目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

目的 探讨TBL(Team-Based Learning)教学在临床实践教学中的应用效果。方法 将2015年外科实习学生分为应用传统教学的对照组与应用TBL教学的实验组,教学效果采用出科考核成绩、实习效果调查和TBL教学法可行性调查问卷进行评估。结果 两组学生出科考核成绩无明显差异, TBL有助于提高学生解决临床问题的综合能力、课堂参与度、自觉知识掌握度、实习满意度。结论 TBL可以增强学生主动思考学习、团队协作能力,在临床实践教学中切实可行。

Objective To explore the application effect of TBL (Teaching Team-Based Learning) in clinical practice teaching. Methods The surgical internship students of the year 2015 were divided into the control group with traditional teaching and the experimental group with TBL teaching. The teaching effect was evaluated by the examination results, the internship effect survey and the TBL pedagogical feasibility questionnaire. Results There was no significant difference between the two groups in their test scores. TBL helped to improve students' comprehensive ability to solve clinical problems, classroom participation, degree of self-knowledge and internship satisfaction. Conclusion TBL may enhance students' ability of active thinking and learning, teamwork and practicing in clinical practice teaching.

目的 探究骨质疏松性椎体压缩骨折治疗中3D打印技术的应用及其效果。方法 选取我院2016年1月—2018年10月收治的90例行经皮椎体成形术治疗的骨质疏松性椎体压缩骨折患者作为研究对象,随机分为常规组45例和实验组45例。常规组采用MR+常规穿刺方法,通过MR引导,注入骨水泥;实验组采用CT+3D打印技术,在应用CT的基础上,借助制作模型的引导,实施精准定位并实施手术治疗,对两组各项围术期治疗指标(手术时间、射线暴露次数、后凸Cobb角改善)和治疗前后的VAS评分、ODI评分以及骨水泥渗漏情况。结果 在手术时间、射线暴露次数、后凸Cobb角改善等围术期治疗指标方面,实验组均要优于常规组,差异有统计学意义(P<0.05)。在骨水泥渗漏发生率方面,常规组为17.78%(8/45),实验组为4.44%(2/45),实验组低于常规组,差异有统计学意义(P<0.05)。在VAS评分、ODI评分方面,常规组和实验组治疗前、治疗后相比差异均无统计学意义(P>0.05)。结论 骨质疏松性椎体压缩骨折经皮椎体成形术治疗中,配合3D打印技术能够有效提升治疗的有效性,促进患者的健康恢复,值得推广应用。

目的 了解老年冠脉支架植入患者的临床特征及治疗疗效。方法 按照纳入、排除标准入选2015年10月—2017年10月于我院住院并接受冠状动脉支架治疗的患者372例,分为女性组和男性组,收集临床资料并随访预后。结果 女性组157例,男性组215例,2组冠脉病变支数、发生心血管不良事件比例无统计学意义(P>0.05),女性组不稳定性心绞痛、合并糖尿病、高血压比例及胆固醇、甘油三酯、低密度脂蛋白、脂蛋白a、TSH水平均高于男性组(P<0.05),急性心肌梗死、吸烟比例及年龄、血肌酐均低于男性组(P<0.05)。结论 老年患者合并可控制的危险因素较多,女性要强调血糖、血脂的控制,男性要强调戒烟。冠脉病变支数、术后1年发生不良心血管事件比例无性别差异。

目的 探讨四磨汤联合穴位按摩对早产儿喂养不耐受的影响。方法 将165例出现喂养不耐受的早产儿分组,82例于常规治疗基础上予四磨汤加穴位按摩为研究组,另83例予常规治疗为对照组,观察两组早产儿发生呕吐、胃潴留、腹胀等情况,并在喂养2周后作胃泌素和胰岛素的测定。结果 研究组早产儿发生呕吐、腹胀、胃潴留例数及所占比例分别为 12(14.6%) 、13(15.9%) 、18(22.0),发生率低于对照组(P<0.05);研究组早产儿喂养前和喂养后血清胃泌素分别是(250.41±73.76)ng/L 和(308.27±70.67)ng/L,血清胰岛素是(7.63±2.12)ng/L和(9.43±3.13)ng/L,与对照组相比,2周后的血清胃泌素和胰岛素水平增高(P<0.05)。结论 健脾导滞法可减少早产儿呕吐、腹胀、胃潴留等症状的发生,促进血清胃泌素和胰岛素的分泌,减少早产儿的喂养不耐受的发生。

目的 观察小剂量阿帕替尼联合经肝动脉化疗栓塞术(TACE)对晚期肝癌的疗效。方法 选择2016年1月1日—2017年12月31日在我院住院治疗的晚期肝癌患者38例,将其随机分为对照组和观察组,每组19例,对照组给予TACE治疗,观察组在TACE治疗的基础上联合口服阿帕替尼(250 mg/d)。随访两组患者的存活状态,Kaplan-Meier 法计算中位生存期,并绘制生存曲线,采用log-rank法比较两组患者生存曲线的差异。结果 对照组和观察组中位生存期分别为4.3月、5.8月,两组生存曲线比较有差异(χ²=4.691,P=0.043)。结论 相比于单纯TACE治疗,小剂量阿帕替尼联合TACE方案可以延长晚期肝癌患者的生存期。

目的 探讨原发于前列腺的产黏液尿路上皮型腺癌的临床病理特征、诊断及鉴别诊断。方法 对1例极其罕见的原发于前列腺的产黏液尿路上皮型腺癌病例的临床诊治经过、病理组织学及免疫组织化学特征进行观察和总结,并复习国内外相关文献。结果 患者77岁,因排尿困难入院, B超提示前列腺增大,前列腺异常回声性质待查;CT及肠镜检查均未发现膀胱及结直肠恶性肿瘤;血清PSA未见升高。在当地医院行前列腺穿刺检查,病理诊断为前列腺黏液腺癌。遂于我院行腹腔镜下前列腺根治手术,镜下表现为黏液腺癌伴多量黏液湖形成,并见尿路上皮的腺性化生及原位腺癌与黏液腺癌的移行过渡;免疫组化示CK7及34βE12弥漫表达,CDX-2及CEA局灶表达,其余CK20、β-catenin、GATA3、PSA、PSAP、AR及P504S均阴性。结论 原发于前列腺的产黏液尿路上皮型腺癌十分罕见,其预后差,对内分泌治疗不敏感,准确诊断将有利于指导临床医生选择正确的治疗方法及评估其预后。

Objective To investigate clinicopathological characteristics, diagnosis and differential diagnosis of primary mucin-producing urothelial-type adenocarcinoma of prostate. Methods We reported a rare case of mucin-producing urothelial-type adenocarcinoma of prostate and reviewed relevant literatures to discuss the clinicopathological features, diagnosis and differential diagnosis. Results In this case, the patient was a 77-year-old male with the history of dysuria. B-ultrasound indicated benign prostatic enlargement and abnormal echogenicity remained to be determined. CT scan and gastrointestinal endoscopy didn't show any evidence of bladder and colorectal tumor. No serum prostate-specific antigen (PSA) increased. The patient underwent laparoscopic radical resection of prostate cancer. Microscopically, the tumor presented as mucinous carcinoma, similar to colorectal mucinous carcinoma, but the migration from the normal prostatic urethra was observed and the urethral epithelium at the transitional site was characterized by adenoepithelial metaplasia and adenocarcinoma in situ. Immunohistochemical staining showed neoplastic cells were diffuse and strongly positive for CK7 and 34βE12, focally positive for CDX-2 and CEA and negative for CK20, β-catenin, GATA3, PSA, PSAP, AR and P504S. Conclusion Mucin-producing urothelial-type adenocarcinoma of prostate is an extremely rare tumor. It has a poor prognosis and it is not sensitive to endocrine therapy.

目的 分析献血者献血后血肿(瘀斑)应用不同治疗方法的效果。方法 随机选取147例在广州血液中心献血后出现血肿(瘀斑)的献血者,根据其采用处理方式的差异分为甲组(n=66)、乙组(n=48)、丙组(n=33),为甲组献血者实施冷热敷法,为乙组献血者实施马铃薯片贴敷法,为丙组献血者实施喜辽妥(多磺酸粘多糖)软膏外敷法。结果 乙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=4.63,P＜0.05),丙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=13.99,P＜0.05),丙组献血者临床总有效率高于乙组献血者,2组差异有统计学意义(χ²=3.99,P＜0.05)。结论 献血者献血后血肿应用喜疗妥软膏外敷法疗效确切,可使其身心健康得到改善。

Objective To analyze the effects of different treatment methods on blood donors with haematoma(or bruise) after blood donation. Methods 147 blood donors with haematoma(or bruise) after blood donation in our blood station were randomly selected. According to the difference of treatment methods, they were divided into group A (n=66), group B (n=48) and group C (n=33), for the group A of blood donors to carry out cold and hot compress method, for the group B blood donors to implement the potato slice application method, for the group C blood donors to implement the hi-treatment ointment external application method. Results The total effective rate of group B blood donors was higher than that of group A blood donors. The difference was statistically significant (χ²=4.63,P＜0.05). The total clinical effective rate of group C blood donors was higher than that of group A blood donors. There is statistical significance (χ²=13.99,P＜0.05). The total effective rate of donors in group C was higher than that in group B. The difference between the two groups was statistically significant (χ²=3.99,P＜0.05). Conclusion The effect of external application of Hirudoid(Mucopolysaccharide Polysulfate Cream) on blood donors after blood donation is effective, which may improve their physical and mental health.

目的 探讨血浆BNP预测急性肺栓塞患者发生心血管疾病的临床价值。方法 选择2017年1月—2017年12月在我院诊断为急性肺血栓栓塞患者97例为研究对象,根据有无出现心血管并发症分为观察组(21例)和对照组(76例)。比较两组间实验室指标的差异性和相关性,并采用ROC曲线分析BNP预测急性肺栓塞患者发生心血管疾病的临床价值。结果 观察组共出现21例心血管并发症,占21.65%。观察组中BNP、Hs-CRP 、TnI 、AST、CK和DD的浓度分别为(413.01±33.09)(pg/mL)、(20.49±2.88)mg/L、(0.154±0.103)μg/L、(131.23±27.05)U/L、(421.64±50.70)U/L和(1.95±0.18)mg/L,高于对照组(P<0.05)。Spearman相关性分析,血浆BNP水平与Hs-CRP 、TnI 、AST、CK和DD水平呈正相关(r=0.802、0.718、0.683、0.705、0.753,P<0.05)。ROC曲线分析,BNP的AUC面积最高,为0.834(95%CI:0.795~0.935),敏感度和特异度分别为90.5%和87.5%,联合诊断的AUC面积为0.892(95%CI:0.811~0.976),敏感度和特异度分别为84.6%和91.3%。结论 血浆BNP对于预测急性肺栓塞患者发生心血管疾病具有极高临床价值,采取多指标联合检查可以更加有效发现心血管疾病的发生。

Objective To investigate the clinical value of plasma BNP in predicting cardiovascular disease in patients with acute pulmonary embolism. Methods 97 cases of acute pulmonary thromboembolism diagnosed in our hospital from January to December 2017 were selected.The patients were divided into the observation group (21 cases) and control group (76 cases) according to whether there were cardiovascular complications.The differences and correlations of laboratory indexes between the two groups were compared, and the ROC curve was used to analyze the clinical value of BNP in predicting the occurrence of cardiovascular disease in patients with acute pulmonary embolism. Results 21 cases of cardiovascular complications occurred in the observation group, accounting for 21.65%.The concentration of BNP, Hs-CRP, TnI, AST, CK and DD in the observation group were (413.01±33.09) (pg/mL), (20.49±2.88) mg/L, (0.154±0.103) μg/L, (131.23±27.05) U/L, (421.64±50.70) U/L and (1.95±0.18) mg/L, which were higher than those of the control group(P<0.05). Spearman correlation analysis showed that plasma BNP levels were positively correlated with the levels of Hs-CRP, TnI, AST, CK and DD (r=0.802,0.718,0.683,0.705,0.753,P<0.05). The ROC curve analysis showed that the area of AUC of BNP was 0.834 (95%CI:0.795~0.935) of the highest, the sensitivity and specificity were 90.5% and 87.5% respectively. The area of combined diagnosis of AUC was 0.892 (95%CI:0.811~0.976),the sensitivity and specificity were 84.6% and 91.3%, respectively. Conclusion Plasma BNP is of high clinical value for predicting the incidence of cardiovascular disease in patients with acute pulmonary embolism. Multi-index combined examination may be more effective to detect the occurrence of cardiovascular disease.

目的 本研究旨在探讨2型糖尿病不同程度肾病与chemerin、SOD及MDA的相关性。方法 选取2016年1月—2017年12月期间于广州市第一人民医院内分泌科门诊和住院的患者100例,根据尿白蛋白/肌酐比(ACR)分为正常尿蛋白组(NA组,n=33),微量白蛋白尿组(MA组,n=34)及大量蛋白尿组(CA组,n=33),另选取32例我院体检中心体检结果正常的正常健康人作为对照组(NC组,n=32),测定血糖、糖化血红蛋白、血肌酐、ACR、24小时尿蛋白定量、胆固醇、甘油三酯、SOD、MDA、chemerin等水平。结果 SOD的水平:NC组> NA组> MA组>CA组(P<0.05);MDA的水平:CA组>MA组>NA组>NC组(P<0.05);Chemerin水平:CA组>MA组>NA组>NC组(P<0.05)。相关性分析提示ACR与血清SOD呈负相关,与MDA、chemerin呈正相关。多元回归分析显示,病程、胆固醇、糖化血红蛋白、chemerin是影响ACR的主要因素。结论 Chemerin、MDA、SOD可能参与糖尿病肾病的发生发展,检测其水平可以在一定程度上反映2型糖尿病肾病患者的病情严重程度。

Objective To explore the relationship between different type of Type 2 diabetes nephropathy and chemerin,SOD,MDA. Methods A total of 100 inpatients and outpatients were enrolled in this study between January 2016 and December 2017 in Guangzhou First People's Hospital. They were divided into normal urinary protein group (NA group, n=33), microalbuminuria group (MA group, n=34) and massive proteinuria group (CA group, n=33) based on ACR. Another 32 healthy people were collected as a control group in medical examination center (NC group, n=32). The levels of blood sugar, glycated hemoglobin, serum creatinine, ACR, 24-hour urinary protein, cholesterol, triglyceride, SOD, MDA and chemerin were measured. Results The level of SOD: NC group > NA group > MA group > CA group (P< 0.05). The level of MDA: CA group > MA group > NA group > NC group (P< 0.05). The level of chemerin: CA group > MA group > NA group > NC group (P< 0.05). Correlation analysis showed that ACR was negatively correlated with serum SOD and positively correlated with MDA and chemerin. Multivariate logistic regression demonstrated that course of disease, CHOL, HbA1c and chemerin were the main factors affecting ACR. Conclusion Chemerin, MDA and SOD may be involved in the occurrence and development of diabetic nephropathy. Chemerin, MDA and SOD may reflect the severity of type 2 diabetic nephropathy