目的 采用生物信息学方法预测低氧预处理人胎盘绒毛膜间充质干细胞环状RNAs相对应的miRNA及其靶基因,并分析靶基因所参与的生物学过程和信号通路。方法 用Arraystar公司的商业软件为环状RNAs预测其相对应的miRNAs,分别用targetScan7.1和mirdbV5数据库预测miRNAs的靶基因,并取两个预测结果的合集,应用在线网站http://www.geneontology.org和http://www.genome.ad.jp/kegg对靶基因进行功能富集分析和信号通路富集分析。结果 功能富集分析表明,circRNAs的靶基因主要涉及到细胞发育、细胞分化和细胞发育调控。东京基因和基因组百科全书信号通路富集分析表明肿瘤中转录失控和有丝分裂原激活蛋白激酶(MAPK)信号通路最有意义,而且分析发现MAPK信号通路为核心通路。本研究表明,低氧预处理使得间充质干细胞中部分circRNAs的表达量发生差异性变化。结论 低氧预处理人胎盘绒毛膜间充质干细胞环状RNAs同低氧预处理间充质干细胞的生物学特性变化密切有关,为了解低氧预处理影响间充质干细胞特性发生变化的分子机制提供新思路。

Objective To predict the miRNA and its target genes of circular RNAs in hypoxia- preconditioned human palcenta chorionic mesenchymal stem cells using bioinformatics, and analyze the biological process and signaling pathway. Methods Arraystar's commercial software was used to predict the corresponding miRNAs of circular RNAs. The target genes of miRNAs were predicted by targetScan7.1 and mirdbV5 databases respectively, and an intersection of two prediction results was obtained. The online databases http://www. geneontology.org and http://www.genome.ad.jp/kegg performed functional enrichment analysis and signal pathway enrichment analysis of target genes. Results Functional enrichment analysis indicated that the target genes of circRNAs mainly involved cell development, cell differentiation and cell development regulation. The signal enrichment analysis of the Tokyo Gene and Genome Encyclopedia indicates that transcriptional misregulation in cancer and mitogen-activated protein kinase (MAPK) signaling pathway are most meaningful, and the MAPK signaling pathway is found to be the core pathway. This study showed that hypoxic preconditioning caused significant changes in the expression of mesenchymal stem cell circRNAs. Conclusion The changes of circular RNAs in hypoxia-preconditioned human placental chorionic mesenchymal stem cell is closely related to the biological characteristics of hypoxia-preconditioned mesenchymal stem cells. This study provides a new idea for understanding the molecular mechanism of hypoxic preconditioning affecting the changes of biological characteristics in mesenchymal stem cells.

目的 探讨利用微信群保留机采血小板无偿献血者的应用效果。方法 从本血站穿越安全输血标准化管理系统中调取2015年1月1日—2018年12月31日捐献机采血小板无偿献血者信息,根据初次捐献机采血小板后是否自愿加入机采微信群的机采血小板无偿献血者分为实验组和对照组,统计分析各组机采血小板无偿献血者重复献血 2～3 次和≥4 次以上机采血小板无偿献血者人数及平均献血次数。结果 2015—2018年间机采血小板采集量、献血人数及平均献血次数逐年上升;重复献血 2～3 次和≥4 次以上人数,实验组均高于对照组,机采血小板平均献血次数实验组均高于对照组,其中2016年和2018年实验组机采血小板平均献血次数高于对照组(P<0.05)。结论 通过机采微信群预约与管理机采血小板无偿献血者可提高机采血小板招募的工作效率,有效扩大和稳定机采血小板无偿献血者固定队伍。

目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。

目的 了解医务人员临床工作中血源性职业暴露的情况、暴露后的心理健康状况及其影响因素,采取干预措施,保障医务人员身心健康。方法 对医院2013年1月—2017年12月上报的79例血源性职业暴露者,在1个月内进行现状调查,同时采用自填式问卷症状自评量表(SCL-90)对调查对象进行调查,对其暴露后的心理影响程度进行评估。结果 医务人员在发生血源性职业暴露后其中躯体化因子、人际关系敏感因子、抑郁因子、焦虑因子在职业暴露前后的比较及与未发生职业暴露的医务人员相比较,均有不同程度的提高,差异均有统计学意义(P<0.001)。单因素分析显示影响血源性职业暴露后医务人员的心理健康状况的因素有年龄、职业、工龄、既往发生职业暴露史和患者患传染病种类(P<0.05)。其中年龄在21~25岁年龄的医务人员的得分较高,职业为医生和陪护工人的得分较高,工龄在1~5年的得分较高,既往发生过职业暴露的医务人员得分较高,患者患传染病类型为梅毒及暴露源不明的得分较高。结论 医务人员在发生血源性职业暴露后,其心理健康状态可受到较大影响;工龄、既往发生职业暴露史和患者患传染病种类是医务人员发生血源性职业暴露后心理状况健康的独立影响因素。医院管理者在重视预防及减少职业暴露的同时,更应关注血源性职业暴露后的心理变化,及时提供心理支持和医疗帮助。

目的 探讨胸苷激酶1活性检测在胸腔积液鉴别诊断中的敏感度及特异度。方法 回顾性分析诊断明确的肺炎旁胸腔积液、结核性胸腔积液、癌性胸腔积液患者的临床资料,收集并检测三组患者胸腔积液标本中胸苷激酶1活性并进行比较。结果 三组胸腔积液胸苷激酶1含量分别为: 肺炎旁胸腔积液组: (1.18±0.73)pmol/L、结核组活性(1.31±0.64)pmol/L、癌性组(2.07±1.47)pmol/L。统计分析显示癌性组胸苷激酶1含量高于肺炎旁胸腔积液组及结核组,差异有统计学意义,而肺炎旁组与结核组胸苷激酶1含量无统计学差异。在诊断价值分析方面,当胸苷激酶1≥1.28 pmol/L时支持癌性胸腔积液诊断,但是当胸苷激酶1＜1.28 pmol/L时,无法鉴别肺炎旁和结核性胸腔积液。因此,胸苷激酶1对于癌性胸腔积液的诊断价值较好,对肺炎旁胸腔积液和结核性胸腔积液鉴别诊断效能差。临床可考虑与其他指标,如降钙素原、腺苷脱氨酶等指标联合诊断。结论 胸腔积液胸苷激酶1含量在癌性胸腔积液与非癌性胸腔积液的鉴别诊断中有较好诊断价值。

Objective To investigate the of thymidine kinase 1in differential diagnosis of pleural effusion. Methods A retrospective analysis of thymidine kinase1 activity in the parapneumonic pleural effusion and tuberculous pleural effusion and malignant pleural effusion were conducted. Results The thymidine kinase 1 of this three groups are respectively: parapneumonic group (1.18±0.73pmol/L), tuberculosis group (1.31±0.64pmol/L), and cancer group (2.07±1.47pmol/L). It was shown that the activity of thymidine kinase 1 in cancer group was higher than that of inflammation group and tuberculosis group, the difference was statistical significance, but there was no significant difference between parapneumonic group and tuberculosis group. It supported the diagnosis of malignant pleural effusion when thymidine kinase 1 was greater than or equal to 1.28pmol/L, but when the thymidine kinase 1 was less than 1.28pmol/L, it was impossible to distinguish parapneumonic pleural effusion and tuberculous pleural effusion. Therefore, the diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion is well, but the diagnosis efficiency of thymidine kinase 1 in parapneumonic pleural effusion and tuberculous pleural effusion is not well. Conclusion The diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion and non-malignant pleural effusion is well.

目的 探讨磁共振磁敏感加权成像(SWI)对脑膜、脑转移瘤的诊断价值。方法 随机选取2016年3月—2018年3月我院收治的经临床、病理确诊的50例脑膜、脑转移瘤患者为研究对象,所有患者除常规行T1WI、T2WI扫描及T1WI增强扫描检查外,额外进行SWI检查。观察不同来源脑转移瘤转移部位、肿瘤实质信号在不同成像序列上的特征及对瘤内血管情况和出血状况的判断。结果 脑转移瘤的发生部位多为顶叶(29.75%)和枕叶(20.66%),就血供区域而言,多发生于中动脉(45.45%)和颈内动脉供血区域(38.02%)。不同MRI成像序列中肿瘤信号特征比较,显示均有差异(P<0.001)。其中,肺癌脑转移瘤T1WI呈低信号(62.96%),胃癌T2WI呈现高信号(68.75%),SWI成像序列上多显示为混杂信号。SWI序列成像显示瘤内出血55例(45.45%),显示引流血管16条,瘤内出血及肿瘤血管检出率均明显高于T1WI平扫检查,差异有统计学意义(P<0.05)。结论 不同来源的脑转移瘤MR的表现不同,为逆向推测脑转移瘤来源提供依据,同时SWI是对常规序列的重要补充,尤其是在脑瘤出血和血管检出上有重要作用,值得临床推广使用。

Objective To investigate the diagnostic value of susceptibility-weighted imaging(SWI) in meningiomas and brain metastases. Methods 50 cases of clinically and pathologically confirmed patients with meningioma and brain metastasis admitted to our hospital from March 2016 to March 2018 were randomly selected as the study subjects. All patients received routine T1WI, T2WI scan and T1WI enhanced scan, and additional SWI examination was performed. We observed the characteristics of metastatic sites and tumor parenchymal signals in different imaging sequences of brain metastatic tumors from different sources and to judge the status of intramedullary blood vessels and bleeding. Results The majority of brain metastatic tumors occurred in the parietal lobe (29.75%) and occipital lobe (20.66%). In terms of the blood supply region, the majority occurred in the middle artery (45.45%) and the blood supply region of the lower artery (38.02%). Comparison of tumor signal characteristics in different MRI imaging sequences showed differences, P<0.001. Among them, T1WI of brain metastatic tumor of lung cancer presented significantly low signal (62.96%), T2WI of gastric cancer presented high signal (68.75%), and SWI imaging sequence mostly showed mixed signal.SWI sequence imaging were showed in 55 cases (45.45%) of intracranial hemorrhage and 16 drainage vessels. The detection rate of intracranial hemorrhage and tumor blood vessels was higher than that of T1WI plain scan, with statistically difference (P<0.05). Conclusion MR manifestations of brain metastatic tumors from different sources are different, providing a basis for reverse speculation of the source of brain metastatic tumors. At the same time, SWI is an important supplement to routine sequences, especially in the hemorrhage of brain tumors and the detection of blood vessels, which is worthy of clinical promotion and use.

目的 本研究以ICSI后未成熟卵母细胞为研究对象,分析比较卵母细胞不同发育阶段冷冻对其后续效果的影响,评估ICSI后未成熟卵母细胞的利用价值。方法 未成熟卵母细胞直接成熟培养(新鲜组)与玻璃化冷冻后成熟培养(冷冻组)的成熟率,并利用孤雌激活的方法比较卵母细胞的发育潜力。结果 发现新鲜组与冷冻组体外培养卵母细胞成熟率、受精率、卵裂率、优质胚胎率和囊胚率均无差异(P>0.05)。但两组的GV期卵母细胞成熟率低于MI期(P<0.05),且冷冻组的GV期卵母细胞受精率低于MI期(P<0.05)。不过裸卵体外成熟培养效果欠佳,特别是对GV期卵母细胞,体外成熟培养后的卵母细胞发育潜力低下,无囊胚形成。结论 ICSI后未成熟卵母细胞的冷冻对卵母细胞的发育潜力没有明显影响,但体外成熟培养的卵母细胞发育潜力低下,有待进一步提高体外成熟培养技术。

Objective In this study, the immature oocytes after ICSI were used to analyze the effects of freezing on the subsequent development of oocytes at different developmental stages, and to evaluate the utilization value of immature oocytes after ICSI(intracytoplasmic sperm injection). Methods The immature oocytes was directly cultured (fresh group) and matured after vitrification (frozen group), and the development potential of the oocytes was compared by parthenogenetic activation. Results There was no significant difference in the oocyte maturation rate, fertilization rate, embryo cleavage rate, high quality embryo rate and blastocyst rate between the fresh and frozen groups (P>0.05). However, the maturation rate of GV oocytes in the two groups was lower than MI oocytes (P<0.05), and the fertilization rate of GV oocytes in the frozen group was lower than MI oocytes (P<0.05). However, the in vitro maturation of naked oocytes was not effective, especially for GV oocytes, the oocyte development potential after in vitro maturation was low, there was no blastocyst formation. Conclusion The freezing of immature oocytes after ICSI has no significant effect on the development potential, but the development potential of naked oocytes matured in vitro was low, and the in vitro maturation culture technology of naked oocyte needs to be further improved.

目的 评价Turbohawk定向斑块切除系统联合药物涂层球囊在下肢动脉硬化闭塞症中临床应用价值。方法 对于术前超声以及下肢动脉CTA检查诊断为下肢动脉硬化闭塞症的8例患者,行Turbohawk斑块旋切以及药物涂层球囊治疗,术后行常规抗凝治疗,定期行彩超复查。结果 8例患者下肢动脉均全部再通成功,技术成功率为100%,术后缺血症状明显改善,术后平均踝肱指数为0.78±0.06,高于术前的0.31±0.12(P<0.05)。住院期间无并发症发生,随访3～18个月,患者保肢均获得成功。结论 Turbohawk定向机械旋切系统联合药物涂层球囊治疗下肢动脉硬化闭塞症,具有创伤小、疗效好以及安全性高等优点,值得临床推广使用。

Objective To evaluate clinical application of using Turbohawk atherectomy device in combination with drug-coated balloon in treatment of atreriosclerosis obliterans in lower extremity. Methods Turbohawk atherectomy device and DCB was performed in 8 patiments with atreriosclerosis obliterans in lower extremity. All patients were diagnosed by ultrasound and CTA. Routine anticoagulation drugs were used after the operation. Follow-up was carried out with color Doppler ultrasound. Results Revascularization was gained in 8 patients. The technically successful rate was 100% and ischemic symptoms relieved significantly immediately after the operation. The post-operative ankle brachinal index(ABI) was 0.78±0.06,which was higher than that of before operation(0.31±0.12). No obvious complications occurred after operation. The follow-up range was 3~18 months and limbs were salvaged successfully. Conclusion With minimal invasive, safe and few complications, Turbohawk atherectomy device in combination with drug-coated balloon is proved to be a very effective treatment atreriosclerosis obliterans in lower extremity and it is worth to popularize.

目的 应用FRAX^®工具评估广州社区中老年人发生骨质疏松性骨折的风险。方法 回顾性研究1 140例广州社区中老年人的临床资料,应用FRAX^®工具计算未来10年发生主要骨质疏松性骨折及髋部骨折的风险,分析不同危险因素与骨折风险的关系。结果 广州社区中老年人群10年内发生主要骨质疏松性骨折概率为(4.2±3.6)%,髋部骨折概率为(1.3±2.4)%。主要骨质疏松性骨折风险及髋部骨折风险、OSTA值均随着年龄增长而增加。多因素回归分析结果显示: 年龄、性别、既往骨折、继发性骨质疏松、股骨颈T值、跌倒对主要部位骨折及髋部骨折风险具有独立性预测意义。结论 FRAX^®工具可用于评估广州社区中老年人骨质疏松性骨折风险,建议在社区中老年人健康体检时应用FRAX^®工具进行骨折风险评估。

Objective To predict the osteoporotic fracture risk in senile people in Guangzhou communities by FRAX,the fracture risk assessment tool published by WHO. Methods Clinical data of 1140 cases were collected for the retrospective analysis. The FRAX tool was uesed to calculate the 10-year probability of a major osteoporotic and hip fracture.The relationship between different risk factors and the fracture risk predicted by FRAX was analyzed. Results The 10-year probability of major osteoporotic fractures was (4.2±3.6)%, and the 10-year probability of hip fractures was (1.3±2.4)%.The 10-year probability of the major osteoporotic and hip fracture increased with age.Multivariate regression analysis showed that age,gender,previous fracture,secondary osteoporosis,T-score of femoral neck BMD and fall were independent predictors of the 10-year probability of major osteoporotic fracture and hip fracture. Conclusion The FRAX tool may be effectively applied to assess the fracture risk of senile population in Guangzhou communities.We recommedated that FRAX-tool should be included in routine health check-up.