（P<0.01）。8周后评估疼痛完全缓解16例,部分缓解 22例,轻度缓解8例,无效4例,总有效率为76%。随访日期截至2021年 12月,所有配合随诊的患者3、6、9、12个月全脊柱MRI复查结果显示,VMAT技术照射野内重叠处均未见脊髓及其他组织急慢性损伤情况。结论 VMAT技术对长靶区多中心放疗剂量分布均匀,近期疗效显著,安全性良好。
Objective To investigate the application of volumetric modulated arc therapy（VMAT） in the radiotherapy for multiple bone metastases in the whole spine,and observe of efficacy and evaluation of safety．Methods The clinical data were selected from 50 patients who were treated in our department between January 2018 and January 2021 with palliative analgesic radiotherapy for multiple metastases of the whole spine．Conformal radiotherapy（CRT）and multicenter VMAT plans were respectively applied to target areas of whole spine,and dose volume histogram was used to evaluate the dose coverage of target area and organ at risk（OAR）. After radiotherapy,the short-term efficacy was evaluated by visual analog scale in between 1-8 weeks,and the whole spine MRI was reviewed every 3 months to observe the adverse reactions of radiotherapy．Results The dose coverage,target conformality index and homogeneity index of VMAT treatment were significantly better than those of CRT treatment（P<0.01）,and no obvious dose hotspots and cold spots were observed in the overlapping area of irradiation field. When VMAT treatment was applied,the exposure volume of V5 Gy in OAR was significantly higher when compared with CRT treatment（P<0.01）．Except for stomach,pancreas and small intestine,the exposure volume of V10 Gy in OAR was significantly higher for VMAT treatment when compared with CRT treatment （P<0.01 or P<0.05）．When VMAT treatment was applied,the exposure volume of V20 Gy in OAR was significantly lower when compared with CRT treatment（P<0.01）,and except for kidney,the exposure volume of V30 Gy in OAR was significantly lower when compared with CRT treatment（P<0.01）．When VMAT treatment was applied,the maximum exposure of OAR was significantly lower than that of CRT（P<0.01 or P<0.05）,however,except for the heart,pancreas and small intestine,the average exposure of VMAT treatment to OAR was higher than that of CRT （P<0.01 or P<0.05）．Compared with CRT,VMAT treatment had significantly increased beam-out time（P<0.01）,the therapist setting time of CRT was increased when compared with that of VMAT（P<0.05）,and the total treatment time of VMAT was increased when compared with that of CRT（P<0.01）. In the assessment 8 weeks after the treatments,16 patients had complete pain relief,22 had partial relief,8 had mild relief,and 4 had no effect,which total effective rate was 76%．The follow-up was ended in December 2021．There was no acute or chronic injury to the spinal cord and other tissues in the overlapping areas of the irradiation fields observed for all follow-up patients in the 3rd,6th,9th and 12th month whole-spine MRI re-examination．Conclusions VMAT has uniform dose distribution in multi-center radiotherapy for long target areas,with significant short-term efficacy and safety.
目的 了解广州市白云区医护人员对艾滋病感染者/患者（PLWHA）的歧视态度情况,分析其影响因素,并为降低医护人员对PLWHA的歧视态度提供建议。方法 以Lau等设计的AIDS歧视态度量表和张燕等研制的医护人员对PLWHA治疗意愿量表为主设计的调查问卷,对广州市白云区的医护人员进行随机抽样调查,对结果进行描述,研究两量表得分与HIV知识水平的相关性。结果 广州市白云区7家医疗机构并接受培训议会的医护人员AIDS歧视态度量表和治疗意愿量表平均得分分别为（46.66±10.23）分和（32.74±5.89）分,医护人员性别和接受HIV培训的AIDS歧视量表得分存在统计学差异（P<0.01）,单位、性别和接受HIV培训与否的治疗意愿量表得分存在统计学差异（P<0.05）;HIV知识水平与AIDS歧视量表得分和治疗意愿量表得分存在相关性,相关系数值rs分别为-0.301（P<0.001）和-0.219（P<0.001）。结论 广州市白云区医护人员的性别、接受培训与否和HIV知识水平对AIDS歧视量表和治疗意愿量表得分均有影响。应加强白云区医护人员的艾滋病知识培训和各人群的权益保护,以降低医护人员对PLWHA的歧视态度。
Objective To understand the discriminatory attitudes of medical staff to people living with HIV/AIDS（PLWHA）in Guangzhou Baiyun District,analyze the influencing factors,and provide suggestions for reducing the discriminatory attitudes of medical staff to PLWHA．Methods Based on Lau's AIDS Discrimination Attitude Scale and Zhang Yan's Medical Personnel's Adjustment Questionnaire for PLWHA Treatment Willingness Scale,the questionnaire was designed to do a random sampling survey among medical personnel in Guangzhou Baiyun District,and the results were described by regression analysis,to study the correlation between the scores of the two scales and the level of HIV knowledge．Results The average scores of AIDS Discrimination Attitude Scale and Treatment Willingness Scale of medical staff in 7 medical institutions with training in Guangzhou Baiyun District were（46.66±10.23）and（32.74±5.89）respectively．There were statistical differences in AIDS discrimination scale scores of medical staff's gender and whether they received training or not（P< 0.01）,and there were statistical differences in Treatment Willingness Scale scores among institutions,gender and whether they received training or not（P< 0.05）．HIV knowledge level was correlated with the scores of AIDS Discrimination Scale and Treatment Willingness Scale,and the correlation coefficients were -0.301（P < 0.001）and -0.219（P < 0.001）．Conclusions Gender,training or not,and HIV knowledge level of medical staff in this area have an impact on the scores of the AIDS Discrimination Scale and the Treatment Willingness Scale．In order to reduce the discriminatory attitude of medical staff towards PLWHA,the AIDS knowledge and the protection of rights and interests of all groups should be strengthened.
目的 了解并分析白云区不同年龄段男性精液质量现状。方法 选取2020年1月—2021年12月在我中心就诊的已婚孕前体检男性为研究对象,开展常规精液检测,采集精液标本进行分析。结果 白云区育龄男性精液各项指标均在正常范围仅有3 176例（占比57.52%）,随年龄的增加,精液指标总活力、存活率和精子前向运动指标逐渐降低（P<0.05）。结论 26~30岁年龄段男性的精液质量各项指标正常率较其他年龄组更好（P<0.05）,是男性生育的黄金年龄。
Objective To understand and analyze the status of semen quality in men of different ages in Baiyun District of Guangzhou. Methods From January 2020 to December 2021,married men who received pre-pregnant physical examination in our center were selected as the research subjects．Routine semen testing was conducted,and samples were collected for semen analysis. Results Only 3176 cases（57.52%）of male semen data of childbearing age in Baiyun District were within the normal range．With the increase of age,total semen motility,survival rate and sperm forward motility decreased gradually（P < 0.05）. Conclusions Men in the age group of 26-30 years had higher normal rates of all indicators of semen quality than other age groups（P < 0.05）,which is the golden age of male fertility.
目的 观察阶梯式呼吸管理策略在改善感染性休克伴急性肺损伤（ALI）患者中的价值。方法 纳入我院2019年1月—2020年12月收治的感染性休克伴ALI患者共146例为研究对象,数字表法随机分为观察组（73例）与对照组（73例）。对照组常规护理方案,观察组阶梯式呼吸管理,对比干预前后患者心肺功能的差异。结果 观察组平均动脉压、PaCO2水平低于对照组,心脏指数、中心静脉压、血管外肺水指数、PaO2与氧合指数高于对照组（P<0.05）;观察组复苏成功率与临床总有效率高于对照组,复苏时间与呼吸平稳时间低于对照组（P<0.05）;观察组气管切开率、有创呼吸机使用率及呼吸机相关性肺炎与气道并发症发生率均低于对照组（P<0.05）。结论 感染性休克并急性肺损伤患者建立阶梯化呼吸管理策略能够显著改善患者的心肺功能,提高临床复苏效果,降低相关并发症风险。
Objective To observe the value of stepwise respiratory management strategy in improving patients with septic shock and acute lung injury（ALI）．Methods A total of 146 patients with septic shock and ALI treated in our hospital from January 2019 to December 2020 were included as the research objects．They were randomly divided into observation group（73 cases）and control group（73 cases）by digital table method．The control group received routine nursing plan,and the observation group received stepwise respiratory management．The differences of cardiopulmonary function before and after the intervention were compared．Results The levels of mean arterial pressure,PaCO2 in the observation group were significantly lower than those in the control group,cardiac index,central venous pressure,extravascular lung water index,PaO2 and oxygenation index in the observation group were significantly higher than those in the control group（P<0.05）．The success rate of resuscitation and total clinical effective rate in the observation group were significantly higher than those in the control group,and the resuscitation time and respiratory stability time in the observation group were significantly shorter than those in the control group（P<0.05）．The tracheotomy rate,the rate of using invasive ventilator and the incidence of ventilator associated pneumonia and airway complications in the observation group were lower than those in the control group（P<0.05）．Conclusions The establishment of stepwise respiratory management strategy in patients with septic shock and ALI can significantly improve their cardiopulmonary function,improve the effect of clinical resuscitation and reduce the risk of related complications.
目的 分析在临床治疗腰椎间盘突出症过程中采取脊柱微创手术的价值。方法 回顾研究2019年2月-2021年2月本院的102例腰椎间盘突出症患者,按照电脑排序将患者分为参照组51例与研究组51例。其中,接受传统手术治疗的为参照组,接受脊柱微创手术治疗的为研究组,将不同方案下的效果进行对比。结果 研究组切口长度指标更低于参照组,术中出血量指标比较差异有统计学意义少于对照组,手术时间更短于参照组,比较差异有统计学意义（P<0.05）。研究组术后引流量指标均更低于参照组,术后活动时间及住院时间指标均更低于参照组,比较差异有统计学意义（P<0.05）。两组患者接受治疗前疼痛程度评分对比,无比较差异有统计学意义差异性（P>0.05）,治疗后研究组患者疼痛评分均更低于参照组,比较差异有统计学意义（P<0.05）。研究组治疗后并发症发生概率5.88%更低于参照组的21.57%,比较统计差异比较差异有统计学意义（P<0.05）。结论 在临床治疗腰椎间盘突出症过程中采取脊柱微创手术效果良好,比较差异有统计学意义地降低患者手术损伤,缓解了患者手术疼痛感,促进患者尽快术后康复,防止并发症的发生,适合于临床中应用。
目的 了解维持性血液析透析（MHD）合并糖尿病患者与非合并糖尿病患者人体成分的差异,对MHD合并糖尿病患者透前体液分布特点进行分析。方法 选择MHD患者66例,按是否合并糖尿病分为MHD合并糖尿病组27例和MHD非合并糖尿病组39例,收集患者的临床资料、生化指标,应用生物电阻抗法测量患者细胞外液等人体成分参数,并进行比较。结果 MHD合并糖尿病组患者细胞外液、细胞外液/总体水量、脂肪组织指数、收缩压、超滤量、血糖高于MHD非糖尿病组,差异有统计学意义;MHD合并糖尿病组患者血红蛋白低于MHD非糖尿病组,差异有统计学意义。结论 相比较MHD非糖尿病患者,MHD合并糖尿病的患者透前细胞外液、细胞外液/总体水量、脂肪含量分布异常情况更明显,高血压及贫血情况更严重。MHD合并糖尿病患者容量控制较非糖尿病组差,故需对糖尿病患者加强宣传教育,严格控制血糖水平和液体的摄入。
目的 探讨噻托溴铵/奥达特罗对C、D组慢性阻塞性肺疾病（COPD）稳定期患者的临床治疗效果。方法 选取2021年1月—2021年10月期间本院收治的C、D 组COPD稳定期患者70例,按照随机数字表达均分为研究组（35例）和对照组（35例）。研究组给予噻托溴铵/奥达特罗雾化吸入治疗,对照组采取规律吸入布地奈德/福莫特罗粉治疗。均持续6个月治疗。比较2组一般资料、治疗前后肺功能指标、住院时间、mMRC评分、CAT评分、急性发作和糖皮质激素使用时间,以及不良反应。结果 治疗6个月后,研究组的肺功能指标包括第1秒用力呼气容积（FEV1）、FEV1%预计值（FEV1%pred）、用力肺活量（FVC）以及FEV1/ FVC比值相比对照组均改善（均P< 0.05）。且相比对照组,研究组患者住院时间更短、治疗后mMRC评分和CAT评分更低、急性发作和糖皮质激素使用时间>30 d的例数更少（均P< 0.05）。此外,研究组患者治疗期间口干、恶心/呕吐、声音嘶哑和口腔感染的不良反应总发生率相比对照组更低。结论 噻托溴铵/奥达特罗能有效改善C、D 组COPD稳定期患者肺功能和临床症状,缩短住院时间和激素使用时间,减少急性发作和不良反应发生率,降低患者的治疗费用。
新生儿引起肝内胆汁淤积是由感染、遗传代谢性疾病、胃肠外营养、基因突变等各种不同病因导致胆汁形成、分泌和排泄障碍。胆汁在体内淤积会影响新生儿的生长发育,严重者出现肝纤维化、肝功能衰竭等不可逆的改变,其发病的机制涉及参与肝脏胆汁酸分泌的各种转运体、肝细胞膜转运蛋白转录和和转录后的调控等。本文归纳总结近年来国内外关于胆汁酸转运体及其转录和转录后的调控,从而为此疾病的防治提供理论依据,为将来降低其发生率和改善预后。
Neonatal intrahepatic cholestasis is caused by infection,genetic metabolic diseases,parenteral nutrition,gene mutation and other different causes leading to bile formation,secretion and excretion disorders．Bile stasis in the body will affect the growth and development of the newborn,and in severe cases,irreversible changes such as liver fibrosis and liver failure will occur．The pathogenesis of bile stasis involves various transporters involved in the secretion of bile acids in the liver,transcription and post transcription regulation of liver cell membrane transporters．In this paper,we summarized the recent studies on bile acid transporters and their transcriptional and post transcriptional regulation at home and abroad,so as to provide a theoretical basis for the prevention and treatment of this disease,and to reduce its incidence and improve its prognosis in the future.
分泌性中耳炎（SOM）的临床特征表现为听力下降和中耳积液,与中耳化脓性炎症常伴随耳部急性感染不同,SOM常伴随耳部闷胀、轻微耳痛等,致使听力出现障碍。SOM发病机制较为复杂,可能与感染、免疫、咽鼓管功能障碍等多种因素相关,治疗方法也因此呈现出多样化的特点。本文就SOM的病因病机及其治疗方式展开综述,以期为临床及早诊断和治疗SOM提供理论依据。
The clinical characteristics of secretory otitis media（SOM）are hearing loss and effusion in the middle ear．Different from acute ear infection of suppurative inflammation in the middle ear,SOM is often accompanied by ear tightness and mild earache,resulting in hearing impairment．The pathogenesis of SOM is complex,which may be related to infection,immunity,eustachian tube dysfunction and other factors．Therefore,the treatment methods are diversified．This paper reviews the etiology,pathogenesis and treatment of SOM,in order to provide theoretical basis for clinical early diagnosis and treatment of SOM.
