目的 探讨甲状腺乳头状癌患者在严重短期甲减的状态下甲状腺功能及相关因素对血脂水平的影响。方法 纳入61例通过病理确诊为甲状腺乳头状癌的患者,采集所有患者在手术前与碘治疗前的甲状腺功能水平与血脂水平等资料,比较患者不同性别、年龄、术式、淋巴结转移情况等相关因素对血脂的影响。结果 碘治疗前的全部血脂指标均高于手术前的基线水平;在促甲状腺激素 (TSH)>60 mIU/L组中的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(APO-A1)、载脂蛋白B(APO-B)、脂蛋白(LP)水平明显高于TSH≤60 mIU/L组;女性患者的甘油三酯(TG)、动脉硬化指数(AI)水平明显低于男性患者,男性组的HDL-C、APO-A1水平低于女性组,年龄>45岁的患者TC水平高于年龄≤45岁的患者,差异均有统计学意义(P均＜0.05);不同术式及淋巴结转移分组间的血脂水平未见明显差异(P＞0.05);TC水平与游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺素(T4)水平呈负相关(r分别为-0.342、-0.370、-0.340),HDL-C、LDL-C及APO-B水平与T4水平呈负相关(r分别为-0.294、-0.354、-0.324),APO-A1水平与FT4、三碘甲状腺原氨酸(T3)、T4水平呈负相关(r分别为-0.306、-0.262、-0.263),LPa水平与T3、T4水平呈负相关(r分别为-0.268、-0.313)。结论 甲状腺乳头状癌碘治疗前短期甲减可以导致全套血脂指标升高,在此甲减状态下程度越严重的甲减可产生越高的血脂水平,同时男性患者与中老年患者也可伴随更高的血脂水平。

Objectives To investigate the influence of thyroid function and related factors on blood lipid levels in patients with papillary thyroid cancer under short-term severe hypothyroidism. Methods Sixty-one patients with papillary thyroid carcinoma diagnosed by pathology were included. The data of thyroid function and blood lipid levels of all patients before operation and iodine treatment were collected. The effects of gender, age, operation mode, lymph node metastasis and other related factors on blood lipid were compared. Results Before iodine treatment, all blood lipid indexes were higher than the baseline level before operation. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (APO-A1), apolipoprotein B (APO-B), lipoproteins (LP) in the thyroid stimulating hormone (TSH)>60 mIU/L group were significantly higher than those in the TSH≤60 mIU/L group.Triglyceride (TG) and arteriosclerosis index (AI) levels were significantly lower in female patients compared with male patients, HDL-C and APO-A1 levels were lower in male patients compared with female patients, and TC levels were higher in patients aged>45 compared with those aged≤45, with significant differences (all P<0.05). No significant differences were observed in lipid levels among the different surgical procedures and lymph node metastasis subgroups (P>0.05). TC levels were negatively correlated with free triiodothyronines (FT3), free thyroxine (FT4), thyroxine (T4) levels (r=-0.342,-0.370,-0.340,respectively). HDL-C, LDL-C, and APO-B levels were negatively correlated with T4 levels (r=-0.294, -0.354, -0.324,respectively), APO-A1 levels were negatively correlated with FT4, triiodothyronine (T3), T4 levels (r=-0.306,-0.262,-0.263,respectively), and LP levels were negatively correlated with T3 and T4 levels (r=-0.268,-0.313, respectively). Conclusions Short term hypothyroidism before iodine treatment for papillary thyroid cancer could lead to the increase of full set of blood lipid indexes, male patients and middle-aged and elderly patients could also be accompanied by higher blood lipid levels.

目的 探讨不同浓度的青藤碱对肾癌细胞增殖、细胞周期及凋亡的影响。方法 以不同浓度的青藤碱处理肾癌细胞786-O,采用四氮唑蓝盐法检测细胞增殖能力,流式细胞术检测细胞周期分布,Annexin-v FITC/PI双染流式细胞分析仪检测细胞凋亡率;采用实时荧光定量PCR及蛋白免疫印迹(WB)检测c-myc、Bax、Caspase-3等细胞周期、凋亡相关基因表达情况。结果 青藤碱显著抑制786-O细胞的增殖能力,诱导细胞周期G1/S期阻滞及细胞凋亡;且随着青藤碱浓度的增加,其抑制率也逐渐增加;青藤碱显著下调c-myc蛋白表达,而诱导凋亡蛋白Bax、Caspase-3表达上调。结论 青藤碱可以显著抑制786-O细胞中c-myc表达,使其增殖能力减弱,诱导细胞周期阻滞及凋亡。青藤碱可能具有潜在的抑制肾癌生长作用。

Objective To investigate the effects of different concentrations of sinomenine on proliferation, cell cycle and apoptosis of renal carcinoma cells. Methods The renal carcinoma cells were treated with different concentrations of sinomenine. MTS was used to analyze the effects of sinomenine on proliferation in 786-O renal carcinoma cells, the cell cycle changes were determined using flow cytometry, while the changes of apoptosis were detected by Annexin V-FITC / PI double staining. The expression of apoptosis-related proteins such as c-myc, Bax and Caspase-3 were detected by Western blot. Results Sinomenine significantly inhibited the proliferation of 786-O cells and induced cell cycle arrest and apoptosis in G1/S phase. With the increase of sinomenine concentration, the inhibition rate increased gradually. Sinomenine significantly down-regulated the expression of c-myc protein, while the expressions of the apoptotic protein Bax, Caspase-3 were up-regulated. Conclusions Sinomenine can significantly inhibit the expression of c-myc in 786-O cells, reduce proliferation ability, and induce cell cycle arrest and apoptosis. Sinomenine may have a potential therapeutic effect on renal cancer.

目的 探讨新冠疫情影响下日间手术制度在乳腺外科住院模式中的应用情况。方法 2021年1月—12月广州市第一人民医院实施日间手术制度,对乳腺外科30张床位实施预约管理,依据患者病情进行日间手术预约,合理安排患者入院。结果 2021年1月—12月我院乳腺外科共入院2 787人/次,手术人数1 497人,其中日间手术720台,占比48.10%。结论 日间手术制度可提升了医院手术服务能力,增加手术量,缩短了平均住院日,为患者提供方便、高效的医疗服务,值得基层医院推广。

目的 探讨在COVID-19流行期间血库资源紧张状态下输血时机对儿童输血效果及临床预后的影响。方法 本回顾性队列研究纳入2020年1月—2020年12月在广州市妇女儿童医疗中心儿科急诊就诊并申请输血的患儿的临床预后。结果 共566例发起红细胞和血小板的非手术输血申请的患儿纳入研究,包括 260 例的红细胞申请和306例血小板申请。260份红细胞申请中:209 例及时输血,40 例延时输血,11 例未输血;及时组和延时组的输血有效率分别为37.8%和35.0%(P=0.737);1名不良预后的死亡病例出现在及时组中,余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.886)。306份血小板申请中:195 例及时输血,108 例延时输血,3例未输血;1名不良预后的死亡病例出现在及时组中(0.51%),3名不良预后的死亡病例出现在延时组中(2.78%),余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.131)。结论 符合红细胞与血小板输血指征的非急诊手术用血的急诊患儿中,及时组、延时组和未输血组之间的临床结局没有差异。输血时机进一步需要大样本的循证研究加以确定。

Objective To investigate the influence of blood transfusion timing on blood transfusion efficacy and clinical prognosis in children under the strain of blood bank resources during COVID-19 pandemic. Methods This retrospective cohort study included clinical outcomes of pediatric emergency patients who applied for blood transfusion in Guangzhou Women and Children's Hospital from January 2020 to December 2020. Results A total of 566 children applicated blood transfusion for red blood cells and platelets for non-emergency surgical use were enrolled, including 260 red blood cells cases and 306 platelets cases. Among the 260 applications for red blood cells, 209 cases received timely transfusion, 40 cases received delayed transfusion, and 11 cases did not receive transfusion.The effective rate of transfusion for red blood cells was 37.8% in the timely group and 35.0% in the delayed group (P=0.737). One death case with poor prognosis was found in the timely transfusion group, and the clinical prognosis of the rest cases was good. There was no statistical difference in the clinical outcomes among the three groups (P=0.886). Among 306 applications for platelet, 195 cases had timely transfusion, 108 cases had delayed transfusion, and 13 cases did not had transfusion.One case with poor prognosis died in the timely transfusion group (0.51%), and three with poor prognosis died in the delayed transfusion group (2.78%). The rest of the cases had good clinical prognosis, and there was no statistical difference in clinical outcomes among the three groups (P=0.131). Conclusions There were no significant differences in clinical outcomes among the timely transfusion group, the delayed transfusion group, and the non-transfusion group for red blood cell and platelet transfusion respectively. The timing of transfusion may need to be determined by evidence-based studies with large samples.

目的 探讨分析胃肠道套细胞淋巴瘤的临床病理学特点分析及预后情况。方法 选取2019年1月—2021年2月间赣州市人民医院收治的50例胃肠道套细胞淋巴瘤患者为观察组,选取本院同期就诊的50例非胃肠道套细胞淋巴瘤患者为对照组。结果 50例胃肠道套细胞淋巴瘤患者的主要临床表现以腹痛为主占比50.00%;好发于回盲部、回肠、升结肠、直肠、乙状结肠,占比依次为54.00%、42.00%、36.00%、36.00%、28.00%;以多发性黏膜息肉样病变40.00%多见,死亡16例(32.00%)。年龄＞60岁、伴有脾脏肿大的胃肠道套细胞淋巴瘤死亡率更高(P<0.05)。观察组患者浅表淋巴结侵犯的比例明显高于对照组(P<0.05)。结论 胃肠道套细胞淋巴瘤主要表现为腹痛等,多发于结直肠,浅表淋巴结侵犯相对更多,以多发性黏膜息肉样病变多见,年龄＞60岁、伴有脾脏肿大的患者预后相对较差。

目的 分析ABCC2基因表达水平与肺腺癌预后之间的关联性,并对其影响机制进行初步探索。 方法 采用TCGA数据库和HPA数据库对肺腺癌病人癌组织和癌旁组织基因表达数据进行差异性分析,单因素及多因素COX回归评估ABCC2与肺腺癌预后之间的关联性,GSEA用于探讨与ABCC2显著关联的信号通路。 结果 ABCC2在肺腺癌肿瘤组织中存在过表达现象,Kaplan-Meier生存分析曲线结果显示ABCC2基因过表达使肺腺癌病人的死亡风险显著升高(HR=1.46,95%CI=1.09~1.95; P=0.010)。单因素及多因素COX回归结果显示ABCC2基因过表达是肺腺癌病人不良预后的独立危险因素。GSEA结果显示ABCC2可能通过调节药物代谢从而对肺腺癌的发展进行调控。 结论 ABCC2基因过表达使肺腺癌病人的死亡风险显著升高,ABCC2可能是肺腺癌不良预后的潜在分子生物标志物。

Objective To estimate the association between ABCC2 mRNA expression and the prognosis of lung adenocarcinoma and explore the potential influencing mechanism.Methods Difference analysis was used to evaluate the gene expression in tumor tissues and adjacent normal tissues based on The Cancer Genome Atlas database and Human Protein Atlas database.Multivariate COX regression and Kaplan-Meier analysis were performed to evaluate the association between ABCC2 gene expression and the prognosis of lung adenocarcinoma.Gene-set enrichment analysis (GSEA) was performed to screen differentially enriched pathways associated with the ABCC2 high expression phenotype.Results ABCC2 was overexpressed in lung adenocarcinoma tumor tissues compared with adjacent normal tissues.Kaplan-Meier survival analysis showed a significant relationship between ABCC2 mRNA expression and lung adenocarcinoma prognosis (HR=1.16,95% CI=1.09-1.95; P=0.010).Univariate and multivariate Cox regression analysis showed that ABCC2 mRNA expression was an independent risk factor affecting the survival of patients with lung adenocarcinoma.The results of GSEA suggested that ABCC2 may influence the development of lung adenocarcinoma by regulating the metabolism of targeted drug the treatment.Conclusions ABCC2 overexpression can significantly increase the risk of death in patients with lung adenocarcinoma,ABCC2 may be a potential molecular marker for poor prognosis in lung adenocarcinoma.

目的 分析基于微信平台步行运动训练对慢性充血性心力衰竭(CHF)患者心脏康复水平的影响。方法 本次研究对象来源于梅州市中医医院一内科2020年11月—2021年12月住院的90例CHF患者,根据随机数字表法分组(每组n=45),对比组给予常规药物治疗,观察组在对比组基础上给予基于微信平台步行运动训练治疗,对比两组临床疗效、心脏功能指标、血清NT-proBNP、D-D、6分钟步行距离、日常生活能力评分、明尼苏达心力衰竭生活质量调查表(MLHFQ)评分。结果 观察组临床总有效率(95.56%)高于对比组(66.67%),观察组治疗后左心室舒张末期内径、左心室收缩末期内径均低于对比组,观察组治疗后左室射血分数高于对比组,观察组治疗后血清NT-proBNP、D-D均低于对比组,观察组治疗后6分钟步行距离、日常生活能力评分均高于对比组,观察组治疗后MLHFQ评分低于对比组,P＜0.05(差异均具有统计学意义)。结论 基于微信平台步行运动训练可有效改善CHF患者心功能,抑制NT-proBNP、D-D高表达,提高日常生活能力、生存质量。

Objective To analyze the effect of walking training through Wechat on cardiac rehabilitation of chronic congestive heart failure (CHF) patients. Methods A total of 90 patients with CHF hospitalized in the First Internal Medicine Department of Meizhou Traditional Chinese Medicine Hospital from November 2020 to December 2021 were enrolled in this study. They were divided into two groups according to the random number table method (45 patients in each group).The control group was given routine drug treatment,and the observation group was given walking training through Wechat on the basis of control group. The clinical efficacy,cardiac function indexes,serum NT-proBNP,D-D levels,6-minute walking distance,ability of daily life (ADL) score and Minnesota Living with Heart Failure Questionnaire (MLHFQ) score were compared between two groups. Results The total clinical effective rate of the observation group (95.56%) was higher than that of the control group (66.67%),the LVEDd and LVESd of the observation group were lower than those of the control group after treatment,the LVEF of the observation group was higher than that of the control group after treatment,the serum NT-proBNP and D-D levels of the observation group were lower than those of the control group after treatment,the 6-minute walking distance and ADL score of the observation group were higher than those of the control group after treatment,and the MLHFQ score of the observation group was lower than that of the control group after treatment,P<0.05 (the difference was statistically significant).Conclusions Walking training by Wechat could effectively improve the cardiac function of CHF patients,inhibit the high expression of NT proBNP and D-D,and improve the ability of daily living and quality of life.

目的 探寻病案首页国际疾病分类(ICD)编码的准确率对按疾病诊断相关分组(DRGs)分值付费影响。方法 整体抽取2019年心血管内科和脊柱关节外科医保病例,分析DRGs分值付费存在的问题,对全院病案首页ICD编码采取相应的干预措施。结果 2019年病案首页ICD编码准确率为81.55%,DRGs分值付费亏损2 812 804.7元,经干预后,2020年病案首页ICD编码准确率为97.13%,DRGs分值付费结余14 089 039.36元。结论 准确、规范的填写病案首页ICD编码,提高病案首页ICD编码的准确率,避免医院在DRGs分值付费模式下出现亏损有重要意义。

Objective To investigate the influence of the front page International Classification of Diseases(ICD) coding accuracy of medical records on diagnosis related groups(DRGs) score payment system.Methods Medical insurance cases of cardiovascular medicine and spine and joint surgery in 2019 were totally selected,the problems of DRGs score payment system were investigated and analyzed,and managements improving the ICD coding on the medical records of discharged patients were carried out.Results In 2019,the accuracy of ICD coding of medical records was 81.55%,and the DRGs score payment system had lost 2 812 804.7 yuan.After improving,in 2020,the ICD coding accuracy achieved 97.13%,and DRGs score payment system had a positive balance of 14 089 039.36 yuan.Conclusions The accuracy and standardization of ICD coding on the medical records is of great significance in avoiding losses on DRGs score payment system.

目的 探究青少年首发抑郁症患者治疗中联合应用艾司西酞普兰与重复经颅磁刺激(rTMS)的总疗效及应用价值。方法 选取东莞市第七人民医院2020年5月—2021年10月80例青少年首发抑郁症患者,参考“数字双盲法”,分为对照组和观察组(各40例)2组,对照组接受伪rTMS+艾司西酞普兰治疗,观察组接受rTMS+艾司西酞普兰治疗。评价指标:临床总疗效、抑郁评分(17项汉密尔顿抑郁量表,HAMD-17)、认知功能评分(威斯康星卡片分类测验,WCST)、生活质量(SF-36评分),不良反应发生率(副反应量表,TESS)。结果 观察组患者总有效率95.00%较对照组80.00%明显高(P＜0.05);且2组不良反应率比较(P＞0.05)。观察组治疗1周、2周、4周HAMD-17评分均较对照组低,同时治疗4周后WCST项目中完成分类评分较对照组更高(P＜0.05)。观察组SF-36(角色、社会、躯体、认知)评分均较对照组高(P＜0.05)。结论 青少年首发抑郁症患者,在艾司西酞普兰用药基础上联合rTMS,可获取更为显著的治疗效果,控制病情进展,减轻抑郁症状,同时对认知功能无影响,促进生活质量大幅度提高,且用药安全性有保障。

Objective To explore the total efficacy and application value of escitalopram combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of adolescent patients with first-episode depression.Methods A total of 80 adolescent patients with first-episode depression in Dongguan Seventh People's Hospital from May 2020 to October 2021 were selected.Referring to the “digital double-blind method”,they were divided into control group and observation group (40 cases each).The control group was treated with pseudo rTMS and escitalopram,and the observation group was treated with rTMS and escitalopram.Evaluation indexes: total clinical efficacy,depression score (17-item Hamilton Depression Scale,HAMD-17),cognitive function score (Wisconsin Card Sorting Test,WCST),quality of life (SF-36 score),adverse reaction rate (Treatment Emergent Symptom Scale,TESS).Results The total effective rate of 95.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05); the incidence of adverse reactions was compared between the two groups (P>0.05).The HAMD-17 scores of the observation group at 1 week,2 weeks and 4 weeks were significantly lower than those of the control group.At the same time,the classification scores of WCST items after 4 weeks of treatment were higher in observation group (P<0.05).The SF-36 (role,society,body and cognition) scores in the observation group were higher than those in the control group (P<0.05).Conclusions Adolescent patients with first-episode depression treated with rTMS on the basis of escitalopram can obtain more significant therapeutic effect,control the progress of the disease,reduce depressive symptoms,have no effect on cognitive function,greatly improve the quality of life,and ensure the safety of medication.

目的 比较2012版和2007版美国睡眠医学会判读标准(AASM₂₀₁₂和AASM₂₀₀₇)对慢性阻塞性肺疾病(COPD)合并阻塞性睡眠呼吸暂停(OSA)的诊断及其睡眠和临床特点的影响。方法 分别采用AASM₂₀₀₇与AASM₂₀₁₂分析41名稳定期COPD患者的睡眠呼吸事件,比较两种判读标准对COPD患者的呼吸暂停低通气指数(AHI),合并OSA的比例的影响;再对符合AASM₂₀₁₂但不符合AASM₂₀₀₇诊断的重叠综合征患者(OS_2012-2007)与仅符合AASM₂₀₀₇诊断的COPD患者(COPD_AASM2007)的睡眠参数和临床指标进行比较。结果 对比AASM₂₀₀₇,AASM₂₀₁₂显著增加COPD的睡眠呼吸暂停低通气指数(AHI)[1.0 (1.0, 7.5) h^-1 vs 11.5 (4.1, 25.1) h^-1, P<0.001],及合并OSA的比例(36.6% vs 70.7%, P<0.05)。OS_2012-2007与COPD_AASM20072组之间的微觉醒指数与3期睡眠比例有统计学差异,但其他睡眠参数、血压及高血压患病人数均无明显差异。结论 AASM₂₀₁₂显著增加COPD患者AHI,及合并OSA的比例,但初步的结果提示 AASM₂₀₁₂下新增的OS_2012-2007患者的病理损害相对少且轻。

Objective To compare the effects of the 2012 and 2007 American Academy of Sleep Medicine (AASM₂₀₁₂ and AASM₂₀₀₇) scoring criteria on the diagnosis, sleep and clinical characteristics of chronic obstructive pulmonary disease (COPD) with obstructive sleep apnea (OSA). Methods AASM₂₀₀₇ and AASM₂₀₁₂ were used to analyze the sleep respiratory events of 41 patients with stable COPD. Differences in apnea-hypopnea index (AHI) and diagnosis of OSA in COPD patients between AASM₂₀₀₇ and AASM₂₀₁₂ criteria were compared. Differences in sleep parameters and clinical indexes were compared between patients with overlap syndrome who met the AASM₂₀₁₂ not AASM₂₀₀₇ criteria (OS_2012-2007) and COPD patients who only met the AASM₂₀₀₇ criteria (COPD_AASM2007). Results Using the AASM₂₀₁₂ criteria, the number of AHI [1.0 (1.0, 7.5) h^-1 vs 11.5 (4.1, 25.1) h^-1, P<0.001] and the proportion complicated with OSA (36.6% vs 70.7%, P<0.05) significantly increased compared to the AASM₂₀₀₇ criteria. There was a significant difference between OS_2012-2007 and COPD_AASM2007 in arousal index and third stage of sleep, but no significant difference in other sleep parameters, blood pressure and the number of patients with hypertension. Conclusions Using AASM₂₀₁₂ significantly increased AHI and the proportion complicated with OSA in COPD patients, but the preliminary results demonstrated that pathological damages of OS_2012-2007 were relatively mild.