目的 研究子宫内膜异位症生育指数（EFI）评分对子宫内膜异位症（EMT）患者腹腔镜术后生育指导的应用价值。方法 对2015年3月—2017年4月于我院进行腹腔镜手术治疗的76例EMT患者进行EFI评分,并依据其结果施加相应生育指导,随访2年观察患者术后妊娠情况。结果 随访2年结果显示,76例患者共出现68例妊娠,且其妊娠率及自然妊娠率随EFI评分减少而降低,组间均有性差异（P<0.05）;68例妊娠患者足月分娩率为76.47%,同时不同EFI评分患者不良妊娠结局比较,组间均无显著性差异（P>0.05）。结论 腹腔镜手术能够提高EMT患者妊娠率及自然分娩率,同时可根据EFI评分,综合评估患者的生育状况,对于指导术后处理的选择以及指导后续治疗均有重要参考意义。

Objective To study the application value of uterine endometriosis index （EFI） on the postoperative reproductive guidance of patients with endometriosis （EMT）. Methods From March 2015 to April 2017,76 EMT patients in our hospital underwent laparoscopic surgery for EFI score. On the basis of corresponding guidance,the patients were followed up and observed for 2 years for results in postoperative pregnancies. Results The two-year follow-up period showed that there were 68 cases of pregnancy in 76 cases. Pregnancy rate and natural pregnancy rate decreased with the decrease of EFI score. There was a difference between the groups （P<0.05）. The monthly delivery rate of 68 cases was 76.47%. At the same time,there were no significant differences between the groups in the pregnancy outcomes of patients with different EFI scores （P>0.05）. Conclusion Laparoscopic surgery can improve pregnancy rate and natural delivery rate of EMT patients. At the same time,according to the EFI score,comprehensive assessment of the patient's reproductive status is important for guiding the selection of postoperative treatment and for guiding follow-up treatment.

目的 不同通道下的经皮肾镜取石术肾盂压力监测治疗鹿角形肾结石的临床分析。方法 选取我院2016年1月–2017年12月收治的鹿角形肾结石患者120例,通过随机分组,分别采用16F、18F、20F、22F、24F 作为手术通道,在气管插管全麻下置入8/9.8F 输尿管镜行经皮肾镜气压弹道碎石取石术,行经皮肾镜取石术,术中通过监测输尿管导管的压力,即肾盂内压并记录。测压系统每秒钟采集一次数据并录入数据库。观察不同通道下肾盂内压力以及取石速度。结果 在24F通道下肾盂内压力最低,与其他通道组进行比较,差异有统计学意义（P<0.05）;肾盂内压力大于40 cmH₂O时在24F通道下取石速度最短,与其他通道组进行比较,差异有统计学意义（P<0.05）;24F通道与22F通道下取石速度最快,与其他通道组进行比较,差异有统计学意义（P<0.05）。结论 肾盂内压监测使经皮肾镜取石术更加安全和精确,值得临床进一步推广应用。

Objective To investigate the pyelolithic pressure monitoring in percutaneous nephrolithotomy of different channel in treatment of renal staghorn calculi. Methods 120 patients of staghorn renal calculi in our hospital were selected from January 2016 to December 2017. These patients were randomly divided into 5 groups according to the operation channel（16F,18F,20f,22F,24F）. During operation,renal pelvis,ureter catheter pressure and operation time were recorded. Results The lowest renal pelvis pressure could be found in the 24F channel and the difference was statistically significant（P<0.05）. The lowest operation time could be found in the condition of the renal pelvis pressure of more than 40cmH₂O and 24F channel（P<0.05）. Beside of this, the fastest stone-free rate could be found in 22F and 24F channel（P<0.05）. Conclusion Monitoring of renal pelvic pressure makes percutaneous nephroscopic surgery more accurate and safety. It is worthy of clinical application.

目的 探讨胆碱能受体激动剂尼古丁对子痫前期大鼠的治疗作用及机制。方法 将30只妊娠SD大鼠分为对照组（n =10）、子痫前期组（n =10）和尼古丁治疗组（n =10）。子痫前期组中,大鼠妊娠第14天注射内毒素（l.0 μg/kg）;对照组给予等量生理盐水2 mL,研究组妊娠第14 天开始皮下注射尼古丁1 mg/（kg·d）至妊娠第19天。检测各组干预前后收缩压、24小时蛋白、妊娠结局和大鼠外周血IL-6,TNF-α,IFN-γ和IL-1β的表达水平。结果 和对照组相比,大鼠动脉收缩压妊娠第14天注射LPS后升高,治疗组中在尼古丁注射后,妊娠第16天、第18天较子痫前期组血压下降（14.99±0.48 vs 16.61±0.55 kPa,15.01±0.60 vs 17.04±0.49 kPa,P<0.05）;大鼠24 h蛋白尿在子痫前期组中妊娠第17、19天升高（P<0.05）,尼古丁治疗组尿蛋白较子痫前期组降低（P <0.05）。妊娠第20天,子痫前期组胎儿重量和对照组相比下降（P <0.05）,尼古丁治疗组较子痫前期模型组胎儿重量增加（P <0.05）。各组间存活胎儿数、胎盘重量差异无统计学意义（P >0.05）。子痫前期组炎性因子IL-6,TNF-α,IFN-γ和IL-1β 较对照组升高,差异有统计学意义;尼古丁治疗组IL-6,TNF-α,IFN-γ 和IL-1β 降低（P <0.05）。结论 胆碱能受体激动剂尼古丁通过降低炎性反应来改善子痫前期大鼠的妊娠结局。

Objective To examine the effects and mechanism of cholinergic receptor agonist nicotine on preeclampsia rats. Methods 30 pregnant SD rats were divided into control group（n=10）,preeclampsia group（n=10） and nicotine treatment group（n=10）.In preeclampsia group,rats were injected LPS（l.0 μg/kg） on the day 14th of gestation,the control rats were injected 2 mL of physical saline on the day 14th of gestation,the rats in nicotine treatment group were injected nicotine 1mg/（kg·d） from the day 14th to the day 19th of gestation. The systolic blood pressure,24 hour urine protein,pregnancy outcome and serum levels of IL-6,TNF-α,IFN-γ and IL-1β were compared between each groups. Results Compared to control group,the systolic blood pressure rose after LPS injection on the day 14th of gestation,the systolic blood pressure in nicotine treatment group decreased on the day 16th and the day 18th of gestation compared to preeclampsia group（14.99±0.48 vs 16.61±0.55 kPa,15.01±0.60 vs 17.04±0.49 kPa,P<0.05）.The 24 hour urine in preeclampsia group rose on day 17 and day 19 of gestation（P <0.05）,which decreased in nicotine group（P <0.05）. The fetal weight were higher in nicotine treatment group compared to the preeclampsia group,there were no statisitical difference in viable fetal number and placental weight among groups. The serum levels of IL-6,TNF-α,IFN-γ IL-1β were higher in preeclampsia group compared to the control group,while nicotine decreased the levels of IL-6,TNF-α,IFN-γ IL-1β（P <0.05）. Conclusion Nicotine improved pregnancy outcome of LPS induced preeclampsia rats by decreasing inflammatory levels.

宫内发育迟缓(IUGR)又称小于胎龄儿(SGA),不仅影响近期健康,且对远期健康和生长发育具有重要影响,成年后2型糖尿病、肥胖、高血压、冠心病等代谢综合征的发病率明显增高。可能的机制是在生命早期个体对不利的刺激高度敏感,产生基因表达的异常,影响内分泌系统,从而对某些器官的结构或功能产生长期或永久性的影响。我们需从做好产前母体的营养与健康管理、小于胎龄儿出生后的系统管理、喂养选择纯母乳喂养等措施减少疾病的发生。

Intrauterine growth retardation (IUGR), also known as the small for gestational age (SGA), not only affects the recent health and has an important influence on long-term health and growth development. They are more easy to get the metabolic syndrome such as adult metabolism of type 2 diabetes, obesity, hypertension, coronary heart disease. Possible mechanism is produced in the early life of individual, is highly sensitive to adverse stimuli gene expression abnormalities which affecting the endocrine system, thus it have a long-term or permanent impact on the structure and function of some organs. We need to do more in prenatal maternal nutrition and health management, system management of SGA infants, pure breast feeding. Thus these could reduce the occurrence of metabolic syndrome.

目的 为科学合理的测算公立医院人员编制以及编制管理改革提供参考。方法 对各省市公立医院机构编制标准以及相关文献进行系统分析,系统总结编制影响因素以及编制测算方法。结果 公立医院人员编制受多方面因素影响,而现阶段人员编制测算主要以床位数与门诊量为主要考量因素,其他因素为辅。结论 结合我国公立医院人事管理改革方向,在公立医院人员编制管理上,首先需要科学核定医院应配备人员总量,全方位考虑各影响因素,并设定一定的可伸缩区间,使医院可根据实际情况在一定范围内自主选择。

Objective To provide references for public hospital personnel calculation and personnel system reform. Methods The related standards of public hospitals in various provinces and literatures were analyzed systematically to sum up influence factors and calculation methods. Results Public hospital personnel complement is affected by various factors. At this stage that was mainly measured by the number of beds and outpatient service,and supplemented by other factors. Conclusion With the reform of personnel management in public hospitals in our country, in the management of public hospital staff, the first need to scientifically measure the total amount of personnel that hospital should be equipped with considering various factors. And to set an interval, the hospital may make an independent choice according to the actual situation.

目的 探讨不同剂量右美托咪定(Dex)对腰硬联合麻醉下经皮肾镜碎石术患者的镇静效应和安全性。方法 腰硬联合麻醉下行俯卧位经皮肾镜碎石术患者80例,随机分成4组。D1组、D2组、D3组俯卧位后静脉泵注负荷剂量DEX 0.5 μg/kg,输注的时间为10min,随后分别静脉泵注DEX 0.3 μg/(kg·h)、0.5 μg/(kg·h)、 0.7 μg/(kg·h)至术毕;C组俯卧位后静脉泵注生理盐水10 mL/h至术毕。记录T0～T6共7个时点的HR、MAP、p(O₂)和BIS值;在T0、T3～T6等时点对患者静息Ramesay镇静评分;观察患者不良反应发生情况;询问综合满意度。结果 D2组和D3组的HR、MAP、BIS、Ramesay镇静评分在T3~T6等时点明显慢于C组(P＜0.05);D3组心动过缓和头晕等不良反应的发生率明显高于D1组、D2组和C组(P＜0.05),D2组和D3组术中躁动的发生率明显低于D1组和C组(P＜0.05),D1组、D2组和D3组高血压、寒战和恶心呕吐的发生率明显低于C组(P＜0.05),且综合满意度明显高于C组。结论 DEX本药物用于该类手术的镇静疗效及安全性均优于对比的药物。建议临床使用剂量为DEX负荷剂量0.5 μg/kg,随后以0.5 μg/(kg·h)维持。

目的 回顾性分析不同病理类型乳腺黏液腺癌的超声声像图特征,从而提高术前乳腺黏液腺癌不同亚型的超声诊断准确率。方法 分析43名患者共44例手术切除或穿刺活检证实为乳腺黏液腺癌病灶的声像图资料,包括病灶的边界、边缘、形态、回声类型、生长方向、钙化、后方回声、血流分级、腋窝淋巴结形态,并对病灶进行BI-RADS分类。将超声声像图特征与手术或活检后病理结果进行对比,总结出不同亚型的乳腺黏液腺癌的超声声像图特征。结果 44例乳腺黏液腺癌病理类型分为21例单纯型黏液腺癌和23例混合型黏液腺癌,混合型黏液腺癌大多数表现为病灶边界不清(73.9%)、边缘模糊毛刺(73.9%)、形状不规则(91.3%)、以及内部回声不均匀(87%)、病灶内钙化更多见(52.2%)。混合型黏液腺癌的淋巴结转移率明显高于单纯型黏液腺癌(P<0.05)。对比术前病灶的BI-RADS分类及术后病理诊断,超声对恶性病灶诊断准确率68%,单纯型黏液腺癌和混合型黏液腺癌的诊断准确率分别为48.6%、87%。结论 不同病理类型乳腺黏液腺癌间具有一些不同的声像图特征。混合型黏液腺癌大多数表现为病灶边界不清、边缘模糊毛刺、形状不规则、回声不均匀、病灶内钙化多见;单纯型乳腺黏液腺癌通常表现为边界清晰、形态规则、钙化少见、淋巴结转移少等良性肿块声像特征,超声对其误诊率较高,需提高警惕。

Objective Retrospectively evaluate the sonographic features of different types of mucinous breast carcinoma to improve the preoperative ultrasound diagnostic accuracy rate. Methods Sonographic features of 44 cases of MBC proven by pathological biopsy were analyzed, including the margin,lesion boundary,shape,echo pattern,lesion growth pattern, calcification, posterior acoustic feature,blood flow, lymph node form and data system(BI-RADS)classification for the lesion to sum up the different subtypes of breast ultrasonic ultrasonographic features of mucinous carcinoma. Results 21 cases of pure mucinous carcinoma (PMBC)and 23 cases of mixed mucinous carcinoma(MMBC)were founded. MMBC were more likely to have unclear boundary (73.9%), indistinct or spiculate of margin(73.9%), irregular shape (91.3%), heterogeneous internal echo (87%), more calcification in lesions(52.2%). Lymph node metastasis in MMBC was obviously higher than that of PMBC(P<0.05). Compared with preoperative of the BI-RADS classification and pathological diagnosis, ultrasonography in diagnosing accuracy rate was 68% in malignant lesions, 48.6% in PMBC and 87% in MMBC. Conclusion There are some different ultrasonographic characteristics in different types of breast mucinous carcinoma.MMBC are more likely to have unclear boundary, indistinct or spiculate of margin, irregular shape, more calcification in lesions. On the contrary, PMBC has a circumscribed boundary, abrupt interface edge, rare calcification, rare lymph node metastasis and are easily misdiagnosed as benign lesions. We should pay more attention to avoid misdiagnosis in ultrasonography.

目的 研究BAG-1基因与乳腺癌他莫昔芬(TAM)治疗敏感性的相关性。方法 以58例乳腺癌患者为观察组,50例乳腺良性肿瘤患者为对照组。予以观察组患者TAM治疗,检测并统计2组患者肿瘤组织BAG-1基因的阳性率;并根据检测结果将观察组患者分为BAG-1阳性组与阴性组,对比分析观察组BAG-1阳性者与阴性者的临床预后及血清肿瘤标志物水平,包括癌胚抗原(CEA)、糖类抗原153(CA153)。结果 观察组BAG-1基因阳性率为74.14%,对照组为12%,2组比较, P＜0.05。观察组BAG-1阳性组患者临床缓解率为46.51%,阴性组为66.67%,2组比较,P＜0.05;BAG-1阳性组患者临床控制率为67.44%,阴性组为86.67%,2组比较,P＜0.05。观察组BAG-1阳性组患者平均OS为(1.55±0.86)a,PFS为(1.02±0.31)a,阴性组依次为(2.76±0.95)a、(2.06±0.82)a,2组比较,差异均有统计学意义(P＜0.05)。治疗后,观察组BAG-1阴性组患者血清CEA、CA153指标值均低于对照组(P＜0.05)。结论 BAG-1基因与乳腺癌TAM治疗敏感性密切相关,BAG-1阳性者行TAM治疗的临床效果及预后均较阴性者差。

Objective To study the correlation between BAG-1 gene and the sensitivity of tamoxifen (TAM) in breast cancer. Methods 58 cases of breast cancer patients as the observation group, 50 cases of benign breast cancer patients as the control group.The positive rate of BAG-1 gene in two groups of patients was detected and statistically analyzed by TAM. The patients in the observation group were divided into BAG-1 positive group and negative group according to the test results, and the positive rate of BAG- (CEA), carbohydrate antigens 153 (CA153) and carcinoembryonic antigen (CEA). Results The positive rate of BAG-1 gene was 74.14% in the observation group and 12% in the control group, P<0.05. The clinical response rate of BAG-1 positive group was 46.51% and negative group was 66.67%, P<0.05; The clinical control rate of BAG-1 positive group was 67.44%, negative group was 86.67%. Compared 2 groups , it was P<0.05. The mean OS was (1.55±0.86) years, PFS was(1.02±0.31) years in the BAG-1 positive group and (2.76±0.95) years in the negative group and (2.06±0.82) years in the negative group, (P<0.05). After treatment, the serum CEA and CA153 values in the negative group of BAG-1 were lower than those in the control group (P<0.05). Conclusion BAG-1 gene and breast cancer TAM treatment sensitivity is closely related to BAG-1 positive TAM treatment of clinical efficacy and prognosis were worse than negative.

目的 研究中山市南部镇区医院人员关于继续医学教育的政策知悉程度、参加继续医学教育的途径、障碍因素及动机,为完善继续医学教育管理工作提供决策依据。方法 采用简单随机抽样的方法,选取中山市南部镇区医院200名医务人员,采用问卷调查方法,了解中山市南部镇区医务人员继续教育的参与情况,接受继续教育的主要途径与障碍。结果 24～40岁年龄段、初级职称人员知悉程度较高,而40～48岁年龄段、中高职称人员参与程度较高;晋升和发展是主要参与动机,时间和空间因素是主要参与障碍。结论 医院应根据不同层次专业技术人员继续教育的需要开展继续教育,并创造有利条件,克服时间上和空间上的障碍,更好地使继续教育的效果转化为知识结构的不断优化。

瘦素是维持人体能量代谢平衡的蛋白质,在人体中主要由白色脂肪组织分泌,通过与瘦素受体结合发挥作用。近年来有许多与瘦素相关的研究证明高血压患者及代谢综合征患者的血清瘦素水平较健康人群明显升高。两种疾病均可出现心室肥厚,蛋白尿,动脉粥样硬化等表现,说明二者存在共同的靶器官。瘦素代谢异常可出现瘦素抵抗并通过影响肾素-血管紧张素-醛固酮系统(renin angiotensin aldosterone system, RAAS)及炎症细胞因子来损伤靶器官。本文旨在总结瘦素在高血压及代谢综合征中的作用机制,并探讨瘦素对高血压合并代谢综合征靶器官损伤作用的研究进展。

Leptin is a protein that maintains the balance of energy metabolism in human body. It is mainly secreted by white adipose tissue in human body. In recent years, many studies have shown that the serum leptin level in patients with hypertension complicated with metabolic syndrome is significantly higher than that of healthy people. Both of the diseases can lead to left ventricular hypertrophy, proteinuria, atherosclerosis and other manifestations. The abnormal metabolism of leptin may contribute to leptin resistance which damages target organs by affecting the angiotensin aldosterone system and inflammatory cytokines. The aim of this article is to summarize the mechanism of leptin in hypertension and metabolic syndrome, and to explore its effect on the target organ damage in patients with hypertension complicated with metabolic syndrome.