目的 研究细胞周期调控因子E2F-1和p16蛋白与宫颈上皮内瘤变及宫颈鳞癌的表达及其临床意义。方法 通过免疫组化SP法检测宫颈上皮内瘤变Ⅰ-Ⅱ级(CINⅠ-Ⅱ级)、宫颈上皮内瘤变Ⅲ级(CINⅢ级)、宫颈鳞癌各40例中E2F-1和p16蛋白的表达情况,并用20例慢性宫颈炎组织作对照。结果 E2F-1蛋白在CINⅠ-Ⅱ级、CINⅢ级和宫颈鳞癌组中阳性率分别为17.5%、67.5%和80.0%, 3组间有差异(χ²=37.278,P<0.001)。p16蛋白表达阳性率分别为27.5%、70.0%和82.5%,3组间差异有统计学意义(χ²=27.708, P<0.001)。CINⅠ-Ⅱ级与CINⅢ级组及宫颈鳞癌组比较均有差异,但CINⅢ级与宫颈鳞癌组间无差异。p16蛋白的表达与E2F-1蛋白表达有正相关关系;在鳞癌组中E2F-1与p16的异常表达与组织学分级、临床分期有关(P<0.05)。结论 子宫颈鳞癌的形成与E2F-1 、p16蛋白过表达是呈正相关关系,E2F-1 、p16 蛋白可能作为子宫颈鳞癌及CIN的标志物,对子宫颈癌筛查和预防有重要意义。

Objective To explore the clinicopathologic significance of the protein expression of cell cycle regulators E2F-1 and P16 in cervical intraepithelial neoplasia(CIN) and cervical squamous cell carcinoma(SCC). Methods Immunohistochemical technique S-P was used to determinate the expression of E2F-1 and P16 protein in 40 cases with CINⅠ-Ⅱ, 40 cases with CINⅢ and 40 cases with cervical squamous cell carcinoma. Results The positive rate of E2F-1 protein expression in CINⅠ-Ⅱ, CINⅢ and cervical squamous cell carcinoma was 17.5%,67.5% and 80.0%, respectively. There were significant differences among the three groups(χ²=37.278,P<0.001). The positive rate of P16 protein expression in CINⅠ-Ⅱ, CINⅢ and cervical squamous cell carcinoma was 27.5%,70.0% and 82.5%, respectively. There were significant differences among the three groups (χ²=27.708, P<0.001). The group with CINⅢ and cervical squamous cell carcinom compared with the group withCINⅠ-Ⅱ did have differences. But there were no significant differences in the group with CINⅢ and the group with cervical squamous cell carcinoma. The relative expressions between P16 and E2F-1 showed positive correlation. In the cervical squamous cell carcinoma group, the abnormal expression of E2F-1 and p16 were correlated with the histological grade and clinical stage. Conclusion It showed positive correlation between very high expression of p16 protein and E2F-1 infection in CIN and SCC. p16 protein and E2F-1 can be an indicator in SCC and CIN,which has very significance in preventing and screening of cervical cancer.

目的 观察miR-9在胃癌组织中的表达水平及其与临床病理的相关性。方法 采用实时荧光定量PCR方法分别检测28例胃癌及正常胃组织中miR-9的表达水平,并分析其表达情况与临床病理资料的关系。结果 胃癌组织miR-9的表达水平[0.0078(0.0031~0.0142)]显著低于相应正常胃组织[0.0177(0.0084~0.0311), P<0.05],尤其是伴淋巴结转移者[0.0021(0.0006～0.0685)]miR-9表达水平明显降低。结论 胃癌组织中miR-9低表达,且与胃癌淋巴结转移有关。

Objective To investigate the correlation between the level of miR-9 expression and clinicopathology in gastric carcinoma. Methods The expression of miR-9 in 28 cases of gastric carcinoma tissues and normal gastric tissues were detected by quantitative real-time PCR, and the relationship between the expression and clinicopathology was analyzed. Results The expression of miR-9 expression in gastric carcinoma tissues [0.0078(0.0031~0.0142)] was significantly lower compared with the corresponding normal gastric tissues [0.0177(0.0084~0.0311), P<0.05], especially in lymph node-invasive carcinoma [0.0021(0.0006～0.0685)]. Conclusion miR-9 was down regulated in gastric cancer tissues, which was significantly associated with lymph node metastasis.

目的 探讨运用目标管理法优化妇科病人的临床护理路径的应用效果。方法 采用历史对照研究,以腹腔镜子宫切除术病人作为研究对象,将2014年1月—2014年12月采用临床护理路径的98例病人作为对照组;2015年1月—2015年12月运用目标管理法优化临床护理路径的105例病人作为研究组,比较两组护理缺陷发生情况、病人满意度、住院时间和住院费用。结果 研究组健康知识知晓水平高于对照组,术后首次功能锻炼时间短于对照组(P＜0.05)。研究组护理缺陷发生率为3.81%,对照组发生率为14.29%(P＜0.05)。研究组对健康教育和基础护理满意度高于对照组(P＜0.05)。结论 目标管理法优化的临床护理路径可使各项操作更加规范细化,提高工作质量,减少护理缺陷,护理质量有一定程度的提高,同时对病人满意度的提高有积极的促进作用。

目的 探讨联合运用透明质酸钠及雌激素预防人工流产术后子宫内膜炎的临床疗效。方法 选择2015年1月—2015年6月在我院接受人工流产术者97例,随机分为观察组48例及对照组49例。对照组术后服用雌激素,观察组同时服用雌激素及透明质酸钠。于术后1周、3周时检测两组患者子宫内膜炎症状评分及宫颈分泌物炎症指标。结果 经过21天的干预之后,两组患者子宫内膜炎症状相比较,观察组患者下腹疼痛、白带增多及发热得分都低于观察组(P<0.05)。宫颈分泌物的CRP、IL-6、IL-9水平检测,术前两组患者之间差异不显著;治疗1周时,两组炎症因子水平均升高,但对照组变化更为明显;干预3周后,两组炎症因子水平较之1周时有所下降,但观察组基本降至正常水平,与对照组相比,差异有统计学意义(P<0.05)。结论 透明质酸钠联合雌激素预防人工流产术后子宫内膜炎效果明显,值得临床推广。

目的 探讨卵巢上皮性癌患者治疗前后外周血血小板计数(PLT)变化的临床意义。方法 采用全血细胞自动分析仪检测115例卵巢上皮性癌患者治疗前和经过有效治疗后的97例患者血小板计数增多检出率的比较,并分析卵巢上皮性癌患者治疗前血小板计数增多与临床病理因素的相关性。结果 33.04％卵巢上皮性癌患者治疗前伴有血小板计数增多,经过有效治疗后,血小板计数增多者降为9.28%,较治疗前明显下降,差异有统计学意义(P<0.05)。卵巢上皮性癌患者治疗前血小板增多与FIGO分期、残余肿瘤灶直径、腹水细胞学和临床疗效相关(P＜0.01)。结论 血小板作为一种简单、经济、灵敏的临床常用指标,监测其表达对于预测卵巢癌临床疗效和预后评估具有临床价值。

目的 探讨胰腺神经鞘瘤的临床特点和诊治方法。方法 总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果 共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁(范围17～89岁),其中女性40例(56%)。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6.1 cm(1～20 cm)。肿瘤位于胰头部29例(40%)、胰体/尾部32例(44%),沟突部6例(8%)。肿瘤表现为实性肿物27例(38%)、囊性28例(39%)、囊实性10例(14%)。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例 (7%) 患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[(13.8±6.2)cm vs (5.6±4.1)cm,P=0.0004)]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论 胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。

Objective To analyze clinical presentation, diagnosis, treatment options, and outcome of pancreatic schwannoma. Methods A retrospective study of clinical data of a case in our hospital and 71 cases reported in literature with pancreatic schwannoma. Results 72 cases were analysed. The mean age was 54 years (range 17-89 years), with 56 % of patients being female. Mean tumor size was 6.1 cm (range 1-20 cm). Tumor location was the head (29 cases), body and tail (32 cases), and uncinate process (6 cases). 27 cases exhibited solid tumors and 28 cases exhibited cystic tumors. Treatment included pancreaticoduodenectomy (23 cases), distal pancreatectomy (15 cases), enucleation (16 cases). 5 cases (7%) were malignant schwannoma. Tumor size of malignant group was significant larger than benign group (13.8±6.2 cm vs 5.6±4.1 cm,P=0.0004). There was no local recurrence metastasis,or death at the follow-up after operation (range 3-65 months). Conclusion The clinical manifestations of pancreatic schwannoma are lack of specificity and preoperative diagnosis remains difficulty. The tumor size was significantly related to classification of malignant or benign. Pancreatic schwannoma has satisfactory prognosis with surgical treatment.

目的 探讨重症急性胰腺炎诊治特点。方法 回顾性分析13例重症急性胰腺炎患者临床资料,包括一般资料、生化检测及影像资料、治疗措施与预后结果,纳入标准为急性胰腺炎合并器官衰竭＞48 h(改良Marshall评分≥2分)。结果 重症急性胰腺炎患者一般资料中普遍突出存在心率增快(121.07±28.09)次/分、APACHE II评分偏高(18.92±7.34),病因排序则是高脂血症(38.5%)＞胆石症(30.8%)＞酒精性(23.1%),SAP合并ARDS发生率可达46.2%,合并AKI则高达69.2%;WBC(12.60±5.57)×10⁹/L、CRP(138.16±67.06)mg/L及PCT(15.76±27.33)ng/L等炎症指标升高提示SAP普遍存在炎症反应,影像学中69.2%患者合并发生肺炎及腹腔积液则提示多处感染部位,其他脏器指标异常升高也提示SAP患者心肺肝肾均存在不同程度的受损;接受CRRT治疗及呼吸支持可分别达46.2%及76.9%,7天内死亡例数为1例(7.7%),28天内死亡例数为4例(30.8%),ICU及总住院时间为(10.77±7.38)及(19.61±13.40)天。结论 重症急性胰腺炎是全身及局部性的炎症反应累及全身各个脏器的急性复杂病变,以合并发生ARDS及AKI为临床特征,需要多器官功能保护与替代、外科干预等多学科综合协作治疗。

Objective To evaluate characteristics of diagnosis and treatment on severe acute pancreatitis. Methods To respective analysis clinical data of 13 patients with severe acute pancreatitis. The data included baseline characteristics, biochemical tests and imaging data, treatment and prognosis, inclusion criteria for acute pancreatitis with organ failure > 48 h (modified Marshall score > 2). Results Higher heart rate(121.07±28.09) times/min and APACHEII scores(18.92±7.34) were universally found in SAP, which primary disease contained hyperlipidemia (38.5%) > cholelith disease (30.8%) > alcohol (23.1%) with incidence of ARDS and AKI being 46.2% and 69.2%; Higher inflammatory biomarkers including WBC(12.60±5.57)×10⁹/L, CRP(138.16±67.06)mg/L and PCT(15.76±27.33)ng/L indicated widespread inflammation with many infection sites revealing by 69.2% pneumonia and peritoneal effusion on imaging; Other abnormally biochemical index prompted some injury of viscera including heart, lungs, kidney and liver; 1 case suffered death within 7 days and 4 cases also did within 28 days, ICU and total length of hospital stay was (10.77±7.38) and (19.61±13.40) days, CRRT treatment and respiratory support respectively reached 46.2% and 46.2%. Conclusion Severe acute pancreatitis is a acute complex pathological changes on various organs induced by acute systemic and local inflammation with feature of mergence with the ARDS and AKI, which need the multidisciplinary integrated collaborative treatment on organ function protection and sustain and surgical intervention.

目的 观察康复路径在髋关节置换术后的临床应用效果,探讨其临床应用价值 。方法 将广州市第一人民医院2014年10月—2015年10月收治行髋关节置换术患者100例为研究对象,随机分为对照组与观察组各50例。对照组采取常规围手术期护理,观察组按照康复路径护理,比较两组患者术后并发症、住院时间、费用、患肢功能以及日常生活自理能力。结果 观察组住院时间和住院费用均少于对照组(P<0.01);两组术后并发症发生率、患肢功能评分及日常生活自理能力比较,差异均有统计学意义(P<0.01 )。结论 康复计划护理用于髋关节置换术后效果显著,可明显降低患者术后并发症,缩短住院时间,降低住院费用,有利于促进患者术后功能以及自理能力的恢复。

Objective To observe the effect of clinical application of rehabilitation in the path of a hip replacement, and to explore its clinical application value. Methods October 2014 to October 2015 in Guangzhou First People's Hospitalhip arthroplasty cases werecollected of 100 patients as the research object, randomly divided into control group and observation group with 50 cases in each group. The control group adopted conventional perioperation period nursing care, observation group in accordance with the recovery paths. We compared two groups of patients complications, hospitalization time, expense, limb function and activities of daily living. Results In the observation group, the hospitalization time and cost of hospitalization were significantly less than that of the control group (P<0.01); The incidence of limb function score, ability of daily living and postoperative complications were compared between the two groups, the differences were statistically significant (P<0.01). Conclusion Rehabilitation nursing care plans for after hip replacement effect is significant. It can significantly reduce the postoperative complications, shorten the time of hospitalization, reduce hospitalization expenses, and is beneficial to the recovery of the function of promoting postoperative and self-care ability.

目的 探究孕妇血清PAPP-A、IR与妊娠期糖尿病的临床相关性。方法 以我院2013年4月—2014年4月期间收治的160例妊娠期糖尿病孕妇作为观察组,以同期收治的妊娠期正常孕妇作为对照组。对比分析两组孕妇血清PAPP-A含量与IR计算值差异。结果 观察组孕妇血清PAPP-A水平低于对照组,而IR计算值明显高于对照组,差异有统计学意义(P<0.05)。结论 孕妇血清PAPP-A与IR水平与妊娠期糖尿病相关性显著,妊娠期糖尿病患者血清PAPP-A明显降低,而IR则明显增加,可为临床诊断提供参考依据。

Objective To explore the clinical relevance of the pregnant women serum PAPP -a, IR and gestational diabetes. Methods The 160 cases of gestational diabetes mellitus were treated in our hospital from April 2013 to April 2014 as the observation group, and the normal pregnant women were treated as the control group. The differences of serum PAPP-A levels and IR values in the two groups were compared and analyzed. Results The serum PAPP-A level of the observation group was significantly lower than that of the control group, while the IR value was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion The level of serum PAPP-A and IR in pregnant women is significantly related to the gestational diabetes mellitus. The serum PAPP-A of the patients with gestational diabetes is significantly decreased, while the IR is significantly increased, which can provide reference for clinical diagnosis.

目的 探讨双歧三联活菌联合补中益气丸治疗腹腔镜胆囊切除术后腹泻患者的临床疗效及安全性。方法 将2014年3月—2015年3月我院收治的68例腹腔镜胆囊切除术后腹泻患者随机分成观察组和对照组(每组34例),观察组患者给予双歧三联活菌联合补中益气丸治疗,对照组患者给予双歧三联活菌治疗,比较两组患者治疗前后的临床症状积分,总体临床疗效以及不良反应。结果 治疗4周后,观察组和对照组患者大便次数、大便性状积分和腹痛/腹部不适积分均明显低于治疗前(P＜0.05),同时观察组患者大便次数、大便性状积分和腹痛/腹部不适积分低于对照组患者(P＜0.05);观察组和对照组患者临床症状总积分均低于治疗前(P＜0.05),且观察组患者临床症状总积分低于对照组患者(P＜0.05);观察组患者临床疗效总有效率(91.2%)高于对照组患者临床疗效总有效率为(70.6%)(P=0.03);观察组和对照组患者治疗期间均未出现明显药物不良反应。结论 双歧三联活菌联合补中益气丸治疗腹腔镜胆囊切除术后腹泻能明显改善患者的临床症状,总体疗效较好,不良反应率较低,值得在临床上推广应用。

Objective To investigate the clinical efficacy and safety of bifid triple viable combined with buzhongyiqi pills in treatment of patients with diarrhea after Laparoscopic cholecystectomy. Methods 68 patients with diarrhea after Laparoscopic cholecystectomy in our hospital between March 2014 and March 2015 were randomly divided into observation group and control group with each 34 cases. The patients in observation group were given bifid triple viable and Buzhongyiqi pills therapy and the patients in control group were given bifid triple viable therapy. The clinical symptoms, clinical efficacy and adverse reactions were observed before and after treatment and were compared between two groups. Results After 4 weeks of treatment, the frequency of excrement, scores of excrement consistency and scores of abdominal pain and abdominal unwell in the observation group and the control group were significantly lower than those in relevant groups before treatment (P<0.05) and the frequency of excrement, scores of excrement consistency and scores of abdominal pain and abdominal unwell in observation group were significantly lower than that in the control group (P<0.05). The aggregate score of clinical symptoms in observation group and control group were both significantly lower than that in each group before treatment (P<0.05), and the aggregate score of clinical symptoms in observation group patients was significantly lower than that in the control group patients (P<0.05). The total clinical effective rate in observation group(91.2%)was significantly higher than that in control group(70.6%)(P=0.03). There were no adverse drug reactions in the observation group and the control group during treatment period. Conclusion Bifid triple viable combined with Buzhongyiqi pills in treatment of patients with diarrhea after laparoscopic cholecystectomy could significantly improve clinical symptoms and get good overall effect, which is worthy of clinical application.