目的 分析接受永久性膀胱造瘘男性患者相关尿标本病原菌学分布特点及耐药性,进一步为药物防治导管伴随性尿路感染提供科学依据。方法 回顾性分析2019年1月—2021年8月我院收治的368例接受永久性膀胱造瘘男性患者尿标本病原菌分离培养结果,观察其病原菌构成和分布特征,进一步分析相关耐药性。结果 (1)本组接受永久性膀胱造瘘男性患者共368例,尿培养阳性316例,阳性率85.87%(316/368);共分离出病原菌112株,分离率30.43%(112/368),其中革兰阴性菌80株,占71.43%(80/112),以大肠埃希菌、铜绿假单胞菌为主;革兰阳性菌31株,占27.68%(31/112),以表皮葡萄球菌、粪肠球菌为主;真菌1株,占0.89%(1/112)。(2)大肠埃希菌对氨苄西林耐药率66.67%、哌拉西林64.71%、头孢曲松60.78%、头孢他啶60.78%、环丙沙星62.75%,对青霉素耐药率较低,仅为5.88%,对亚胺培南和美罗培南的耐药性为0。铜绿假单胞菌对氨苄西林、头孢噻肟完全耐药,耐药率高达100.00%;对头孢曲松83.33%、哌拉西林72.20%、头孢他啶72.22%;对庆大霉素的耐药率较低,仅为16.67%,对亚胺培南、美罗培南无耐药性。(3)表皮葡萄球菌对氨苄西林耐药性和青霉素的耐药性均为100.00%;对哌拉西林、头孢曲松、头孢噻肟耐药率＞60%;对磺胺甲噁唑／甲氧苄啶的耐药率较低,仅为12.50%,对万古霉素无耐药性。粪肠球菌对庆大霉素完全耐药,耐药率为100.00%;对头孢曲松、环丙沙星、左氧氟沙星、红霉素的耐药率＞60.00%;对头孢他啶的耐药性较低,耐药率仅为25.00%,对青霉素、万古霉素无耐药性。结论 永久性膀胱造瘘患者病原菌主要是大肠埃希菌、铜绿假单胞菌等革兰阴性菌,革兰阳性菌以表皮葡萄球菌为主,对于不同抗菌药物的耐药性差异较大。

目的 观察龙氏正骨手法配合浮针临床上治疗颈源性头痛的疗效。方法 将本院80例颈源性头痛患者按1:1随机分为观察组和对照组,观察组采用龙氏正骨手法配合浮针治疗,对照组采用龙氏正骨手法治疗,于1疗程后比较2组临床疗效、疼痛视觉模拟评分(VAS)和颈椎活动度评分(ROM)情况。结果 治疗后两组VAS较治疗前均有改善(P<0.05),观察组较对照组明显(P<0.05)。2组ROM较治疗前均有改善(P<0.05),组间差异无统计学意义(P>0.05)。治疗组的愈显率高于对照组(P<0.05)。结论 龙氏正骨手法配合浮针治疗颈源性头痛能更好地减轻疼痛程度,方便高效。

Objective To observe the clinical effect of Long's bone-setting manipulation combined with floating acupuncture therapy on cervicogenic headache. Methods A total of 80 patients with cervicogenic headache in our hospital were randomly divided into observation group and control group evenly. The observation group was treated with Long's bone-setting manipulation combined with floating acupuncture therapy, and the control group was treated with Long's bone-setting manipulation only. After one course of treatment, the clinical efficacy,pain visual analogue score (VAS) and cervical joint range of motion (ROM) in the two groups were compared. Results After treatment, the VAS of the two groups was improved compared with that before treatment (P<0.05), and the VAS of the observation group was significantly higher than that of the control group (P<0.05). ROM in the two groups was improved compared with that before treatment (P<0.05), and there was no significant difference between the two groups (P>0.05). The effective rate of the treatment group was higher than that of the control group (P<0.05). Conclusions Long's bone-setting manipulation combined with floating acupuncture therapy in the treatment of cervicogenic headache can better reduce the degree of pain, which is convenient and efficient.

目的 分析中枢神经系统孤立性纤维瘤(SFT)11例患者的临床特点、影像学及病理学表现、手术结果。方法 回顾性分析2013年—2021年于广州医科大学附属第二医院神经外科接受手术并经病理检查证实为中枢神经系统SFT的11例患者的临床资料。结果 11例患者主要症状为头晕、头痛或肢体乏力。MRI:病灶主要表现为T1WI等-低信号,T2WI混杂信号或等-稍高信号。病理组织学:镜下表现为疏密不一的梭形肿瘤细胞呈交替排列。免疫组化:肿瘤细胞主要表现为STAT6阳性、CD34阳性等特点。病灶全切除患者预后较好,病灶次全切除或既往有SFT复发病史患者容易再次复发。结论 中枢神经系统SFT患者MRI T2WI信号有助于诊断,但是最终诊断依靠病理学检查。手术切除是首选的治疗方式。

Objective To analyze the clinical features,radiological and pathological manifestations and surgical results of 11 patients with solitary fibrous tumors (SFT) of the central nervous system (CNS). Methods The clinical data of 11 patients with SFT of CNS confirmed by pathological examination in the Neurosurgery Department of the Second Affiliated Hospital of Guangzhou Medical University from 2013 to 2021 were retrospectively analyzed. Results The main symptoms of 11 patients were dizziness,headache or extremity weakness. MRI: the lesions mainly showed iso-low signal on T1WI,mixed signal or iso-slightly high signal on T2WI. Histopathological features: microscopically,there were alternating rows of spindle tumor cells with irregular density. Immunohistochemistry showed that the tumor cells were STAT6 positive,CD34 positive,etc. Patients with total resection of the lesion had a better prognosis. Patients with subtotal resection of the lesion or previous history of SFT relapse were prone to relapse. Conclusions MRI T2WI signals in patients with CNS SFT were helpful for diagnosis,but the final diagnosis depended on pathology. Surgical excision is the preferred treatment.

目的 探究阿司匹林联合低分子肝素治疗高凝状态复发性流产(RSA)的临床效果。方法 选择2018年9月—2019年9月我院收治的80例高凝状态RSA患者,随机分为两组,各40例。比较两组胎儿的结局情况;比较两组治疗前、妊娠12周后D-二聚体、血小板聚集率;比较两组用药安全性。结果 观察组足月产率、活产率高于对照组,流产率低于对照组,差异有统计学意义(P＜0.05);治疗后,观察组D-二聚体、血小板聚集率均低于对照组,差异有统计学意义(P＜0.05);两组不良反应率之间,差异无统计学意义(P＞0.05)。结论 阿司匹林、低分子肝素联合治疗高凝状态RSA的效果显著,可以改善胎儿结局,降低D-二聚体、血小板聚集率,改善孕妇机体高凝状态,且安全性高。

目的 研究探讨体质指数和体脂百分比与老年类风湿关节炎患者发生肌少症的相关性。方法 纳入2018 年1月— 2020 年 6 月我院治疗的230例RA患者以及110例正常体检人员,分别设为研究组与对照组。采用双能X线骨密度仪测定骨骼肌肉量,四肢骨骼肌总量,体脂百分比(PBF),计算骨骼肌质量指数(SMI),体质指数(BMI);根据SMI水平将RA患者分为有、无肌少症组,比较两间组指标差异,采用Logistics回归分析探讨RA患者合并肌少症的独立影响因素。结果 ①RA组患者肌少症发生率高于对照组(49.1％ vs 18.2％,χ²=29.927,P＜0.001)。RA组患者消瘦百分比高于对照组(20.9％ vs 8％,χ²=5.375,P=0.020), RA组与正常对照组间BMI分组构成比比较差异有统计学意义(χ²=8.157,P=0.043)。②RA组BMI、骨骼肌量及四肢骨骼肌量均低于对照组,差异有统计学意义(P＜0.05),体脂百分比高于对照组,差异有统计学意义(P＜0.05)。③RA消瘦组肌少症发生率高于正常组(χ²=10.716,P＜0.001)、超重组(χ²=28.073,P＜0.001)和肥胖组(χ²=11.601,P＜0.001);RA消瘦组、正常组、超重组、肥胖组间肌少症发生率差异有统计学意义(χ²=32.522,P＜0.001)。PBF分组肌少症发生率正常组高于超重组,差异无统计学意义(χ²=2.609,P=0.016)。④RA肌少症组BMI消瘦百分比高于无肌少症组(22.1％ vs 3.4％,χ²=40.593,P＜0.001),BMI正常百分比高于无肌少症组(60.1％vs 51.3％,χ²=1.843,P=0.175);BMI超重百分比低于无肌少症组(15.0％ vs 39.3％,χ²=33.895,P＜0.001), BMI肥胖百分比低于无肌少症组(2.6％ vs 6.0％,χ²=1.531,P=0.216)。两组间PBF构成比比较差异无统计学意义(χ²=2.609,P=0.106)。⑤RA消瘦组患者肌少症的发生风险高于正常组(OR=7.197,95％CI:3.103～23.614,P＜0.001),超重RA患者肌少症的发生风险低于正常组(OR=0.095,95％CI:0.036～0.268,P=0.026),年龄为RA患者发生肌少症的危险因素(OR=1.096,95％CI:1.015～1.390,P＜0.001)。结论 肌少症在老年RA患者中发病率高,与体质指数具有一定相关性。

目的 探讨血必净注射液对ANP大鼠肠道菌群及肠黏膜屏障功能的影响。方法 40只SD大鼠随机分为空白组、假手术组、ANP组和血必净治疗组(每组10只),空白组不作任何处理,假手术组翻动十二指肠后关腹,ANP组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射建模,治疗组在建模后经鼠尾静脉注射血必净注射液(3 mL/kg)。24 h后处死大鼠并采样,ELISA法测血AMS、CRP、LPS、TNF-α、IL-6、IL-1β、DAO和D-乳酸等指标,粪菌样本行16SrRNA高通量测序分析,实时定量PCR法检测5种细菌数量,病理检测胰腺和回肠组织,比较各组大鼠的指标。结果 ①ANP组大鼠血AMS升高,CRP、LPS、TNF-α、IL-6、IL-1β、DAO、D-乳酸水平以及胰腺、小肠病理评分均高于空白组和假手术组(P<0.001);②治疗组AMS低于ANP组,血必净可降低上述各种血清指标水平和胰腺、小肠病理评分(P<0.001);③肠道菌群微生态分析显示,血必净可改善ANP大鼠粪菌的丰富度和多样性,缩小与空白组、假手术菌种种类的差异,增加厚壁菌门菌量;治疗组乳酸杆菌、双歧杆菌和普拉梭菌的菌量高于ANP组,肠球菌和大肠埃希的菌量低于ANP组(P<0.001)。结论 血必净可增加ANP大鼠肠道菌群的丰富度和多样性,增加有益菌的含量,减少内毒素和促炎因子释放,改善肠黏膜屏障功能。

Objective To investigate the effect of Xuebijing injection on intestinal flora and intestinal mucosal barrier function in ANP rats. Methods 40 SD rats were randomly divided into blank group, sham operation group, ANP group and Xuebijing treatment group (10 in each group). The sham operation group closed the abdomen after turning the duodenum. The ANP model was established by retrograde injection of 4.5% sodium taurocholate solution into the biliopancreatic duct. Xuebijing injection (3mL/kg) was injected into the tail vein of the rats in the treatment group. 24 hours later, the rats were sacrificed and sampled. AMS, CRP, LPS, TNF-, il-6, il-1, DAO and d-lactic acid were measured by ELISA. The fecal bacteria samples were analyzed by 16SrRNA sequencing technique. Real-time quantitative PCR was used to detect the populations of 5 bacteria in fecal sample. The pathology of pancreas and ileum were examined, and the indexes of rats in each group were compared. Results ①In ANP group, AMS was increased, levels of CRP, LPS, TNF-, il-6, il-1, DAO, d-lactic acid, pancreatic and intestinal pathology scores were higher than those in the blank group and the sham group (P<0.001).②In treatment group,AMS was lower than ANP group, and Xuebijing could reduce the levels of the above factors and scores of pancreatic and intestinal pathology (P<0.001).③ The microecological results of intestinal flora showed that Xuebijing treatment could improve the richness and diversity of fecal bacteria, reduce the difference between Xuebijing group and blank group and sham operation group, and increase the quantity of firmicutes. The amount of Lactobacillus, Bifidobacteria and Clostridium prasei in the Xuebijing group was higher than that in ANP group, while the amount of enterococci and Escherichia coli was lower than that in the ANP group (P<0.001). Conclusion Xuebijing can increase the richness and diversity of intestinal flora, increase the content of beneficial bacteria, reduce the release of endotoxin and pro-inflammatory factors, and improve the intestinal mucosal barrier function in ANP rats.

目的 探讨系统性红斑狼疮(SLE)患者外周血中25-羟基维生素D(25-OH-D)和白介素-17(IL-17)水平的变化及其临床意义。方法 选取40例SLE患者作为研究对象, 20例健康体检人员为健康对照组。运用电化学发光法检测25-OH-D水平,酶联免疫吸附法检测IL-17水平。结果 SLE患者25-OH-D水平明显低于健康对照组(P<0.01),活动期SLE患者25-OH-D水平明显低于缓解期患者(P<0.01)。SLE患者IL-17水平明显升高(P<0.01)。低25-OH-D水平与肾损害(P<0.01)相关,与疾病活动度评分(SLEDAI评分)(r=-0.844,P<0.01)及IL-17水平(r=-0.596,P<0.01)负相关。结论 SLE患者25-OH-D水平降低,低25-OH-D水平与肾损害、病情活动及高IL-17水平相关,25-OH-D可能参与了SLE的炎症进程。

Objective To assess the 25-hydroxyvitamin D (25-OH-D) and interleukin-17(IL-17) status in patients with systemic lupus erythematosus(SLE) and its clinical significance. Methods 40 SLE patients along with 20 matched controls were collected. Chemilumineseent immunoassay (CLIA) was used to detect the levers of serum 25-OH-D. The levels of serum IL-17 were evaluated using enzyme-linked immunosorbent assay (ELISA). Results Serum 25-OH-D level in SLE patients was significantly lower than in healthy controls (P<0.01). Serum 25-OH-D level in active SLE patients was significantly lower than in inactive SLE patients (P<0.01). Lever of IL-17 was significantly higher in SLE patients than in healthy controls (P<0.01). Insufficiency of 25-OH-D was related to renal disorders. Serum 25-OH-D level was negatively correlated with systemic lupus erythematosus disease activity index (SLEDAI) scores(r=-0.844, P<0.01)and serum levels of IL-17(r=-0.596, P<0.01). Conclusion Insufficiency of 25-OH-D is prevalent in SLE patients. It is associated with nephritis, disease activity and high serum levels of IL-17, thus it may play an important part in the inflammatory process in SLE.