目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.

目的 粪菌移植(fecal microbiota transplantation,FMT)是治疗疾病的新途径,本文总结我院408例(1 085例次)FMT的临床疗效和安全性。FMT治疗艰难梭菌感染有效率达80%,抗生素相关性腹泻68%,炎症性肠病52%,功能性肠病65%,代谢性疾病50%,其他疾病57%,安全性良好,未见严重不良事件发生,结果和多数文献相符。还需更多随机对照试验才能明确FMT的临床价值。

目的 探讨继发性肺结核合并肺部真菌感染的临床特点及相关高危因素。方法 收集广州市胸科医院2017年7月—2019年10月收治的继发性肺结核患者资料,病程均大于3个月,分为真菌感染组106例和非真菌感染组100例进行回顾性分析。结果 单因素分析结果显示,合并肺部其他疾病、非初治、咯血、空洞、应用广谱抗生素>l周、侵袭性操作存在统计学差异(P<0.05)。Logistic多因素分析结果显示,广谱抗生素使用>l周、侵袭性操作为真菌感染的独立危险因素(P<0.05)。结论 对于应用广谱抗生素、进行侵袭性操作的肺结核患者应警惕真菌感染风险,及早预防及诊治。

Objective To investigate the clinical characteristics and related high risk factors of secondary pulmonary tuberculosis complicated with pulmonary fungal infection. Methods Data of patients with secondary tuberculosis admitted to Guangzhou Chest Hospital from July 2017 to October 2019 were collected. All patients with a course of disease longer than 3 months were divided into the fungal infection group (n =106) and the non-fungal infection group (n =100) for retrospective analysis. Results Univariate analysis results showed that there were statistical differences in combined other pulmonary diseases, non-initial treatment, hemoptysis, cavity, application of broad-spectrum antibiotic > for 1 week, and invasive operation (P<0.05). Logistic multivariate analysis showed that >1 week of broad-spectrum antibiotics and invasive procedures were independent risk factors for fungal infection (P<0.05). Conclusion Patients with tuberculosis who are treated with broad-spectrum antibiotics and invasive procedures should be alert to the risk of fungal infection, early prevention and treatment should be undertaken.

目的 探讨无创血流动力学监测(non-invasive cardiac output monitoring,NICOM)在儿童脓毒性休克早期液体复苏的临床应用评价。方法 选取2019年1月—2020年6月期间在我院PICU患儿诊断为儿童脓毒性休克61例,随机分为对照组(未接受NICOM监测29例)和干预组(接受NICOM监测32例),记录液体复苏后6、12、24小时血气分析(pH值、剩余碱、乳酸)、尿量以及病死率、NICOM监测(CO、CI、SVR、SV、SVRI、HR、MAP)等结果。结果 液体复苏6 小时后两组HR、MAP、乳酸、剩余碱、尿量比较无统计学差异 (P>0.05),液体复苏12 h后干预组乳酸较对照组降低,差异有统计学意义(P<0.05);液体复苏24 h后两组HR、MAP、乳酸、剩余碱及尿量比较,差异均有统计学意义 (P<0.05)。干预组治疗后12 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05),干预组治疗后24 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05)。结论 NICOM具有敏感度及准确率高,且操作简单,可有效用于指导脓毒性休克早期液体复苏,针对个体化治疗提供客观依据,正确指导容量管理,具有科学实用价值,值得推广。

Objective To evaluate the clinical application of non-invasive cardiac output monitoring (NICOM) for early fluid resuscitation in children with septic shock. Methods 61 children diagnosed with septic shock in the PICU at our hospital between January 2019 and June 2020 were randomly divided into a control group (29 without NICOM monitoring) and an intervention group (32 with NICOM monitoring), and the results of blood gas analysis (pH,lactate and residual base), urine volume, and mortality, and NICOM monitoring (CO, CI, SVR, SVRI, HR, and MAP) were recorded at 6, 12, and 24 h after fluid resuscitation. Results There was no statistically significant difference in HR, MAP, lactic acid, residual base and urine volume between the two groups after 6 h of fluid resuscitation (P>0.05), and lactic acid was lower in the intervention group than that in the control group after 12 h of fluid resuscitation (P<0.05); the differences in HR, MAP, lactic acid, residual base and urine volume between the two groups after 24 h of fluid resuscitation were all statistically significant (P<0.05). The differences were statistically significant (P<0.05) in CO, CI, SVR, SVI, HR, and MAP at 12 h and at 24 h after treatment in the intervention group compared with that of the pre-treatment (P<0.05). Conclusion NICOM has high sensitivity and accuracy and it can be operated in simple processes. It may be effectively applied to guide the early fluid resuscitation of septic shock. It also provides Objective evidence for individualized treatment and correctly guides volume management. Its scientific and practical value makes it worth promoting.

目的 了解广州市肾综合征出血热住院病例临床表现和流行病学特征,分析患者出现重症的影响因素,为加深疾病认知和识别重症提供科学依据。方法 回顾性选取2014年1月以来在广州市二级及以上医疗机构住院的明确诊断为肾综合征出血热的患者572例作为本研究研究对象,自行设计问卷,收集患者流行病学史、临床表现和实验室检测结果,采用多因素Logistic回归分析识别患者重症HFRS的影响因素。结果 572例患者中男406人,女166人,男女比2.45:1,年龄最小者14岁,最大89岁,平均年龄(41.21±14.16)岁。临床表现以发热、起病急、乏力为主,三者分别占比96.33%、88.29%和82.32%,重症病例93例,重症率16.26%,不同颈红、胸红、腹痛、腹泻、恶心、呕吐、眼睑浮肿、黄疸、少尿或无尿、低血压、休克、白细胞计数减少、尿膜状物情况和鼠类暴露情况的患者重症发生率差异有统计学意义(均 P<0.05),多因素Logistic回归分析结果显示年龄为40～49岁、呕吐、休克、房内有老鼠及食物粮食无防鼠设备是患者发生重症的危险因素,其OR值和95%CI分别为2.712(95%CI:1.039~7.077)、2.99(95%CI:1.462~6.114)、5.822(95%CI:1.891~17.927)和3.292(95%CI:1.479 ~7.327)。结论 临床表现有呕吐和休克症状以及有明确的啮齿类动物暴露史者重症的风险更高,在今后的防治中,应进一步加强健康宣传教育,广泛开展灭鼠活动,临床上对存在高危风险的病例进行早期干预以提高患者的预后效果。

Objective To understand the clinical manifestations and epidemiological characteristics of hospitalized cases of hemorrhagic fever with renal syndrome in Guangzhou, analyze the influencing factors of patients with severe illness, and provide scientific basis for deepening disease recognition and identifying severe illness. Methods A retrospective selection of 572 patients with a clear diagnosis of hemorrhagic fever with renal syndrome who were hospitalized in second-level and higher medical institutions in Guangzhou since January 2014 were selected as the research objects. Questionnaires were designed and the epidemiological history clinical manifestations and laboratory test results of patients were collected. Multivariate logistic regression analysis was used to identify the influencing factors of patients with severe HFRS. Results Among the 572 patients, there were 406 males and 166 females. The male-to-female ratio was 2.45:1. The youngest was 14 years old, the oldest was 89 years old, and the average age was (41.21±14.16)years old. The clinical manifestations were mainly fever, acute onset, and fatigue, which accounted for 96.33%, 88.29% and 82.32%. There were 93 severe cases with a severe rate of 16.26%. Different neck redness, chest redness, abdominal pain, diarrhea, nausea, and nausea, vomiting, eyelid edema, jaundice, oliguria or anuria, hypotension, shock, decreased white blood cell count, urine membranes and rodent exposure, there were statistically significant differences in the incidence of severe illness (all P<0.05). The logistic regression analysis of factors showed that the age of 40-49 years, vomiting, shock, the presence of rats in the room, and food without rodent-proof equipment were risk factors for severe illness. The OR values and 95%CI were 2.712 (95 %CI: 1.039-7.077), 2.99 (95%CI: 1.462-6.114), 5.822 (95%CI: 1.891-17.927) and 3.292 (95%CI: 1.479-7.327). Conclusion Patients with clinical manifestations of vomiting and shock symptoms and a clear history of rodent exposure are at higher risk of severe illness. In the future prevention and treatment, health promotion and education should be further strengthened, rodent control activities should be carried out extensively, and early intervention is taken clinically to improve the patient's healing effect.

目的 探究m6A甲基化基因与卵巢癌生存预后的关系,为卵巢癌的靶向治疗、预后评估提供科学依据。方法 从TCGA及GTEx数据库中下载卵巢癌组织与正常组织mRNA表达数据进行组间差异分析,通过LASSO回归筛选与卵巢癌生存相关基因,进一步使用逐步Cox回归分析构建风险评分预测模型,根据风险评分中位数将患者分为高风险组和低风险组并使用ROC曲线下面积评价模型的预测能力。相关性分析构建与m6A基因的共表达调控网络,GO功能富集和KEGG通路分析初步探讨潜在的生物作用机制。结果 在癌组织与正常组织中发现20个m6A甲基化基因差异表达,逐步Cox回归分析筛选出3个基因(HNRNPA2B1,ZC3H13,WTAP)用于构建风险评分模型,高风险组患者的生存期较低风险组患者明显缩短(P=0.001 9),死亡风险显著增加(HR=2.643, P＜0.01),风险评分模型结合患者年龄、临床分级和分期后,1、3、5年的AUC为0.74、0.64、0.64。生物信息学分析结果提示m6A相关基因参与RNA的剪接、定位、转运、代谢调控、蛋白水解、细胞周期、核糖体合成等生物学过程。结论 成功构建卵巢癌m6A甲基化基因预后风险评估模型且该模型具备一定的预测效能。

Objective To explore the relationship between m6A methylated genes and prognosis of ovarian cancer, so as to provide scientific basis for targeted therapy and prognosis assessment of ovarian cancer. Methods The mRNA expression data of ovarian cancer tissues and normal tissues were downloaded from TCGA and GTEx databases for difference analysis between two groups. The genes related to ovarian cancer survival were screened by LASSO regression, and the risk score prediction model was further constructed by step Cox regression analysis. The patients were divided into high-risk group and low-risk group according to the median risk score, and the ROC was used for analysis. Correlation analysis was performed to construct an expression regulatory network with m6A genes, and GO function enrichment and KEGG pathway analysis were performed to preliminarily explore the potential biological mechanism. Results 20 m6A methylation genes were found in differential expression between cancer tissue and normal tissue, three genes (HNRNPA2B1, ZC3H13, WTAP) were used to construct the model through step Cox regression analysis. Patients' survivals of high-risk group were shortened than that of the low-risk group obviously (P=0.001 9), the risk of death significantly was increased (HR=2.643, P<0.01). After risk score model combined with patient age, clinical classification and stage, the AUC of 1, 3, 5 years was 0.74, 0.64 and 0.64. Bioinformatics analysis indicated that those m6A genes were involved in RNA splicing, localization, transport, metabolic regulation, proteolysis, cell cycle, ribosome synthesis and other biological processes. Conclusion The prognostic risk assessment model of m6A methylated genes for ovarian cancer was successfully constructed and the model had certain predictive efficacy.

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 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 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.