目的 调查临床护士对新型冠状病毒肺炎的知信行现状,为制定相关培训策略提供依据。方法 采用便利抽样法,2020年3月选取我院的1 007名临床护士作为研究对象,采用一般资料及临床护士对新型冠状病毒肺炎知信行问卷对其进行调查。结果 1 007名临床护士对新型冠状病毒肺炎的知识、态度、行为得分分别为(28.82±9.22)分、(52.04±5.52)分、(55.38±7.93)分,新型冠状病毒肺炎知信行总分为(136.24±14.52)分。不同年龄、职称、职务、工作年限、何时参加过穿脱防护服操作培训及考核新型冠状病毒肺炎知识得分比较,差异均有统计学意义(P<0.05);工作年限、何时参加过穿脱防护服操作培训及考核,其新型冠状病毒肺炎态度得分比较,差异均有统计学意义(P<0.05);是否参加过穿脱防护服操作的培训及考核、何时参加过穿脱防护服操作培训及考核、是否参加过咽拭子采集的培训及考核的新型冠状病毒肺炎行为得分比较,差异均有统计学意义(P<0.05)。结论 临床护士对新型冠状病毒肺炎的知识得分处于较低水平,态度和行为得分较好,建议护理管理者需加强临床护士对新型冠状病毒肺炎的知识学习及相关培训,以提高护士知识及技能水平。

Objective To investigate the current status of nurses' knowledge, attitude and behavior to new coronavirus pneumonia, to provide the basis for formulating relevant training strategies. Methods In March 2020, 1 007 clinical nurses in our hospital were selected as the research object. The general information and questionnaire about the new coronavirus pneumonia were investigated in these nurses. Results Scores of 1 007 nurses answered the knowledge, attitude and behavior to new coronavirus pneumonia were(28.82±9.22),(52.04±5.52), and(55.38±7.93), respectively. The total score of knowledge, attitude, and behavior to the new coronavirus pneumonia was(136.24±14.52). The differences of scores of knowledge about new coronavirus pneumonia between different ages, job titles, duties, working years, and when they participated in the training and evaluation of wearing and taking off protective clothing were statistically significant (P<0.05). There was a statistically significant difference in the attitude scores of the new coronavirus pneumonia between different working years and when they participated in training and evaluation of wearing protective clothing (P<0.05). There were statistically significant differences in the behavior scores to new coronavirus pneumonia between whether and when they have participated in the training and evaluation of wearing and taking off protective clothing, and whether they had participated in the training and evaluation of pharyngeal swab collection (P<0.05). Conclusion Nurses' knowledge scores for new coronavirus pneumonia are at a low level, but their attitude and behavior scores are higher. It is recommended that new coronavirus pneumonia knowledge and related training should be strengthened for nurses to improve nurses' knowledge and skills.

目的 乳腺癌是世界范围内最常见的恶性肿瘤之一。目前,人们对乳腺癌的发病机制进行了大量的研究,但对其分子机制的认识尚不清楚。本研究采用生物信息学技术,筛选乳腺癌潜在的关键基因,最终为乳腺癌的诊断、治疗及预后判断提供潜在的生物标记物。方法 从基因表达综合数据库(GEO)下载基因芯片GSE36295、GSE71053和GSE86374,通过GEO2R鉴定差异表达基因(DEGs),并进行功能富集分析。利用STRING构建了蛋白质-蛋白质相互作用网络(PPI),并采用Cytoscape进行了模块分析。结果 共鉴定出95个DEGs,包括62个上调基因和33个下调基因。共鉴定出10个Hub基因:CENPF、KIF2C、TOP2A、NUSAP1、HMMR、MELK、KIF4A、ASPM、CEP55、CCNB1。结论 本研究发现的Hub基因可能对乳腺癌的发展和预后存在一定影响,为乳腺癌的诊断和治疗提供候选靶点。

Objective Breast cancer is one of the most common cancers worldwide. At present, a lot of researches have been carried out on the pathogenesis of breast cancer, but the molecular mechanisms of breast cancer are still not well understood. In this study, bioinformatics technology was used to screen the potential key genes of breast cancer, and ultimately to provide potential biomarkers for the diagnosis, treatment and prognosis of breast cancer. Methods The microarray datasets GSE36295、GSE71053和GSE86374 were downloaded from Gene Expression Omnibus (GEO), and the differentially expressed genes (DEGs) were identified by GEO2R, and the enriched functions and pathways of the DEGs were analyzed. Protein-protein interaction network (PPI) was constructed by using String, and the module analysis was performed using Cytoscape. Results A total of 95 DEGs were identified, consisting of 62 upregulated genes and 33 downregulated genes.Ten hub genes were identified: CENPF,KIF2C,TOP2A,NUSAP1,HMMR,MELK,KIF4A,ASPM,CEP55,CCNB1. Conclusion The hub gene was found in this study may be involved in the development and prognosis of breast cancer. It may provide candidate targets for diagnosis and treatment of breast cancer.

目的 分析广州市某精神病院住院病人精神药物用药的情况变化,为该类药物药费控制、合理应用和科学管理提供参考。方法 统计2015年7月15日—2019年7月14日精神药物的销售金额、用药频度、日用药金额并进行分析。结果 该院4类精神药物共40种,抗精神病药销售金额先升后降,DDDs小幅度增加,非典型抗精神病药销售金额占97%以上,DDDs占87%以上;抗抑郁药销售金额和DDDs逐年增长,新型抗抑郁药占99%以上;抗焦虑药销售金额先升后降;心境稳定药销售金额先升后降,DDDs小幅度减少;65%精神药品排序比趋近1;62%精神药品DDDc下降;取消加成后,销售总金额减少,DDDs总和却增加。结论 取消药品加成对抗精神病药影响较大,对抗抑郁药、抗焦虑药以及心境稳定药影响较小;药品零加成可明显减轻患者经济负担,促进用药合理化。

Objective To analyze the changes in the use of psychotropic drugs by inpatients in a psychiatric hospital in Guangzhou, and to provide reference for the control, rational application and scientific management of the drugs. Methods The sales amount, frequency of use, and daily use of psychotropic drugs from July 15, 2015 to July 14, 2019 were counted and analyzed. Results There were a total of 40 kinds of psychotropic drugs of 4 types in this hospital. In the past 4 years, the sales of antipsychotic drugs increased first and then decreased, and DDDs increased slightly. The sales amount of atypical antipsychotic drugs accounted for more than 97% of the total drug cost, and DDDs accounted for more than 87%. The sales amount of antidepressants DDDs were increasing year by year, and new generation antidepressants account for more than 99% of the antidepressants. The sales of anti-anxiety drugs increased first and then decreased. The sales of mood stabilizer increased first and then decreased, and DDDs decreased slightly. 65% of psychotropic drug's rank closes to 1. DDDc in 62% of the psychotropic drugs decreased; after abolishing additional cost of drugs, the total sales amount decreased, but the total DDDs increased. Conclusion Abolishing additional cost of drugs had a greater impact on antipsychotic drugs, but little effect for antidepressants, anxiolytics, and mood stabilizers, which may greatly reduces patient's drug cost and promote rational use of drugs.

目的 探讨健康儿童的个体因素对超声测量下腔静脉内径的影响。方法 使用超声测量210例健康儿童的下腔静脉呼气末内径及腹主动脉内径,并记录他们的个体特征,包括性别、年龄、身高、体质量、腰围、体表面积等,进行相关与回归分析。结果 年龄、身高、体质量、腰围、体表面积与下腔静脉和腹主动脉内径呈正相关。年龄是女性儿童下腔静脉内径唯一的独立影响因素,身高是男性儿童下腔静脉内径唯一的独立影响因素。无论男性或女性,年龄是儿童腹主动脉内径的独立影响因素,而下腔静脉和腹主动脉内径的比值不受这些个体因素的影响。结论 下腔静脉和腹主动脉内径易受个体因素影响,而它们的比值不易受个体因素影响,可以更好的用于预测儿童的容量特征。

Objective To explore the impact of individual characteristics on inferior vena cava diameter ( IVC ) in healthy children. Methods IVC_max and abdominal aorta (AO) diameters were measured by ultrasound in 210 healthy children. The individual characteristics including gender, age,height,weight, waist circumference of each child were recorded. Then the surface area(BSA) and IVC_max/AO were calculated to discuss the relationship between them with multivariate analysis. Results Age, height, weight,waist circumference, and BSA were positively correlated with IVC_max and AO. Multivariate linear regression showed that age was the only independent variable for IVC_max in female children, height was the only independent variable for IVC_max in male children, and age was the only independent variable for AO in both females and males. IVC_max/AO was not significantly influenced by the subjects' characteristics. Conclusion IVC_max and AO were more susceptible to subjects' characteristics than IVC_max/AO. IVC_max/AO could be a reliable and practical parameter in children as it was independent of age, height, and weight.

目的 分析晚期三阴性乳腺癌(TNBC)的危险因素并建立有效的预后列线图。方法 通过检索美国SEER(surveillance, epidemiology, and end results)数据库筛选晚期TNBC患者,采用单因素和多因素分析来确定晚期TNBC的独立预后因素,并以此构建了列线图,通过校准曲线检验和C指数(C-index)评估已建立的列线图。结果 共纳入4 687例晚期TNBC患者,与同期其他分子分型的乳腺癌相比较,TNBC的预后最差。单因素分析发现,年龄、性别、分期、手术、化疗、放疗、转移与更好的预后相关(P<0.05)。多因素分析发现年龄、性别、种族、分期、手术、化疗、放疗、各器官转移是患者预后的独立影响因素(P<0.05),并以此构建了列线图,其C-index为0.75(95％CI,0.71～0.79),校准图显示了预测的总生存期(OS)与观察到的OS之间的最佳一致性。结论 我们分析了晚期TNBC的临床特征,为TNBC患者的OS提供了一些预后因素,并根据这些预后因素制定了列线图,帮助临床医生进行风险管理并选择TNBC患者的长期生存策略。

Objective To analyze the risk factors of advanced triple-negative breast cancer (TNBC) and establish an effective prognostic nomogram. Methods Screening patients with advanced TNBC by searching the SEER (surveillance, epidemiology, and end results) database, using univariate and multivariate analysis to determine the independent prognostic factors of advanced TNBC, and constructing a nomogram based on it. Results A total of 4 687 patients with advanced TNBC were included. Compared with other types of breast cancer over the same period, TNBC had the worst prognosis. Univariate analysis found that age, gender, stage, surgery, chemotherapy, radiotherapy, and metastasis were associated with a better prognosis (P<0.05). Multivariate analysis found that age, gender, race, stage, surgery, chemotherapy, radiotherapy, and metastasis of the organs were independent factors affecting the prognosis of patients (P<0.05), and constructed a nomogram with a C-index of 0.75 ( 95% CI, 0.71～0.79). The calibration chart showed the best agreement between the predicted overall survival (OS) and the observed OS. Conclusion We analyzed the clinical features of advanced TNBC, provided some prognostic factors for the OS of TNBC patients, and developed a nomogram based on these prognostic factors to help clinicians manage risk and choose long-term survival strategies for TNBC patients.

目的 探究宫腔镜结合避孕药治疗子宫内膜息肉的临床疗效与对其安全性的分析。方法 随机选取2016年2月—2017年12月内160例子宫内膜息肉患者,分为对照组(80例,宫腔镜治疗)和观察组(80例,宫腔镜结合屈螺酮炔雌醇片治疗),对比两组临床疗效及不良反应的差异性。结果 与对照组相比,观察组患者月经改善效果更佳,其复发率更低,差异有统计学意义(P＜0.05);在不良反应的对比中,观察组结果与对照组结果相比较,不存在较大差异(P>0.05)。结论 宫腔镜结合避孕药治疗子宫内膜息肉取得了一定的临床疗效,不良反应并不显著,可推广运用。

Objective To explore the clinical efficacy and safety of hysteroscopy combined with contraceptives in the treatment of endometrial polyps. Methods From February 2016 to December 2017, 160 patients with endometrial polyps were randomly selected and divided into control group (80 cases treated by hysteroscopy) and observation group (80 cases treated by hysteroscopy combined with drospirenone and ethinyl estradiol tablets). The differences of clinical efficacy and adverse reactions between the two groups were compared. Results Compared with the control group, the observation group had better menstruation improvement effect and lower recurrence rate. The difference was statistically significant (P<0.05). In the comparison of adverse reactions, there was no significant difference between the observation group and the control group (P>0.05). Conclusion Hysteroscopy combined with contraceptives has achieved certain clinical efficacy in the treatment of endometrial polyps, and the adverse reactions are not significant, which can be popularized and applied.

目的 对我院静脉用药调配中心2017年1月—2019年12月期间的不合理医嘱情况进行汇总及分析,以提高合理用药水平。方法 收集2017年1月—2019年12月广州市第一人民医院静脉用药调配中心的不合理医嘱资料进行回顾性分析,归纳不合理医嘱类型、汇总分析不合理医嘱表现以及改正不合理情况。结果 主要不合理医嘱类型包括溶媒选择错误、溶媒量过多或过少、药物剂量不合理、药物配伍禁忌、其他(用药频次错误、药物选择错误、重复用药等)。结论 根据不合理医嘱情况的汇总分析,及时与临床科室沟通改正,保证合理用药。

Objective To summarize and analyze their rational prescriptions in pharmacy intravenous admixture services(PIVAS)of our hospital from January 2017 to December 2019,so as to improve the level of rational drug use. Methods The data of irrational prescriptions from January 2017 to December 2019 in the pharmacy intravenous admixture services of Guangzhou First People's Hospital were collected for retrospective analysis, and the types of irrational prescriptions were summarized, the performance of irrational prescriptions was analyzed and the irrational situation was corrected. Results The main types of irrational prescriptions include incorrect selection of solvent, improper consumption of solvent, improper drug dosage, incompatibility and others(improper frequency of administration, incorrect selection of drug, repeated administration, etc.). Conclusion According to the summary and analysis of irrational prescriptions, we timely communicate with clinical departments and ensure rational drug use.

目的 通过血常规分析和C反应蛋白(CRP)水平检测,探讨其对儿童甲型和乙型流感的辅助诊断价值,为临床治疗提供参考依据。方法 选择3 069名甲型流感患儿、2 307名乙型流感患儿、855名健康儿童,统计分析血常规参数以及CRP水平。采用ROC曲线分析血常规对甲乙型流感的区分效能。结果 甲组白细胞计数(WBC)均值高于正常组,乙组则相反,甲乙组中性粒细胞百分比(Neut%)、中性粒细胞与淋巴细胞百分比比值(NLR)、单核细胞百分比(Mono%)的均值高于正常组,甲乙组淋巴细胞百分比(Lymph%)、血小板计数(PLT)的均值低于正常组。甲组中性粒细胞计数(Neut#)、单核细胞计数(Mono#)、CRP、PLT的均值均高于乙组,Lymph%和淋巴细胞计数(Lymph#)的均值低于乙组。甲组在WBC>13×10⁹/L、Neut%>70.7、Lymph%<19.1的构成比高于乙组。NLR预测甲型流感临界值为2.08(敏感度为75.9%,特异度为89.4%),预测乙型流感临界值为2.11(敏感度为50.5%,特异度为89.8%)。结论 血常规参数和CRP水平变化可用于判断流感患儿是否存在细菌感染,指导临床用药;NLR作为一种新型预测标志物,其变化可以对区分甲型、乙型流感,尤其是甲型流感具有临床价值。

Objective Through blood analysis and C-reactive protein (CRP) level detection, to explore its value in the auxiliary diagnosis of influenza A and B in children, and to provide reference for clinical treatment. Methods 3 069 children with influenza A, 2 307 children with influenza B, and 855 healthy children were selected, and blood routine parameters and CRP levels were statistically analyzed. The ROC curve was used to analyze the discriminatory efficacy of blood routine on influenza A and B. Results The mean value of white blood cell count (WBC) in group A was higher than that in normal group, but in group B it had the opposite result. The percentage of neutrophils (Neut%), the ratio of neutrophils to lymphocytes (NLR), and the percentage of monocytes (the mean value of Mono%) is higher than that of normal group, and the mean value of lymphocyte percentage (Lymph%) and platelet count (PLT) of group A and B is lower than that of normal group. The mean values of neutrophil count (Neut#), monocyte count (Mono#), CRP and PLT in group A were higher than those in group B, and the mean values of Lymph% and lymphocyte count (Lymph#) were lower than those in group B. The composition ratios of group A in WBC>13×10⁹/L, Neut%>70.7, Lymph%<19.1 were higher than that in group B. The NLR predicted the critical value of influenza A was 2.08 (sensitivity 75.9%, specificity 89.4%), and the predicted influenza B threshold value was 2.11 (sensitivity 50.5%, specificity 89.8%). Conclusion Changes in blood routine parameters and CRP levels can be used to determine whether there is a bacterial infection in children with influenza and to guide clinical medication; NLR as a new predictive marker, its changes can distinguish influenza A or B. Especially in influenza A determination, it has clinical value.

目的 观察椎间孔镜下腰椎间盘突出症的近期疗效,分析不同年龄段对手术疗效的影响。方法 收集120例腰椎间盘突出患者,分成A、B、C三个研究小组:A青年组(年龄≤44岁)、B中年组(44岁<年龄<65岁)、C老年组(年龄≥65岁)。以术前、术后1天、术后3月、术后6月为界限,分析患者的疼痛视觉模拟量表(VAS)评分,并计算相对应的腰椎Oswestry功能障碍指数;术后1年用改良Macnab标准评价疗效优良率。结果 针对不同试验小组的VAS评分、ODI指数等进行对比分析:术后1天的对比差异不存在统计学意义(P>0.05);术后3个月、6个月比较差异有统计学意义(P<0.05),其中C组术后3月、6月VAS评分、ODI指数高于A、B组,差异有统计学意义(均P<0.05),A、B组间比较无统计学差异(P>0.05)。术后1年三组间疗效优良率比较无统计学差异(P>0.05)。结论 不同年龄段患者椎间孔镜的近期疗效显著,中青年患者恢复快,中期疗效好。

Objective To observe the short-term curative effect of transforaminal endoscopy for lumbar disc herniation, and to analyze the influence of different age on the curative effect. Methods 120 patients with lumbar disc herniation were collected, the study was divided into three groups: group A, group B and group C: group A (young adults, 44 years or older), group B (44 years or older) and group C (65 years or older). The visual analogue scale (Vas) scores of the patients were analyzed and the corresponding Oswestry index of the lumbar spine was calculated according to the preoperative, 1 day, 3 months and 6 months postoperatively. A modified Macnab was used to evaluate the rate of excellency and good results 1 year after operation. Results The Vas score and Odi index of different groups were compared. There was no statistically difference at 1 day after operation (P > 0.05). After 3 months and 6 months, there was statistically difference (P<0.05), among them, the VAS scores and Odi index of group C were higher than those of group B, the difference was statistically significant (P<0.05), there was no statistically difference between group A and group B (P > 0.05). There was no statistically difference between the three groups in the first year after operation (P > 0.05). Comparison of VAS score and ODI index among the three groups: there was no statistically difference at 1 day after operation (P>0.05); there was statistically difference at 3 months and 6 months after operation (P<0.05), among which VAS score and ODI index of group C were higher than those of group A and group B (all P<0.05), but there was no statistically difference between group A and group B (P>0.05). There was no statistically difference in the excellent and good rate among the three groups one year after operation (P>0.05). Conclusion The short-term curative effect of intervertebral foramina in patients of different ages is remarkable, the young and middle-aged patients recover quickly, and the medium-term curative effect is good.

目的 本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法 检索2000年1月—2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果 9项临床病例对照研究共1 179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P＜0.000 1)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07, P＜0.000 1),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P＜0.000 1),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.000 1),白细胞(WBC) >11×109/L的患者发生肺栓塞的风险是WBC≤11×109/L患者的6.62倍(P＜0.000 1)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02 (P＜0.000 1)和2.30 (P＜0.000 1)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论 肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞＞11×10⁹/L。

Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients. Methods The following databases such as Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Weipu Database, Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020. Statistical analysis was performed using RevMan 5.3 software. Results 9 controlled trials incorporating 1 179 patients were included in this study. The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism (HR=2.82, 95%CI[2.06,3.87], P<0.000 1). The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio (OR)=3.07 (P<0.000 1). Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II (OR=3.07,P<0.000 1). Furthermore, the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients (P<0.000 1), and 6.62 times higher than those with WBC ≤11×10⁹/L (P<0.000 1). Additionally, the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism, with OR of 3.02 (P<0.000 1) and 2.30 (P<0.000 1), respectively. However, smoking, alcohol consumption, gender, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease, hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients. Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer, and the related risk factors were pathological type, stage, chemotherapy, central venous catheterization, increased D-dimer level, and WBC>11×10⁹/L.