目的 探讨miR-148a对大鼠急性胰腺炎细胞模型中细胞自噬的影响。方法 选取培养AR42J细胞,细胞分为4组,即正常对照组、模型组、miR-148a mimics组及miR-148a阴性对照组。利用Lipofectamine 2000转染miR-148a mimics及阴性对照miR-148a至AR42J细胞,继续培养48 h后,利用浓度为200 μmol的牛磺胆酸钠盐(TLCs)刺激以上两组及模型组AR42J细胞20 min,正常对照组不做处理,然后提取各组细胞蛋白及RNA。利用RT-qPCR检测各组细胞中miR-148a的表达;利用CCK8实验检测各组细胞的活性;利用ELISA法检测各组细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量;利用Western blot检测自噬相关的基因Beclin1、LC3Ⅰ、 LC3Ⅱ的表达。结果 RT-qPCR结果显示,与正常对照组相比较,模型组心肌细胞中miR-148a mRNA的表达降低,而miR-148a mimics组细胞中miR-148a mRNA的表达显著升高;CCK-8实验结果显示,转染miR-148a mimics至细胞后,可提高模型细胞的活性;ELISA实验结果显示,与模型组相比较,转染miR-148a mimics至细胞后,细胞培养液中炎性因子IL-6,IL-1β及TNF-α的含量显著降低;Western blot结果显示,与模型组相比较,转染miR-148a mimics至细胞后,可降低细胞中Beclin1的表达,降低LC3Ⅱ/LC3Ⅰ的比率。结论 利用miR-148a mimics提高TLCs刺激的细胞模型中的miR-148a表达后,细胞中Beclin1的表达降低,LC3Ⅱ/LC3Ⅰ的比率降低,抑制了细胞自噬,降低了炎性因子IL-6、IL-1β、TNF-α的释放,从而提高了细胞的活性,miR-148a可通过调节模型细胞的自噬而发挥细胞保护作用。

Objective To investigate the effect of miR-148a on autophagy in rat acute pancreatitis cell model. Methods AR42J cells were cultured and divided into 4 groups: normal control group, model group, miR-148a mimics group and miR-148a negative control group. miR-148a mimics and miR-148a negative control were transfected to AR42J cells with Lipofectamine 2 000, then cells were cultured for 48 h. The AR42J cells were stimulated with sodium taurocholate (TLCs) at a concentration of 200 μmol for 20 min, the normal control group was not treated, then the protein and RNA were extracted in each group. The expression of miR-148a was detected by RT-qPCR in each group. The activity of cells was detected by CCK8 assay in each group. The contents of IL-6, IL-1β and TNF-α in the cell culture medium were detected by ELISA. Western blot was used to detect the expression of autophagy related genes Beclin1, LC3Ⅰ and LC3Ⅱ. Results RT-qPCR results showed that the expression of miR-148a mRNA in model group was significantly lower than that in normal control group, while the expression of miR-148a mRNA in miR-148a mimics group was significantly higher than that in normal control group. The results of CCK-8 assay showed that miR-148a could significantly increase the activity of model cells stimulated by TLCs. The results of ELISA showed that the contents of IL-6, IL-1β and TNF-α in cell culture medium were significantly decreased after miR-148a mimics transfection, compared with the model group. Western blot showed that miR-148a mimics could significantly decrease the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ, compared with the model group. Conclusion miR-148a mimics was used to enhance the expression of miR-148a in cells model stimulated by TLCs, the expression of Beclin1 and the ratio of LC3Ⅱ/LC3Ⅰ were decreased, and the autophagy was inhibited. The release of IL-6, IL-1β and TNF-α was decreased and the activity of cells was increased. miR-148a plays a cellular protective role by regulating autophagy in model cells.

目的 观察紧密连接蛋白在高尿酸血症致大鼠肾损害模型中的表达变化以及非布司他的干预疗效。方法 将SD大鼠分为正常组,高尿酸血症组(模型组),非布司他组(干预组);氧嗪酸联合尿酸诱导制作高尿酸血症大鼠模型,给予非布司他进行干预,分别于6周后检测各组大鼠血中尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)水平,免疫组化及RT-PCR方法检测紧密连接蛋白包括膜周蛋白-1(ZO-1)、跨膜蛋白(occludin) 的表达变化,采用Masson染色检测大鼠肾间质病理改变。结果 6周时,模型组、干预组ZO-1、occludin表达较正常组降低(均P<0.05);干预组ZO-1、occludin表达较模型组增加,差异有统计学意义(均P<0.05),与正常组相比,模型组、干预组RIF指数均增高(均P<0.05),干预组RIF指数低于模型组,高于正常组(均P<0.05)。结论 紧密连接蛋白表达的降低在高尿酸血症肾间质纤维化发展过程中起着举足轻重的作用,并与血尿酸水平及肾功能损害密切相关。非布司他通过降低血尿酸水平,能改善紧密连接蛋白的表达,延缓肾功能损害,起到肾保护作用。

Objective To observe the expression of tight junction protein in hyperuricemia induced renal damage model in rats and the intervention effect of febuxostat. Methods SD rats were randomly divided into three groups: normal control group, model control group, febuxostat treatment group. Hyperuricemia was induced in rats with oxonic acid per time for three times per day, by gavage and combined with uric acid added in drinking water, while febuxostat were administered by gavage in febuxostat treatment group.The blood of rats were collected to analyse the differences of control, model and treatment group on changes of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA). Immunohistochemistry was used to assay ZO-1 and occludin protein expression and quantitive real time PCR to detect the expression of ZO-1 and occludin in renal tissue of renal interstitial fibrosis model rats induced by hyperuricemia. Paraffin section of kidney was maked and then performed Masson staining to make sure the model is successful. Results At 6 weeks, the expressions of ZO-1 and occludin in the model group and treatment group were lower than those in the normal group (all P<0.05). The expressions of ZO-1 and occludin in the treatment group were higher than those in the model group (all P<0.05). Compared with the normal group, the RIF index in the model group and treatment group were higher (all P<0.05), and the RIF index in the treatment group was lower than that in the model group and higher than that in the normal group (all P<0.05). Conclusion The downregulated expression of ZO-1 and occludin plays a crucial role during the development of hyperuricemia in renal interstitial fibrosis, and are closely related to UA level and renal function impairment. Febuxostat may improve the expression of tight junction by downregurating UA, reduce renal fuction impairment and play a role in renal protection.

目的 探讨不同年龄儿童性早熟的影响因素及预防措施。方法 本文将2020年1月—2021年1月的性早熟儿童45例(观察组)与正常健康儿童45例(对照组)作为研究对象,通过问卷调查的形式了解所选儿童的家庭因素、饮食、生活方式与社会因素等方面的情况,通过单因素分析与多因素分析探讨相关影响因素。结果 观察组不同年龄段儿童在骨龄、身高、体质量、BMI方面存在统计学差异,P＜0.05;观察组性激素水平明显高于对照组,P＜0.05。结论 儿童性早熟的发生与生活习惯、家庭关系、饮食习惯、母亲初潮年龄等因素有关,帮助其养成科学合理的生活习惯与饮食习惯,改善家庭关系可很好的降低并预防儿童性早熟的发生。对于已经出现性早熟现象的儿童来说,学校与家庭要及时给予其合理的健康教育,包括心理方面与生殖健康方面,及时有效的疏导可有效避免性早熟对儿童心理方面造成不良影响。

Objective To explore the influencing factors and preventive measures of precocious puberty in children of different ages. Methods 45 cases of precocious puberty children (observation group) and 45 cases of normal healthy children (control group) from January 2020 to January 2021 were selected as the research objects. The family factors, diets, lifestyles and social factors of the selected children were investigated by questionnaire survey, and the related influencing factors were discussed by single factor analysis and multi factor analysis. Results There were statistical differences in bone age, height, weight and BMI among children of different ages in the observation group, P<0.05. The levels of sex hormones in the observation group were higher than those in the control group, P<0.05. Conclusion The occurrence of children's precocious puberty is related to living habits, family relations, eating habits, mother's menarche ages and other factors. To help them develop scientific and reasonable living habits and dietary habits and improve family relations can reduce and prevent the occurrence of children's precocious puberty. For children with precocious puberty, schools and families should give them proper health education in time, including psychological and reproductive health. Timely and effective counseling can effectively avoid the adverse effects of precocious puberty on children's psychology.

目的 分析重症流感相关性脑病患儿的临床特点及诊治要点。方法 回顾性分析2017年5月—2020年4月收入我院PICU的17例重症流感相关性脑病患儿的临床资料进行回顾性分析。结果 17例患儿中男性10例、女性7例,起病年龄3(2～5)岁。所有患儿均出现发热,1(0～3.5)天后出现神经系统症状,包括惊厥发作(88%)和昏迷(88%)。头颅影像学检查病变主要分布在丘脑、脑干、髓质脑室周围白质,呈对称性和多灶性改变。经颅多普勒检查出现脑血流速度减慢呈震荡波、钉子波的5例患儿均死亡。16例患儿予机械通气,2例予连续性肾替代治疗,死亡8例,存活者出院前均遗留不同程度神经系统损害。结论 儿童重症流感相关性脑病以发热、惊厥和昏迷为主要表现,头颅影像学及脑电图、经颅多普勒等检查有助于早期诊断和预后判断,早期联合应用甲强龙冲击及IVIG的有效性仍需进一步研究。

Objective To analyze the characteristics, diagnosis and treatment of severe influenza-associated encephalopathy in children. Methods The clinical data of 17 children with severe influenza-associated encephalopathy admitted to PICU from May 2017 to April 2020 were retrospectively analyzed. Results Among the 17 cases, 10 were male and 7 were female, and the onset age was 3 (2-5) years old. All children developed fever, and neurological symptoms 1 (0-3.5) days later, including seizures (88%) and coma (88%). The lesions were mainly distributed in the thalamus, brainstem and medullary ventricular white matter, showing symmetry and multifocal changes. All the 5 cases with slowed cerebral blood flow velocity and presented shock wave or nail wave died. 16 children were on mechanical ventilation, 2 with continuous renal replacement therapy, and 8 died. All the survivors had varying degrees of neurological damage before discharge. Conclusion Severe influenza-associated encephalopathy of childhood is mainly characterized by fever, convulsions and coma. Cranial imaging, EEG, TCD and other examinations are helpful for early diagnosis and prognosis judgment. The effectiveness of early combined application of methylprednisolone and IVIG still needs further study.

目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.

目的 探讨老年中度急性胆囊炎患者采用经皮经肝胆囊穿刺引流术与腔镜胆囊切除术联合治疗的效果。方法 本文将2019年2月—2020年2月收治的60例老年中度急性胆囊炎患者作为研究对象,按照随机数字表法分组,对照组30例患者仅采用择期腔镜胆囊切除术治疗,观察组30例患者在对照组的基础上应用经皮经肝胆囊穿刺引流术治疗。统计分析体液免疫指标、细胞免疫指标、手术前后ALP、TBIL、IBLL水平、AMY水平、白细胞计数、VAS评分及并发症发生情况。结果 两组之间ALP、TBIL、IBLL水平、AMY水平、白细胞计数、VAS评分及并发症发生情况相比,观察组低于对照组;体液免疫指标、细胞免疫指标相比,观察组高于对照组,P＜0.05。结论 在采用择期腔镜胆囊切除术治疗老年中度急性胆囊炎的基础上联合经皮经肝胆囊穿刺引流术可提升疗效,降低择期腔镜胆囊切除术的风险,有助于患者术后尽快恢复,还可减轻患者的免疫功能损伤情况,改善体液免疫指标,减轻疼痛程度,降低并发症发生率,具有较高的应用价值。

Objective To investigate the effect of combined treatment of percutaneous transhepatic cholecystectomy and endoscopic cholecystectomy in elderly patients with moderate acute cholecystitis. Methods The research objects were 60 elderly patients with moderate acute cholecystitis, grouping according to random number table method, the control group of 30 cases were treated with selective endoscopic cholecystectomy, the observation group of 30 patients were treated with the percutaneous liver gallbladder puncture drainage on the basis of selective endoscopic cholecystectomy. Statistical analysis of humoral immunity, cellular immunity, ALP, TBIL, IBLL levels before and after operation, AMY, white blood cell count, VAS score and complications were conducted. Results The levels of ALP, TBIL, IBLL, AMY, WBC count, VAS score and complications in the observation group were lower than those in the control group. The indexes of humoral immunity and cellular immunity in the observation group were higher than those in the control group (P<0.05). Conclusion Endoscopic cholecystectomy used in the treatment of elderly moderate acute cholecystitis combined on the basis of percutaneous transhepatic gallbladder puncture drainage can improve curative effect, reduce the risk of selective endoscopic cholecystectomy, help patients with postoperative recovery, also can reduce the patient's immune function damage, improve the humoral immunity indexes, relieve pain, reduce the incidence of complications, which has high application value.

目的 探究椎间孔镜下治疗腰椎间盘突出症切除黄韧带对腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度的影响。方法 选择120例腰椎间盘突出症患者,随机分为观察组与对照组各60例。观察组患者椎间孔镜术中切除部分黄韧带;对照组患者保留黄韧带。比较两组患者术后半年、1年及2年的腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度。结果 观察组术后半年、1年腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度与对照组比较(P＞0.05)。观察组术后2年与对照组比较(P＜0.05)。结论 椎间孔镜下治疗腰椎间盘突出症保留黄韧带术后腰椎前凸角、骶骨倾斜角、腰椎曲线指数及椎间隙高度远期效果优于切除黄韧带。

Objective To explore the effects of ligamentum flavum resection on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space. Methods 120 patients with lumbar disc herniation were randomly divided into observation group and control group. In the observation group, part of the ligamentum flavum was excised by endoscope and in the control group, the ligamentum flavum was preserved. The lumbar lordosis angle, sacral inclination angle, lumbar curve index and intervertebral space height of the two groups were compared at 6 months, 1 year and 2 year after operation. Results At 6 months, 1 year after operation, the lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space in the observation group were compared with those in the control group(P＞0.05). 2 years after operation, the observation group was compared with the control group(P<0.05). Conclusion The long-term effect of ligamentum flavum preserving on lumbar lordosis angle, sacral inclination angle, lumbar curve index and height of intervertebral space is better than that of ligamentum flavum resection.

目的 探讨无症状感染者在新冠肺炎家庭聚集性疫情中的传播风险,分析家庭聚集性疫情中所有患者的住院治疗情况,为防控策略和治疗方案制定提供依据。方法 通过现场流行病学调查获得旅居史和暴露危险因素,并收集临床治疗资料,利用统计软件进行作图和分析。结果 指示病例的潜伏期为15天,其余4名家庭成员的潜伏期为1～15天,其中指示病例作为无症状感染者,在感染后第4～6天内具有传染性相继导致4名成员感染;指示病例携带病毒8天以上,其余4人从2天到31天不等; 症状持续时间5~20天,住院期间共进行CT检查次数为4～10次,肺部炎症最快在住院第三天好转。发病初期只有1个病例出现白细胞、淋巴细胞降低。发病到就诊和住院的时间间隔为1～10天,平均住院时间为23.4天。结论 无症状感染者在家庭聚集性疫情传播中具有关键作用,难以及时发现,存在较大传播风险,为新冠肺炎疫情防控带来较大难度。

Objective To study the transmission risk of asymptomatic patient in a family-clustered outbreak of new coronavirus pneumonia, analyze the hospitalization,and provide a basis for prevention strategies and treatment plan. Methods We collected the information about residence history and exposure risks by onsite epidemiological investigation, and collected clinical treatment-related data, used statistical software for mapping and analysis. Results The incubation period of the indicated case was 15 days, and the incubation period of the remaining four family members were 1-15 days. The indicated case as an asymptomatic patient had infectious succession within 4-6 days after infection,and four family members were infected one after another. The indicated case carried the virus for more than 8 days, and the remaining 4 patients ranged from 2 to 31 days. The duration of symptoms was 5-20 days of all 5 patients, and the number of CT examinations during hospitalization was 4-10 times. The pulmonary inflammation was improved on the third day of hospitalization at best. In the early stage of the disease, only one patient had leukopenia and lymphopenia decreased. The interval between onset and hospitalization was 1-10 days for five family members, with an average hospitalization time of 23.4 days. Conclusion The asymptomatic infected patient of COVID-19 plays a key role in the family convergence epidemic transmission. The symptoms are inapparent, so it is difficult to find in time. It will cause the risk of infection and increase the difficulty of COVID-19 prevention and control.

目的 探讨I¹³¹联合促甲状腺激素(TSH)抑制治疗对术后中高危组甲状腺乳头状癌(PTC)患者心肌纤维化及心房颤动(AF)的影响。方法 选取2016年8月—2017年8月南华大学附属第一医院收治的因PTC行甲状腺双侧腺叶全切术或近全切除术患者69例,根据复发危险度分层分为中危组(49例)和高危组(20例), 两组患者均行I¹³¹ 联合TSH抑制治疗,治疗后嘱患者3个月进行1次复诊或自觉不适及时复诊,观察患者心血管系统症状、心房颤动及心肌纤维化发生情况,患者治疗前后可溶性基质溶素-2(sST2)、生长分化因子-15(GDF-15)、半乳糖凝集素-3 (GAL-3)及血清乳酸脱氢酶(LDHA)含量变化。结果 I¹³¹联合TSH抑制治疗后患者心房颤动发生率和心肌纤维化相关指标水平明显高于治疗前,且高危组患者治疗后心房颤动发生率和心肌纤维化相关指标水平高于中危组,差异均有统计学意义(P<0.05)。结论 I¹³¹联合TSH抑制治疗会增加PTC患者心肌纤维化和心房颤动的发生概率,且高危组PTC患者心肌纤维化和房颤的发生率高于中危组。

Objective To investigate the impact of I¹³¹ combined with thyroid-stimulating hormone(TSH) for suppressive treatment on myocardial fibrosis(MF) and atrial fibrillation(AF) in patients with papillary thyroid (PTC). Methods 69 patients with PTC undergoing total or subtotal thyroidectomy admitted into First Affiliated Hospital of University of South China from Aug. 2016 to Aug. 2017 were selected and divided into middle-risk group (49 cases) and high-risk group (20 cases) according to the recurrence risk stratification. Two groups of patients were given I¹³¹ combined with thyroid-stimulating hormone for suppressive treatment. The patients were instructed to undergo a follow-up visit every 3 months after treatment or whenever felt unwell. The incidences of cardiovascular system symptoms, atrial fibrillation and myocardial fibrosis, changes of contents of serum soluble ST2 (sST2), growth differentiation factor-15 (GDF-15), galectin-3 (GAL-3) and lactate dehydrogenase A (LDHA) were observed. Results After I¹³¹ combined with thyroid-stimulating hormone suppressive treatment, the incidences of atrial fibrillation and myocardial fibrosis after treatment were higher than that before treatment, and the incidences of atrial fibrillation and myocardial fibrosis of high-risk group were higher than those of the middle-risk group, with statistically significant differences (P＜0.05). Conclusion Combined use of I¹³¹ and thyroid-stimulating hormone for suppressive treatment can increase the incidences of atrial fibrillation and ventricular remodeling of patients with PTC, and the incidences of high-risk group were higher than those of the middle-risk group.

目的 探讨基于单个最大层面(2D)及体积(3D)感兴趣区(ROI)的ADC直方图参数在区分肺良性及恶性孤立性实性病灶的价值。方法 本回顾性研究共纳入69例肺部孤立性实性病变患者,其中恶性56例,良性13例。所有患者术前均采用MRI、DWI(b=600 mm/s²)检查,使用OK软件获取病灶最大截面面积(2D)及体积(3D)ADC直方图特征参数值。运用ROC曲线比较两种测量方法的鉴别效能。结果 2D、3D直方图大部分参数在肺良恶性病变组间差异具有统计学意义(P＜0.05),其中以ADC 50分位数(50^th)、75分位数(75^th)、90分位数(90^th)为著(P＜0.001)。2D直方图中的ADC 75^th 及3D直方图中的ADC 50^th有较好诊断效能(AUC分别为0.891、0.894)。当3D ADC 50^th取1.41×10^-3 mm²/s时,诊断的准确性最高,敏感度为80.00%,特异度为92.86%。ADC 最大值(maximum)、ADC 25分位数(25^th)及峰度组间差异无统计学意义(P＞0.05)。结论 2D及3D ADC直方图在肺部病变鉴别有一定价值,其中以3D直方图的ADC 50^th最佳。

Objective To investigate the value of ADC histogram parameters measured by 2D and 3D ROI in distinguishing benign and malignant solitary solid pulmonary lesions (SPL). Methods A total of 69 patients with SPL were included in this retrospective study, including 56 patients with malignant disease and 13 patients with benign disease. All patients underwent preoperative MRI and DWI (b=600 mm/s²) examinations. The ADC histogram parameters of the lesion from 2D and 3D ROI were obtained by OK software. ROC curve was used to compare the discriminative efficacy of these two methods. Results Most parameters of 2D and 3D histogram showed a statistically significant difference between benign and malignant pulmonary lesions (P<0.05), especially ADC 50 quantiles (50^th), 75 quantiles (75^th) and 90 quantiles (90^th) (P<0.001). The ADC 75^th in 2D histogram and ADC 50^th in 3D histogram had better diagnostic efficiency (AUC were 0.891 and 0.894, respectively). When the ADC 50^th of 3D histogram was 1.41×10^-3 mm²/s, the accuracy of diagnosis was the highest, with a sensitivity of 80.00% and a specificity of 92.86%. There were no significant differences in ADC maximum, 25^th and kurtosis among groups (P>0.05). Conclusion Both 2D and 3D ADC histograms had a certain value in the diagnosis of SPL, and ADC 50^th of 3D histogram showed the best efficacy.

目的 探讨选择性会阴侧切术对会阴体及产后盆底功能的影响。方法 选取2018年1月—2019年12月在广州市红十字会医院顺产的初产妇作为研究对象,研究组为选择性会阴侧切组、对照组为常规治疗,统计两组的会阴裂伤情况,盆底Ⅰ类肌、Ⅱ类肌肌力分级,POPQ评分的分级,肛提肌裂孔扩张情况。结果 会阴裂伤率:研究组2.5%,对照组为56.22%,连续性校正χ²为53.14,连续性校正P＜0.05。盆底Ⅰ类、Ⅱ类肌力＜3级发生率:研究组分别为30%、23%,对照组分别为 49%、38%,χ²分别为9.03、5.96,P＜0.05。POPQ 0级率:研究组26.25%,对照组12.5%,χ²为4.84,P＜0.05。肛提肌裂孔无扩张率:研究组16.25%,对照组为5%,χ²为5.33,P＜0.05。结论 在本研究中,与对照组相比,研究组会阴裂伤率、盆底肌力<3级发生率更低;盆腔器官无脱垂率、肛提肌裂孔无扩张率更高。选择性会阴侧切术对会阴体及盆底功能具有保护作用。

Objective To investigate the effect of selective lateral episiotomy on perineal body and pelvic floor function. Methods The primiparas who delivered naturally in Guangzhou Red Cross Hospital from January 2018 to December 2019 were selected as the research subjects. The research group were given selective lateral episiotomy, while the control group were given conventional treatment. The incidence of perineal laceration, pelvic floor muscle strength lower than grade 3, the POPQ score and levator ani hiatus dilatation were analyzed. Chi-square test was used to analyze the incidence of the two groups. Results The incidence of perineal laceration in the research group was 2.5% vs 56.22% in the control group(χ²=53.14, P<0.05). The incidence of pelvic floor muscle(group I) strength lower than grade 3 in the research group was 30% vs 49% in the control group(χ²=9.03, P<0.05). The incidence of pelvic floor muscle(group II) strength lower than grade 3 in the research group was 23% vs 38% in the control group(χ²=5.96, P<0.05). The rate of the incidence of POPQ 0 in the research group was 26.25% vs 12.5% in the control group (χ²=4.84,P＜0.05). The incidence of levator ani hiatus dilatation in the research group was 16.25%, while 5% in the control group (χ²=5.33, P<0.05). Conclusion Compared with conventional treatment group, selective lateral episiotomy group has a lower incidence of perineal laceration and pelvic floor muscle strength lower than grade 3. Selective lateral episiotomy group has a higher incidence of POPQ 0 and no levator ani hiatus dilatation. Selective lateral episiotomy can protect the perineal body and pelvic floor function.

目的 分析肝脓肿的临床基线及病原学特征,旨在提高临床对该病早期识别、病原体预判、并发症警惕及抗感染治疗能力。方法 收集广州番禺区中心医院2019年1月—2020年11月收治的肝脓肿病例相关临床及实验室资料。按病原体培养结果分成阳性组、阴性组。阳性组中,按不同致病菌分成肺炎克雷伯及非肺炎克雷伯亚组。比较不同组别间基线特征及实验室数据。结果 共收集肝脓肿71例,病原学培养阳性率83.1%(59例),其中肺炎克雷伯菌46例(80%)。最常见合并症包括糖尿病(54.9%)、胆道疾病(56.3%)、肺部感染(67.6%)等。病原体阳性组PCT和AST水平高于阴性组(P<0.05),但是两组之间基线特征无差异(P>0.05)。肺炎克雷伯亚组与其他病原体组相比,合并糖尿病的风险更高(P=0.007),PLT、PCT、ALT、AST和白蛋白的水平具有显著差异(P <0.05)。经过积极治疗,大多预后良好,未见死亡病例,其中7例患者发生严重侵袭性脓肿,遗留后遗症。结论 病原体阴性肝脓肿致病力方面与阳性组并无差别。肺炎克雷伯杆菌已成为肝脓肿中最常见菌群,其多见于合并糖尿病患者。其PLT、PCT、ALT、AST指标明显高于其他菌群组,伴白蛋白消耗明显。少数可伴有全身严重侵袭性脓肿。

Objective To investigate the clinical and etiological characteristics of pyogenic liver abscess (PLA) as a reference for its early identification,early prediction of pathogens, alertness to complications and rational antibacterial treatment. Methods A single center retrospective study was carried out in patients with PLA in Guangzhou Panyu Center Hospital from January 2019 to November 2020.The clinical and laboratory data of all liver abscess cases were concluded. Baseline characteristic and laboratory outcomes were grouped into Klebsiella pneumoniae group and non-Klebsiella pneumoniae subgroup according to different pathogenic bacteria. Results Among a total of 71 patients with liver abscess, 83.1%(n=59)had positive cultures. Klebsiella pneumoniae accounted for the most in 46 cases (80.0%). The most common complications included diabetes(50.7%), biliary tract disease(56.3%), pulmonary infection(67.6%) etc. The levels of PCT and AST in pathogen culture-positive group were higher than those in culture-negative group, with statistical significance (P<0.05),on the contrary there were no differences in baseline characteristic among the groups according to the results of pathogens. Compared with other pathogens, the group of Klebsiella pneumoniae liver abscess presented higher risk of diabetes.The levels of PLT, PCT, ALT, AST,and albumin in the two groups were different (P<0.05). Most patients had good outcomes, while 7 patients had residual problems represented with severe invasive abscess. Conclusion There were similar consequences between negative and positive liver abscesses. Klebsiella pneumoniae has become the most common bacteria in liver abscess. Among which, PLT、PCT、ALT、AST indexes are higher than that of other bacteria with obvious albumin depletion, even some of which may be accompanied by systemic severe invasive abscess.

目的 了解颈内动脉超声联合经颅多普勒对产后抑郁症患者的检测效果,为临床产后抑制治疗提供有价值的线索。方法 收集本院于2018年3月—2020年2月收治的78例符合抑郁障碍诊断标准的产妇资料,对资料予以回顾研究,并设为研究组,同时另择选78例健康产妇为对照组,应用颈内动脉超声对两组产妇的颈动脉血流参数[颈动脉内径(D)、收缩期峰值流速(PSV)、舒张末期流速(EDV)以及阻力指数(RI)]进行检测,同时联合经颅多普勒超声(TCD)对两组产妇的左右大脑中(MCA)、脑前(ACA)及脑后(PCA)的动脉与椎基底动脉(VA-BA)血流速度进行监测,并分析两组产妇阻力指数(RI)与搏动指数(PI)变化,对以上数据统计分析并给予组间比较分析。结果 与对照组比较,研究组D、EDV水平明显下降,而RI值升高,差异有统计学意义(P＜0.05);两组产妇的PSV比较,差异无统计学意义(P＞0.05);研究组抑郁产妇的左右大脑中(MCA)、脑前(ACA)及脑后(PCA)的动脉血流速度均加快且差异均有统计学意义(P均＜0.05);研究组抑郁产妇的椎基底动脉(VA-BA)血流速度与对照组比较减慢,差异有统计学意义(P＜0.05);研究组抑郁产妇的阻力指数(RI)与搏动指数(PI)值与对照组比较,差异均无统计学意义(P＞0.05);78例抑郁产妇中,62例呈现脑动脉血流异常。检测异常率为79.49%(62/78)。结论 经颅多普勒检测,可见产后抑郁产妇的3条脑动脉血流速度明显加快,而椎基底动脉血流减缓,由此提示抑郁产妇脑动脉痉挛且脑供血明显不足,颈内动脉超声显示抑郁产妇的颈动脉血流参数有一定变化,能够为产后抑郁患者的治疗提供一定参考。

Objective To understand the detection effect of internal carotid artery ultrasound combined with transcranial Doppler on patients with postpartum depression, and to provide valuable clues for clinical postpartum depression treatment. Methods The data of 78 parturients who met the diagnostic criteria for depression in our hospital from March 2018 to February 2020 were collected. The data were reviewed and set as the study group. At the same time, 78 healthy parturients were selected as the control group.We used internal carotid artery ultrasound to detect the carotid blood flow parameters [carotid artery diameter (D), peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index (RI)] of the two groups of parturients, and combined transcranial color Doppler ultrasound (TCD) to monitor the blood flow velocity of the arteries and vertebrobasilar artery (VA-BA), middle cerebral artery (MCA), anterior cerebral artery (ACA) and posterior cerebral artery (PCA) of the two groups of women. The changes in maternal RI and PI between the two groups were analyzed, and the above data were statistically analyzed and compared between groups. Results Compared with the control group, the D and EDV levels of the study group were decreased, while the RI value was increased, the difference was statistically significant (P<0.05). The comparison of PSV between the two groups was not statistically significant (P>0.05). The arterial blood flow velocity in MCA, ACA, and PCA of the depressed women in the study group were accelerated and the differences were statistically significant (P<0.05). The blood flow velocity of VA-BA of the depressed women in the study group was slower than that of the control group, and the difference was statistically significant (P＜0.05). RI and PI values of depressed women in the study group were compared with those of the control group. There was no statistically significant difference between the groups (P>0.05). Among 78 depressed women, 62 had abnormal cerebral artery blood flow. The abnormal detection rate was 79.49% (62/78). Conclusion Transcranial Doppler examination showed that the blood flow of the three cerebral arteries of the postpartum depressed women was increased, while the blood flow of the vertebrobasilar arteries slowed down, which indicated that the depressed women had cerebral artery spasm and the cerebral blood supply was obviously insufficient. The internal carotid artery ultrasound showed there were certain changes in carotid blood flow parameters of depressed mothers, which can provide a certain reference for the treatment of patients with postpartum depression.

目的 探讨瑞格列奈联合胰岛素治疗2型糖尿病临床疗效及对患者血糖水平的影响效果。方法 选取我院2019年1月—2021年1月收治的2型糖尿病患者324例,用随机数字法分为两组,每组各52例,对照组应用胰岛素治疗,研究组应用瑞格列奈联合胰岛素治疗。对两组2型糖尿病患者的临床疗效、血糖水平(FPG指数、2 h PG指数、HbA1c指数)以及胰岛素水平(HOMA-β水平、HOMA-IR水平)进行比较。结果 研究组疗效高于对照组(P＜0.05);研究组治疗后血糖指数优于对照组(P＜0.05);研究组治疗后胰岛素水平优于对照组(P＜0.05)。结论 2型糖尿病患者在治疗时,应用瑞格列奈联合胰岛素治疗,可增强治疗疗效,有效控制血糖水平,改善胰岛功能,从而促进疾病转归,具有极大的推广价值。

Objective To investigate the clinical efficacy of repaglinide combined with insulin in the treatment of type 2 diabetes mellitus and its effect blood glucose level. Methods A total of 324 patients with type 2 diabetes admitted to our hospital from January 2019 to January 2021 were randomly divided into two groups with 52 patients in each group. The control group was treated with insulin, and the research group was treated with repaglinide combined with insulin. Clinical efficacy, blood glucose level (FPG index, 2HPG index, HbA1c index) and insulin level (HOMA-β level, HOMA-IR level) of patients with type 2 diabetes were compared between two groups. Results The therapeutic effect of the research group was higher than that of the control group (P<0.05). The glycemic index of the research group was better than that of the control group (P<0.05). The insulin level in the research group was better than that in the control group (P<0.05). Conclusion In the treatment of type 2 diabetes mellitus, the application of repaglinide combined with insulin can enhance the therapeutic effect, effectively control the blood glucose level, improve the islet function, so as to promote the outcome of the disease, which has great promotion value.

目的 探讨在关节镜下膝关节前交叉韧带损伤重建术治疗的临床效果。方法 选取2018年3月—2020年3月之间我院接受住院治疗的80名膝关节前交叉韧带损伤患者作为研究对象。根据手术方式的不同,常规手术进行交叉韧带损伤的重建术治疗为常规组,关节镜下膝关节前交叉韧带损伤重建术治疗为研究组,每组各40名患者,比对两组的治疗效果。结果 通过数据得出常规组的膝功能评分(71.8±12.6)及膝功能不稳评分(13.2±1.6)要低于研究组膝功能评分(83.9±12.9)及膝功能不稳评分(19.3±2.3),差异有统计学意义(P＜0.05)。在术后疼痛评分上研究组(3.35±0.23)各项数据均优于常规组(4.35±1.69),差异有统计学意义(P＜0.05)。研究组并发症发生率仅为5%,常规组并发症发生率有17.5%,研究组数据远要低于常规组,差异有统计学意义(χ^<sup>2=5.178,P=0.023)。结论 在膝关节镜下前交叉韧带损伤重建术治疗可有效改善膝关节活动性、稳定性、有效减轻患者的疼痛感,减少并发症的发生,促进膝关节功能的康复。关节镜下进行膝关节前交叉韧带损伤重建术治疗具有临床推广和采纳的价值。

Objective To investigate the clinical effect of arthroscopic anterior cruciate ligament (ACL) reconstruction. Methods 80 patients with ACL injury in our hospital from March 2018 to March 2020 were selected as the research objects. According to the different surgical methods, patients underwent the traditional open surgery for cruciate ligament injury reconstruction treatment were selected as the control group,patients underwent arthroscopic anterior cruciate ligament injury reconstruction treatment were as the study group, 40 patients in each group, the treatment effect of the two groups were compared. Results The Lysholm score (71.8±12.6) and and Lysholm instability score (13.2±1.6) of the control group were lower than those of the study group (83.9±12.9 and 19.3±2.3), the differences were statistically significant (P <0.05). In the postoperative pain score, the study group (3.35±0.23) data was better than the control group (4.35±1.69), the difference was statistically significant (P <0.05). The incidence of complications in the study group was only 2.5%, and that in the control group was 17.5%, which was significantly lower than the control group, and the difference was statistically significant (χ²= 5.178, P= 0.023). Conclusion Arthroscopic anterior cruciate ligament reconstruction can effectively improve the activity and stability of knee joint, effectively reduce the pain of patients, reduce the occurrence of complications, and promote the rehabilitation of knee joint function. Arthroscopic anterior cruciate ligament reconstruction has the value of clinical promotion and adoption.

目的 分析广州北部区域某胸痛中心不同性别的急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的结果。方法 纳入广州市花都区人民医院2016年12月—2020年1月期间接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者。按照不同的性别,评估患者的危险因素、治疗时限性和主要心血管不良事件情况。结果 入选389名患者,73名(18.8%)为女性。和男性患者对比,女性患者年龄更大(69.3±10.8岁vs 55.8±13.1 岁,P＜0.05),具有更高比例的2型糖尿病(26.0% vs 17.7%,P＜0.05)、高血压病(58.9.0% vs 43.0%,P＜0.05)病史。女性患者的症状-首次医疗接触时间和总缺血时间均长于男性患者(分别为229.2 min vs 174.5 min,P＜0.05;424.9 min vs 317.4 min,P＜0.05),PCI术中出现慢血流/无复流的比例更高(26.0% vs 16.5%,P＜0.05)。女性患者主要住院心血管事件风险更高(11.0% vs 4.4%, P＜0.05),其中院内死亡率(4.1% vs 1.6%, P＜0.05)。女性患者在院期间发生心衰及心源性休克的比例更高(分别为34.2% vs 21.2%,P＜0.05; 30.1% vs 18.7%,P＜0.05)。结论 在行急诊介入治疗的急性ST段抬高型心肌梗死患者中,女性患者预后差于男性,具有更高的心血管事件风险,死亡率更高。

Objective We investigated sex-based outcomes after primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) in a chest pain center of northern Guangzhou. Methods From December 2016 to January 2020, consecutive STEMI patients who underwent PPCI in Guangzhou Huadu District People's Hospital were recruited. Risk factors, time variables, and major cardiovascular adverse events (MACE) were assessed according to gender. Results A total of 389 patients were enrolled,with 73(18.8%)women. Compared to men, women patients presented higher risk profiles with old age(69.3±10.8 years vs 55.8±13.1 years,P＜0.05),diabetes (26.0% vs 17.7%,P＜0.05), hypertension (58.9.0% vs 43.0%,P＜0.05).Women had longer symptom onset to first medical contact time and total ischemic time than men had(229.2min vs 174.5min,P＜0.05;424.9min vs 317.4min,P＜0.05).During PCI procedure,women presented higher ratio of slow flow/no reflow(26.0% vs 16.5%,P＜0.05).Women had increased major adverse events(11.0% vs 4.4%, P＜0.05), and higher in-hospital mortality(4.1% vs 1.6%, P＜0.05).Women presented more heart failure incidence (34.2% vs 21.2%,P＜0.05),and cardiac shock incidence(30.1% vs 18.7%,P＜0.05). Conclusion Women with acute STEMI who underwent PPCI had worse outcomes compared to men.They had higher MACE and in-hospital mortality.

目的 探讨多参数磁共振成像-经直肠超声(mpMRI-TRUS)认知融合技术引导前列腺穿刺活检的临床应用价值。方法 选取2018 年1月—2020年12月就诊于本院且为前列腺癌疑似患者作为研究对象,分为mpMRI-TRUS组与TRUS组。mpMRI-TRUS组所有病例穿刺活检前均行mpMRI检查,根据MRI结果确定靶向病灶,行mpMRI-TRUS认知融合靶向活检和系统10针活检。TRUS组患者只行系统13针活检,比较两组间前列腺癌的检出率,同时比较mpMRI-TRUS组中靶向活检和系统活检在前列腺癌检出率方面的差异,并对穿刺病理结果进行观察和分析。结果 mpMRI-TRUS组穿刺活检阳性率为43.59%,TRUS组穿刺活检阳性率为33.07%,两组前列腺癌检出率差异无统计学意义。mpMRI-TRUS组中靶向穿刺的单针阳性率、靶向穿刺组织前列腺癌组织占比高于系统穿刺;mpMRI-TRUS组中靶向穿刺阳性率为38.46%,系统穿刺阳性率为42.30%,两者差异无统计学意义。结论 mpMRI-TRUS认知融合技术在前列腺穿刺活检能够以较少的穿刺针数检出前列腺癌,靶向穿刺能提供更多前列腺癌组织,降低前列腺癌穿刺活检的漏诊率。

Objective To explore the clinical application value of multi-parameter magnetic resonance imaging-transrectal ultrasound (mpMRI-TRUS) cognitive fusion technology to guide targeted prostate biopsy. Methods The research objects were patients suspected of prostate cancer from January 2018 to December 2020 and the patients were divided into mpMRI-TRUS group and TRUS group. All cases in the mpMRI-TRUS group underwent mpMRI examination before needle biopsy. The targeted lesions were determined according to the MRI results.And mpMRI-TRUS cognitive fusion targeted biopsy and system 10-needle biopsy were performed. Patients in the TRUS group only underwent a systematic 13-needle biopsy. The detection rate of prostate cancer between the two groups was compared. At the same time, the difference in the detection rate of targeted biopsy and systematic biopsy in the mpMRI-TRUS group was also compared. The pathological results of puncture were observed and analyzed. Results The positive rate of needle biopsy in the mpMRI-TRUS group was 43.59%, and the TRUS group was 33.07%. There was no significant difference in the detection rate of prostate cancer between the two groups. In the mpMRI-TRUS group, the single-needle positive rate and the proportion of prostate cancer tissue were higher than that of system puncture. The positive rate of targeted puncture in the mpMRI-TRUS group was 38.46%, and the system puncture was 42.30%. The difference between the two groups is not statistically significant. Conclusion The mpMRI-TRUS cognitive fusion technology can detect prostate cancer with fewer needles in prostate biopsy. Targeted biopsy puncture can provide more prostate cancer tumor tissues and reduce the missed diagnosis rate of prostate cancer biopsy.

目的 通过建立特征参数曲线模型分析在不同CT扫描条件下对肺结节鉴别诊断的量化意义。方法 回顾性分析2018年9月—2019年10月我院收治的肺结节患者的CT胸部平扫图像为研究对象,纳入标准为结节直径≥3 mm,无其他病史。在筛选出的96例样本中,符合条件的样本68例(男性39例,女性29例),按扫描剂量的不同将研究对象分为低剂量观察组(管电压120 kV,管电流20 mA)和常规剂量组(管电压120 kV,管电流150 mA),每组各34例;通过测量并计算扫描长度、有效剂量、样本体型、信噪比相关参数,观察不同管电流与有效辐射剂量之间的相关性以及图像质量;运用PACS人工智能软件以及人工综合提取肺结节特征信息(直径、体积、密度纹理、边缘细节、内部结构)并记录数据,进而通过公式计算出肺结节质量;应用U检验分析比较不同管电流下各参数的组间差异,经过单元逻辑对确定的重要参数体积与质量纳入多元逻辑分析,建立特征参数曲线模型并测量曲线下面积及勾画ROC;使用卡方分析评价不同管电流下建立特征参数曲线模型对肺结节定量诊断分析的差异并同时比较不同管电流下的图像质量。结果 研究中发现,样本接受的有效辐射剂量在管电压一定的条件下,随管电流的增加而线性增加;样本肥胖患者(BMI≥23.9)的CT图像在使用低剂量扫描中呈现出明显噪声,影响组织间观察,而BMI标准(18.5≤BMI≤23.9)的样本的CT图像中,肺结节的信噪比与管电流变化未出现明显趋势阈值,差异无统计学意义(P＜0.05);通过特征参数曲线模型显示,肺结节的体积与质量均质性曲线显示出其变化趋势与管电流变化成相关性,且稳定性和一致性较好,故此二要素为模型主要分析成分,观察组ROC曲线显示其曲线下面积为0.826高于常规组ROC曲线显示其曲线下面积为0.747。结论 与常规剂量相比,低剂量CT扫描模式下建立特征参数曲线模型对肺结节鉴别诊断更有可量化意义。

Objective The quantitative significance of differential diagnosis of pulmonary nodules under different CT scanning conditions was analyzed by establishing characteristic parameter curve model. Methods CT plain chest scan images of patients with pulmonary nodules treated in our hospital from September 2018 to October 2019 were analyzed retrospectively. The inclusion criteria were nodule diameter ≥3 mm and no other medical history. Of the 96 selected samples, 68 met the criteria (39 males and 29 females).According to the different scanning dose, the subjects were divided into low dose observation group (tube voltage 120 kV, tube current 20 mA) and conventional dose group (tube voltage 120 kV, tube current 150 mA).There were 34 cases in each group, and the correlation between different tube current and effective radiation dose and image quality were observed by measuring and calculating the relevant parameters of scanning length, effective dose, sample shape and signal-to-noise ratio. PACS artificial intelligence software and artificial synthesis were used to extract the characteristic information (diameter, volume, density texture, edge details, internal structure) of pulmonary nodules and record the data. Furthermore, the mass of pulmonary nodules was calculated by formula, the differences of parameters under different tube currents were compared by U test, the volume and mass of important parameters determined by unit logic were incorporated into multivariate logic analysis. The curve model of characteristic parameters was established, the area under the curve was measured and ROC was sketched. Chi-square analysis was used to evaluate the difference of characteristic parameter curve model for quantitative diagnosis of pulmonary nodules under different tube currents, and to compare the image quality under different tube currents at the same time. Results In the study, it is found that the effective radiation dose received by the sample increases linearly with the increase of tube current under the condition of constant tube voltage. The CT images of obese patients (BMI≥23.9) showed obvious noise when using low dose scan, which affected the inter-tissue observation. However, in the CT images of the samples with BMI standard (18.5 ≤ BMI ≤ 23.9), there was no obvious trend threshold between the signal-to-noise ratio and tube current of pulmonary nodules, and the difference was not statistically significant (P<0.05).The characteristic parameter curve model showed that the volume and mass homogeneity curve of pulmonary nodules showed the change trend was correlated with the change of tube current, and the stability and consistency were good, so the two elements were the main analytical components of the model. The ROC curve of the observation group showed that the area under the curve was 0.826, which was higher than that of the conventional group, the area under the curve of the ROC curve was 0.747. Conclusion Compared with conventional dose, the establishment of characteristic parameter curve model under low dose CT scan mode is more quantifiable for differential diagnosis of pulmonary nodules.

目的 分析濮阳市人民医院肺炎克雷伯菌(Klebsiella pneumoniae,K. pneumoniae, KPN) 的临床分布、流行病学特点及耐药情况,以促进临床合理用药。方法 回顾性分析濮阳市人民医院2020年1—3月临床送检标本中分离出的209株肺炎克雷伯菌的分布及耐药情况。结果 临床标本中共分离出肺炎克雷伯菌209株,在肠杆菌科细菌中占比为68.30%;标本来源以痰液、血液和尿液为主,分别占75.11%、9.09%、5.74%;分离菌株数量较多的科室为ICU、神经外科一病区、EICU病区和胸外科病区,分别占比47.37%、 17.7%、3.35%和3.35%。产超广谱β-内酰胺酶(ESBLs)菌株检出率为11.48%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为58.37%。不同来源KPN的耐药性具有显著差异, 综合ICU KPN的耐药率高于其他病区。结论 濮阳市人民医院临床分离KPN对常用抗菌药物有一定的耐药性,尤其以综合ICU分离菌株耐药严重,应加强监测KPN耐药情况,有针对性的选择抗菌药物,并增强院感防控,以减轻KPN的耐药情况。

Objective To analyze the characteristic of clinical distribution, epidemiological and drug resistance of Klebsiella pneumoniae (KPN) in the People's Hospital of Puyang City,and to provide evidence for rational use of antimicrobial drugs in clinical treatment. Methods A retrospectively analysis was conducted on 209 strains of KPN isolated from the clinical specimens in the People's Hospital of Puyang City from January 2020 to March 2020. Results A total of 209 strains of KPN were isolated from clinical specimens, accounting for 68.30% of enterobacteriaceae bacteria; the sources of specimen were mainly from sputum, blood and urine, accounting for 75.11%, 9.09% and 5.74% respectively; the departments with more isolated strains were ICU department, neurosurgery first department, EICU department, and thoracic surgery department, accounting for 47.37%, 17.7%, 3.35% and 3.35% respectively. Besides, the detection rate of extended spectrum β-lactamase(ESBLs) strains was 11.48%,and the detection rate of carbapenems-resistant klebsiella pneumoniae (CRKP) strains was 58.37%. The results showed that the drug resistance of KPN from different sources was with a significantly difference, and the drug resistance rate of KPN in comprehensive ICU was significantly higher than that of other departments. Conclusion The resistance of KPN isolated from the People's Hospital of Puyang City to common antibiotics is not optimistic. In particularly, the drug resistance of KPN isolated strains from the comprehensive ICU is more serious. Hence, the monitoring of KPN resistance should be strengthened and the effective prevention and control measures of hospital infection should be adopted. Furthermore, antibacterial drugs should be used rationally to reduce the generation of drug-resistant bacteria.

目的 探讨联合镇静胃肠镜检查在安全性、可行性的效果以及优势方面的临床应用,为优化诊疗流程、方便患者提供科学依据。方法 纳入我院2017年6月—2018年3月行镇静胃肠镜检查的140例患者为研究对象,采用便利抽样法随机分为两组,观察组70例患者行联合镇静胃肠镜检查,对照组70例患者行胃肠镜分次检查。记录并对比分析两组患者的预约时间、检查时长、不适反应、疼痛程度、满意度、检查费用。结果 观察组在预约时间和检查时长、检查后心率变化,患者满意度和检查费用方面,与对照组相比有统计学差异(P＜0.05),而在血压、血氧、镇静及遗忘程度、疼痛程度及不适反应方面无统计学差异(P＞0.05)。结论 联合镇静胃肠镜检查在临床应用方面安全可行,具有便宜、时间少、患者配合度好、符合患者意愿、而且满意度高的优势,值得推广。

Objective To explore the scientific evidence in optimization of diagnosis and treatment process for patients' convenience, we evaluated the clinical effect of gastrointestinal endoscopy with sedation on the safety, feasibility and advantage. Methods We enrolled 140 patients who came to our hospital for gastrointestinal endoscopy from June 2017 to March 2018. We used the convenience sampling method that the patients were randomly divided into two groups: observation group of 70 patients with combined endoscopy, and the control group of 70 patients with seperate endoscopy. We recorded and compared the two groups of patients of appointment time, inspection time, pain degree, patient satisfaction, and cost. Results The two groups were different in the appointment time, inspection time, heart rate changes after endoscopy, patient satisfaction and the costs (P<0.05), while no significant difference was found in blood pressure, blood oxygen degree, sedation, pain degree and discomfort reaction(P>0.05). Conclusion Combined sedative gastrointestinal endoscopy is safe and feasible in clinical application, with the advantages of low cost, less time, good patient cooperation, in line with the wishes of patients, and high satisfaction, which is worthy of popularization.

目的 探讨延续性健康指导联合预见性干预对慢性脑卒中患者脑功能影响。方法 选取2019年6月—2020年6月我院收治的慢性脑卒中患者118例,使用随机数字表法将其分为两组,对照组进行预见性干预,研究组进行延续性健康指导联合预见性干预。比较两组效果、神经运动功能、不良反应。结果 研究组效果大于对照组(P＜0.05);研究组神经运动功能大于对照组(P＜0.05);研究组不良反应少于对照组(P＜0.05)。结论 慢性脑卒中护理中,延续性健康指导联合预见性干预效果较好,值得应用。

Objective To investigate the effects of continuous health guidance and combined predictive intervention on cerebral function in patients with chronic stroke. Methods A total of 118 patients with chronic stroke admitted to our hospital from June 2019 to June 2020 were selected and divided into two groups using the random number table method. The control group received predictive intervention, and the study group received continuous health guidance combined predictive intervention. The effects, neuromotor functions and adverse reactions of the two groups were compared. Results The effect of the study group was greater than that of the control group (P<0.05). The neuromotor function of the study group was higher than that of the control group (P<0.05). The adverse reactions in the study group were less than those in the control group (P<0.05). Conclusion In the nursing of chronic stroke, the effect of continuous health guidance combined with predictive intervention is good, and it is worth applying.

目的 了解早产儿母亲群体的知识需求和情感特征,为延续性护理提供证据支持。方法 创建早产儿妈妈群,群成员共43人,通过整理并计量分析2018年9月—2019年1月的该微信群群聊记录,对群聊记录进行主题分类,归纳出对话频次最多及参与人数过半的聊天主题,并统计分析不同孕妇情况不同早产儿情况下早产儿母亲的关注内容。结果 早产儿母亲对早产儿照护相关知识需求较大,尤其在早产儿生长发育管理及疾病管理知识方面。此外,不同家庭月均收入水平、不同文化程度、不同分娩孕周、新生儿出生体质量不同、新生儿住院天数不同,其对话主题明显不同,对比有统计学意义(P<0.05)。结论 延续性护理工作中应加强早产儿照护相关知识宣教,根据孕妇和早产儿情况给予更加针对性的指导,同时不能忽视早产儿母亲的心身需求。此外,对群聊记录进行资料分析的方法可靠,建议在未来的研究中应用。

Objective To investigate the knowledge needs and psychological characters of the mothers of premature infants, providing the basis for continuous nursing. Methods WeChat group of mothers of premature infants was established and 43 group members were included. Chatting records of the WeChat group from September 2018 to January 2019 were extracted and classified into relevant topics. The topics with the most conversations or more than half of the participants and the topic related to the psychological experiences of mothers of premature infants were further analyzed. Results Mothers of premature infants had a large knowledge need for the care for premature infants, especially the knowledge about the growth and development management of premature infants and disease management of premature infants. Moreover, some mothers of premature infants had negative psychological feelings. Mothers with different family monthly income, educational levels, pregnancy duration, different weight and hospitalization cycles of their infants, had different chatting topics, which differences were significant (P<0.05). Conclusion In continuous nursing for mothers of premature infants, education on the care for premature infants should be strengthened and comprehensive measures of mental health should be undertaken. Additionally, the method of analyzing chatting records seems reliable and can be applied in future studies.

目的 观察佩戴软弹性咬合板对磨牙症患者牙周组织应力的影响。方法 创建颌骨和牙列的三维有限元模型,对模型右侧上、下颌的每颗牙加载与牙体长轴呈0°、45°、90°的成人最大咬合力,分析使用不同厚度软弹性咬合板(1 mm、2 mm)后,牙槽骨及牙周膜所受应力的大小及分布,设不使用软弹性咬合板组做阴性对照。结果 在各咬合力加载角度下,与对照组相比,1 mm软弹性咬合板对牙周膜应力的缓冲效率平均为16%,对牙槽骨应力的缓冲效率平均为15%。2 mm软弹性咬合板对牙周膜及牙槽骨应力缓冲效率平均为26%及25%。在所有组别中,牙周组织的最大应力均集中于颊、舌侧牙槽嵴顶附近,但使用软弹性咬合板后应力集中范围减少,应力分布更均匀。结论 软弹性咬合板可以作为咬合应力的缓解装置,它有助于消减磨牙症产生的额外应力对牙周组织造成的破坏。

Objective To observe the effect of wearing an elastic soft occlusal splint on the stress of periodontal tissue in patient with bruxism. Methods A three-dimensional finite element model of jaw and dentition was created. Each tooth in the test area was loaded with the maximum adult occlusal force at 0°, 45°, and 90° with respect to the long axis of the tooth. 1 mm and 2 mm elastic soft occlusal splint were used, and the stress of the alveolar bone and periodontal ligament with and without elastic soft occlusal splint were analyzed and compared. Results Compared with the control group, 1 mm splint reduced the periodontal ligament stress of patient by an average of 16% and the alveolar bone stress by an average of 15%. After wearing a 2 mm splint, the patient's periodontal ligament and alveolar bone stress were reduced by 26% and 25% respectively. In all groups, the maximum stress of the periodontal tissue was on the buccal and lingual alveolar ridge crest, but the stress distribution was more uniform after using the soft occlusal splint. Conclusion The soft occlusal splint can be used to relieve occlusal stress and help eliminate the damage to periodontal tissue caused by the extra stress in bruxism.

目的 探讨D-二聚体在急诊胸痛中心早期鉴别诊断急性主动脉综合征(AAS)的重要性,以及讨论如何结合D-二聚体检测优化现有胸痛中心的急救流程。方法 收集近1年来我院胸痛中心收治的50例以胸痛为主诉的患者资料,其中25例最终确诊AAS的患者作为AAS组,以同一时期诊治的25例进行了急诊经皮冠状动脉介入治疗(PCI)确诊的急性非ST抬高型心肌梗死(NSTEMI)患者作为对照组。所有患者在首诊时检测血D-二聚体,通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),分析D-二聚体对AAS与NSTEMI的鉴别诊断价值,并探讨其优化胸痛中心救治流程的实际意义。结果 AAS组D-二聚体水平明显高于NSTEMI组,差异具有统计学意义(P<0.001),且在D-二聚体为89 500 μg/L时取得最佳截止点。结论 对于胸痛患者早期鉴别诊断,D-二聚体具有重要参考价值。

Objective To explore the importance of D-dimer in early differential diagnosis of acute aortic syndrome (AAS) in the emergency chest pain center. And to discuss how to combine D-dimer detection with optimizing the first aid process of existing chest pain centers. Methods The data of 50 patients who complained of chest pain in the chest pain center of our hospital in the past 1 year was collected, including 25 patients who were finally diagnosed as AAS group. Other 25 patients with acute non-ST elevation myocardial infarction (NSTEMI) diagnosed by emergency percutaneous coronary intervention (PCI) were included as control group. Blood D-dimer was detected in all patients at the first visit. By drawing receiver operating characteristic curve (ROC), the value of D-dimer in differential diagnosis between AAS and NSTEMI was analyzed, and the practical significance of optimizing the treatment process of chest pain center was discussed. Results The level of D-dimer in AAS group was significantly higher than that in NSTEMI group (P<0.001), and the best cutoff point was obtained when D-dimer was 895.00 μg/L. Conclusion D-dimer has reference significance for early differential diagnosis of patients with chest pain.

目的 探讨扩张型心肌病采用诺欣妥治疗的效果及对其心功能的影响。方法 本文将2020年2月—2020年10月收治的扩张型心肌病患者50例作为研究对象,对所有患者按照随机方式进行分组,对照组25例患者以常规抗心衰治疗与依那普利治疗,观察组25例患者在常规抗心衰治疗的基础上给予诺欣妥治疗,统计分析用药后有效率、治疗前后心功能指标、6 min步行距离及炎症因子水平。结果 两组之间炎症因子水平相比,观察组较对照组低;6 min步行距离、用药后有效率相比,观察组较对照组高;心功能指标相比,观察组SV、LVEF较对照组高,LVESD、LVEDD较对照组低,P＜0.05。结论 采用诺欣妥治疗扩张型心肌病效果显著,总有效率较好,可有效改善患者心功能指标,增加6 min步行距离,减轻炎症因子水平,改善患者预后。

目的 快速康复外科理念在老年前列腺电切术后的应用分析。方法 选取我院2019年1月—2020年10月行前列腺电切术老年患者88例,以随机数字表法分为两组,参照组给予常规护理,研究组给予快速康复外科理念下护理,比较两组患者术后尿管拔除时间、术后首次进食时间、术后首次下床活动时间,并比较两组住院天数、及入院时和出院前生活质量(以ADL评价)评分,术后并发症发生情况。结果 研究组术后尿管拔除、首次进食、首次下床活动时间、住院天数短于参照组,术后并发症发生率低于参照组,差异有统计学意义(P＜0.05);入院时,两组ADL评分比较,差异无统计学意义(P＞0.05)。出院前,两组ADL评分高于入院时,且研究组高于参照组,差异有统计学意义(P＜0.05)。结论 老年患者行前列腺电切术后,给予快速康复外科理念下的护理服务,有利于缩短术后尿管拔除、进食、下床活动时间,也能够提高患者生活质量,减轻并发症影响,缩短住院天数,提高床位周转率,具有较高的护理价值。

目的 对喀什地区和广州地区过敏性疾病儿童血清过敏原特异性IgE进行检测并比较检测结果。方法 选择喀什地区第一人民医院(喀什地区)和广东省妇幼保健院、广州市番禺区中心医院(广州地区)过敏性疾病儿童,血清标本采用国产欧博克试剂盒(酶联免疫法)检测过敏原特异性IgE。结果 两地区过敏性疾病儿童的过敏原IgE总阳性率均随年龄增长逐渐升高。广州地区过敏性疾病儿童对牛奶的IgE阳性率随年龄增长逐渐降低,对屋尘螨/粉尘螨则逐渐升高,组间比较均有统计学意义差异(P均<0.05)。喀什地区过敏性疾病儿童对花生/榛子/开心果、葎草/艾蒿/豚草、猫/狗毛皮屑的血清IgE阳性率明显高于广州地区,而对牛奶、屋尘螨/粉尘螨的血清IgE阳性率明显低于广州地区(P均<0.05)。结论 喀什地区和广州地区过敏性疾病儿童过敏原特异性IgE结果存在显著差异,过敏性疾病需要做好不同地区过敏原的监测。

目的 探讨玻璃体切除术联合玻璃体腔注射曲安奈德治疗特发性黄斑前膜患者疗效观察。方法 选取我院2018年1月—2020年1月特发性黄斑前膜(idiopathic macular epiretinal membrane, IMEM)患者38例。随机分为治疗组(18例,18眼)与对照组(20例,20眼)。治疗组在术中予以玻璃体切除联合黄斑前膜剥除及内界膜剥除术,并注入曲安奈德(triamcinolone acetonide,TA),对照组术中单纯行玻璃体切除联合黄斑前膜剥除及内界膜剥除术。比较两组患者手术前及手术后1月、3月、6月的最佳矫正视力(BCVA)及黄斑中心凹厚度数值(CMT)及房水白细胞介素-6(IL-6)的变化情况。结果 术中所有患者成功剥除黄斑前膜,术后所有患者均未出现玻璃体积血、视网膜脉络膜脱离及眼压增高等并发症。两组患者中,所有患者手术后BCVA均较手术前有所提高,且治疗组优于对照组,差异有统计学意义(P＜0.05)。手术后治疗组CMT下降幅度优于对照组,差异有统计学意义(P＜0.05)。手术后治疗组房水中IL-6水平明显低于对照组,差异有统计学意义(P＜0.05)。结论 玻璃体切割及内界膜剥除术联合玻璃体腔内注射TA治疗IMEM,有助于提高患者术后视力,降低患者黄斑中心凹厚度,减轻患者黄斑水肿程度,减少房水中白细胞介素-6的表达。

目的 探讨湿化高流量鼻导管通气(HHFNC)联合枸橼酸咖啡因治疗早产儿呼吸暂停的临床疗效。方法 选取2016年1月—2017年12月我院收治的58例呼吸暂停的早产儿为研究对象,随机分为两组:HHFNC组和对照组,HHFNC组除采用枸橼酸咖啡因治疗方案外,联合HHFNC法进行治疗;对照组采取鼻导管吸氧联合枸橼酸咖啡因治疗。结果 HHFNC组较之对照组治疗早产儿呼吸暂停的总有效率更高,差异有统计学意义(P<0.05);HHFNC组较之对照组总用氧时间、无创辅助通气的时间减少,住院时间缩短,差异有统计学意义(P<0.05)。结论 湿化高流量鼻导管通气(HHFNC)联合枸橼酸咖啡因减少早产儿呼吸暂停的发生,改善早产儿呼吸状况。

目的 探讨中性粒细胞及淋巴细胞比值与急性冠状动脉综合征、冠状动脉狭窄程度的相关性。方法 选取2019年2月—2020年2月我院收治的急性冠状动脉综合征患者90例作为研究对象,根据检查结果将患者分为两组,分别为不稳定心绞痛组(51例)、急性心肌梗死组(39例),同时选取同期在我院检查且没有明显狭窄的患者52例作为对照组。对三组人群的中性粒细胞-淋巴细胞比值进行测定。比较三组人群中性粒细胞-淋巴细胞比值(NLR)、冠状动脉病变(Gensini)评分、不同冠状动脉病变狭窄患者NLR、Gensini评分、分析中性粒细胞-淋巴细胞比值与急性冠状动脉综合征、冠状动脉狭窄程度的相关性。结果 急性心肌梗死组NLR值大于不稳定心绞痛组、对照组(P＜0.05),急性心肌梗死组Gensini评分高于不稳定心绞痛组、对照组(P＜0.05);重度冠状动脉病变狭窄组NLR值大于中度狭窄组、轻度狭窄组(P＜0.05),重度冠状动脉病变狭窄患者Gensini评分高于中度狭窄组、轻度狭窄组(P＜0.05);NLR与急性冠状动脉综合征、冠状动脉狭窄程度呈正相关(r=0.236,P＜0.05;r=0.214,P＜0.05)。结论 中性粒细胞-淋巴细胞比值与急性冠状动脉综合征有明显的关系,且可以对患者的冠状动脉狭窄程度进行判断。