目的 本研究旨在探讨血浆chemerin水平与原发性高血压合并心房颤动的相关性。方法 选择2016年2月—2017年12月期间在广州市第一人民医院心内科及老年心内科住院的高血压患者160例,根据是否合并心房纤颤分为心房纤颤组(AF组,n=72)及非心房纤颤组(NAF组,n=88),另选取140例我院体检中心体检结果正常的正常健康人作为对照组(CON组,n=140)。采用全自动生化检测仪测定甘油三脂、总胆固醇、低密度脂蛋白、C反应蛋白等生化学指标;使用ELISA法检测血浆chemerin水平。结果 AF组患者的血浆chemerin水平较NAF组患者升高[(180.45±15.23)ng/mL vs(162.36±13.44)ng/mL,P<0.05],且均较CON组升高[(142.36±11.83)ng/mL,P<0.05)],多元Logistic回归分析显示血浆chemerin水平与高血压病合并心房纤颤呈独立相关性(OR 1.112, 95% CI 1.023～1.302;P<0.001)。结论 高血浆chemerin水平可能是预测高血压合并心房纤颤的独立危险因素,血清chemerin可能成为一种预测高血压发生心房纤颤的重要生物学标记物。

Objective To explore the relationship between chemerin levels and permanent atrial fibrillation in patients with hypertension. Methods A total of 160 patients with hypertension were enrolled in this study. All the patients were classified as AF(n=72) or NAF(n=88) based on the permanent atrial fibrillation or not. And 140 healthy people were collected as a control group(CON). Triglycerides, total cholesterol, low density lipoprotein cholesterol and C-reactive protein were measured by automatic biochemical detector. Serum chemerin levels were determined by enzyme-linked immunosorbent assay(ELISA). Results Serum chemerin levels were higher in AF patients than those in NAF patients(180.45±15.23 ng/mL vs 162.36±13.44 ng/mL,P<0.05). They were both higher than that of the CON patients(142.36±11.83 ng/mL,P<0.05). Multivariate logistic regression demonstrated that chemerin level was independently associated with the permanent atrial fibrillation in patients with hypertension(OR 1.112, 95% CI 1.023～1.302;P<0.001). Conclusion Serum chemerin is an independent risk factor for permanent atrial fibrillation with hypertension. The results suggest that chemerin might be a useful biomarker for predicting the permanent atrial fibrillation with hypertension.

目的 探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ 4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法 采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65(分):3.06±1.10 比0.85±0.79,P<0.001;PSI(分):144.93±36.48比73.94±27.17,P<0.001; SMART-COP(分):6.54±1.41比 1.67±1.02,P<0.001; APACHEⅡ(分):20.79±5.69比7.94±3.87,P<0.001]。CURB-65≥3分、PSI≥130分、SMART-COP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0.940[95% CI:0.89~0.98, P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001],敏感度分别为65.6%、71.6%、100%、88.1%,特异度分别为100%、100%、78.7%、93.9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHE Ⅱ评分诊断效能更佳。

Objective To evaluate and compare the early diagnosis value of CURB-65,PSI,SMART-COP and APACHEⅡin patients with severe community-acquired pneumonia. Methods This was a prospective study conducted in department of respiratory in Guangzhou First People's Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February of 2014. The lowest scores within 24 hours of CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score,respectively,for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score were higher in SCAP as compared with that of CAP(CURB-65:3.0±1.1 vs 0.9±0.8,P<0.001;PSI:144.6±36.4 vs 73.9±27.1,P<0.001; SMART-COP:6.5±1.4 vs 1.6±1.0,P<0.001; APACHEⅡ:20.6±5.6 vs 7.9±3.8,P<0.001). ROC curve for CURB-65 score≥ 3 scores,PSI score≥ 130 scores,SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0.940[95%CI:0.89~0.98,P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001]. Sensitivity of four kinds of scoring system was 65.6%,71.6%,100%,88.1%, with specificity of 100%,100%,78.7%,93.9% respectively. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score,but the sensitivity was low and easy to miss diagnosis. SMART-COP and APACHEⅡscore systems had a better diagnostic value on SCAP.

目的 研究新辅助化疗联合保肢手术治疗骨肉瘤的临床效果。方法 根据既往治疗骨肉瘤方法的不同,将56例患者分为对传统保肢组（A组）和现代保肢组（B组）,各28例。A组用采用传统保肢方案,即保肢手术+术后化疗方案进行;B组采用现代保肢方案,即新辅助化疗+保肢手术+术后化疗方案进行。化疗方案均采用CTX + VCR +MTX+ ADM方案,比较两组转移/复发率、术后1 年、2年及 3 年生存率、肢体功能、临床疗效情况。结果 比较两组的转移/复发率及3年后的死亡率,B组低于A组(P<0.05);肢体功能优良率及临床疗效,B组高于A组(P<0.05)。结论 新辅助化疗联合保肢手术能够降低骨肉瘤患者转移/复发率、死亡率,改善肢体功能,提高临床疗效。

Objective To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma. Methods Based on the previous methods of treating osteosarcoma, 56 patients were divided into the traditional limb salvage group (A group) and the modern limb salvage group (B group), 28 cases for each. The traditional limb salvage surgery + postoperative chemotherapy regimen were used in group A, and modern limb salvage regimen was performed in group B, ie neoadjuvant chemotherapy + limb salvage surgery + postoperative chemotherapy. The CTX + VCR +MTX+ ADM protocol was used in the chemotherapy regimens. The metastasis/recurrence rate, the 1-year, 2-year and 3-year survival rates, limb function, and clinical efficacy were compared between the two groups. Results The metastasis/recurrence rate and the mortality rate after 3 years in the two groups were compared. The B group was lower than that of the group A (P<0.05). The excellent rate of limb function and clinical efficacy were higher in the B group than that of in the group A (P<0.05). Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery may reduce the metastasis/recurrence rate and mortality of osteosarcoma patients, improve limb function and increase clinical efficacy.

目的 分析2014年482例广州登革热患者的X线胸片特点,探讨X线胸片对登革热患者的临床诊断价值。方法 选取广州市第一人民医院2014年收治的482例登革热患者作为研究对象,观察分析其X线胸片检查结果的特征。结果 登革热患者X线胸片影像学特点以非特异性的肺纹理增多增粗和斑片渗出灶为主要表现,另有胸膜增厚、胸腔积液和间质性改变。结论 X线胸片检查可以经济、便捷地了解登革热患者的肺部改变,为临床诊断和治疗提供帮助。

Objective To analyze the characteristics of chest X-ray in 482 cases of dengue fever in Guangzhou 2014, and to discuss the diagnostic value of chest X-ray in dengue fever patients. Methods 482 patients of dengue fever patients admitted in Guangzhou First People's Hospital were selected as the research object. The characteristics of the chest X-ray were observed and analyzed. Results The characteristics of chest X-ray images included lung markings thickening increased, exudation, and might lead to pleural thickening, effusion and interstitial change. Conclusion Chest X-ray was a convenient examination for dengue fever patients which had an important diagnostic and therapeutic value.

目的 了解广东省罗定市中小学教师的职业倦怠情况,为制定政策提供初步依据。方法 采用中文版Maslach职业倦怠量表(C-MBI)对罗定市42所中小学共590名毕业班教师进行评估。结果 受访者的情感衰竭(emotional exhaustion, EE)和知识枯竭(intellectual burnout, IB)因子分显著高于全国常模(P＜0.05),个人成就感降低(reduced personal accomplishment, PA)因子分显著低于全国常模(P＜0.01)。女性受访者的去个性化(depersonalization, DP)、EE和IB因子分均显著高于男性受访者,PA因子分显著低于男性受访者(P均＜0.01)。结论 广东省罗定市中小学毕业班教师的职业倦怠高于全国平均水平,女性教师的职业倦怠感高于男性教师。

Objective To investigate job burnout among primary and secondary teachers in Luoding city and to provide a preliminary basis for policy formulation. Methods We randomly selected 590 graduating class teachers from 42 primary and secondary schools in Luoding. The outcome variable of burnout was measured by the Chinese Maslach Burnout Inventory for primary and secondary school teachers (C-MBI). Results Emotional exhaustion (EE) score and intellectual burnout (IB) score in respondents were both significantly higher than the national norm used as reference (P＜0.05), reduced personal accomplishment (PA) score was significantly lower than the national norm (P＜0.01). The factor scores of DP, EE and IB were obviously higher in female respondents than that those in the male, while the score of PA was obviously lower (all P＜0.01). Conclusion The level of burnout in these teachers is significantly higher than the national average, and the burnout in female teachers is more serious.

目的 初步研究2型糖尿病并视网膜病变患者的血浆趋化素(chemerin)水平及其与骨密度的关系。方法 选择150名糖尿病患者,按视网膜病变分为视网膜病变组(DR组)和眼底正常对照组(NDR组),采用全自动生化检测仪测定糖化血红蛋、甘油三脂、总胆固醇、低密度脂蛋白、高敏C反应蛋白;使用ELISA法检测血浆chemerin水平。骨密度采用双能X线骨密度仪分别测定腰椎正位(L2、L3、L4)、左侧股骨颈、大粗隆区、Ward's三角区的骨密度。结果 ①与NDR组相比,DR组的糖尿病病程较NDR组显著延长(P<0.05)。②DR组的TC、LDL-C、HbA1c、hs-CRP、chemerin水平较NDR组均显著升高(P<0.05)。③DR组的股骨颈、大粗隆区、Ward's三角区的骨密度较NDR组显著降低(P<0.05)。④血清chemerin水平与病程、BMI、HbA1C呈正相关,与股骨颈、大粗隆区、Ward's三角区的骨密度呈负相关。结论 DR患者的chemerin显著升高,chemerin可能参与DR的发生发展,并可能促使DR患者的骨密度降低。

Objective To explore the relationship between the circulation level of chemerin level and bone mineral density(BMD)in type 2 diabetes retinopathy patients. Methods A total of 150 patients with type 2 diabetes were selected. They were divided into two groups: retinopathy group(DR group), non- retinopathy group(NDR group). HbAlc, triglycerides(TC), total cholesterol(TG), low density lipoprotein cholesterol(LDL-C)and high-sensitivity C-reactive protein(hs-CRP)was measured by automatic biochemical detector. Bone mineral density was measured by the dual-energy X-ray absorptiometry. The BMD of lumbar vertebrae 2-4 and the left side of the femoral neck, the greater trochanter and Ward's triangle were assessed. Results ①Compared with the NDR group, the duration of diabetes in group DR was significantly longer(P<0.05); ②The levels of TC, LDL-C, HbA1c, hs-CRP and chemerin in DR group were significantly higher,③The BMD of the femoral neck, trochanter regionandward's triangle were significant reduction;④The level of chemerin was positively correlated with the duration of diabetes, BMI, HbA1C, and negatively correlated with the bone mineral density of the femoral neck, the greater trochanter, and the s' Ward triangle. Conclusion The level of chemerinin DR patients were significantly increased, and chemerin may play a role in the occurrence and development of DR, may promote the bone density decreased.

目的 通过高通量测序法对多重耐药大肠埃希菌HX43进行耐药分子机制的研究。方法 用Illumina Miseq平台对HX43进行高通量测序,用Edena、RAST、ResFinder、MLST和BLAST等生物信息学工具或数据库进行数据分析,获得耐药基因相关序列数据。结果 HX43对多种临床常用抗生素均不敏感,仅对碳氢霉烯类药物敏感。对高通量测序数据的分析研究发现,该菌存在多种耐药基因,包括β-内酰胺类耐药基因3个(bla_CMY-42、bla_CTX-M-14和bla_OXA-30),氨基糖苷类耐药基因5个(aac(3)-IIa、aadA5、 strA、 strB和aac(6′)-Ib-cr),喹诺酮类耐药基因1个(aac(6′)-Ib-cr),磺胺及甲氧苄啶类耐药基因3个(sul1、sul2和dfrA17),四环素耐药基因1个(tet(B)),氯霉素耐药基因2个(catB3和cmlA1),大环内酯类耐药基因2个(erm(B)和mph(A))。对包含bla_CMY-42的contigs进行分析,发现该基因与ISEcp1插入序列、blc和sugE等基因相关联。质粒分型发现HX43携带5种不相容群的质粒。多位点序列分型(MLST)分析发现HX43属于ST3835,为国内外较少见的序列型。结论 高通量测序技术可准确获得临床菌株抗生素耐药的相关基因信息,为临床抗菌治疗提供重要的实验室数据支持。

Objective To investigate the molecular resistance mechanism of Escherichia coli HX43 by high-throughput sequencing. Methods HX43 was sequenced by the Illumina Miseq platform, and sequencing data were analyzed by the Edena, RAST, ResFinder, MLST and BLAST softwares and databases. Results HX43 was resistant to most common clinical antibiotics except carbapenems. Analysis of data revealed resistance genes to β-lactams (bla_CMY-42, bla_CTX-M-14 and bla_OXA-30), aminoglycosides (aac(3)-IIa, aadA5, strA, strB and aac(6′)-Ib-cr), quinolones (aac(6′)-Ib-cr), trimethoprim/sulfonamides(sul1, sul2 and dfrA17), tetracyclines (tet(B)), chloramphenicol (catB3 and cmlA1), macrolides(erm(B) and mph(A)). Sequence analysis of the contig containing bla_CMY-42 identified correlations of the gene with ISEcp1 insertion sequences, blc and sugE genes. Plasmid typing identified 5 plasmid incompatibility groups in HX43. MLST analysis found that HX43 belonged to ST3835, a relatively rare sequence type in the world. Conclusion Information of resistance genes can be obtained by high-throughput sequencing, which provides important experimental data for clinical antimicrobial treatment.

目的 探讨手动杠杆式胸外按压心肺复苏(CPR)装置对院内心肺复苏按压质量和复苏疲劳的影响。方法 将12名医学生志愿者分为手动杠杆式胸外按压CPR装置组(LDCPR)(n=6)和徒手标准CPR组(STCPR)(n=6)模拟院内心肺复苏场景进行CPR试验。LDCPR组采用手动杠杆式胸外按压CPR装置对模拟人进行连续6min连续胸外按压,STCPR组徒手对模拟人进行6min连续胸外按压。监测复苏期间按压的深度、频率以及按压者的心率和疲劳程度等变化。结果 随着连续胸外按压的进行,按压者的心率和疲劳程度都在不断增加,有效按压深度超过5 cm次数逐渐减少,但是在连续胸外按压的第4～6min,LDCPR组按压者的心率较STCPR组慢(P<0.05),疲劳程度较轻(P<0.05),有效按压的比例更高(P<0.05)。按压频率两组比较无明显差异。结论 在本模拟人试验中,手动杠杆式胸外按压CPR装置可减轻按压者疲劳,有助于提高院内CPR时长时间胸外按压的质量。

Objective We aimed to investigate simulated in-hospital cardiopulmonary resuscitation (CPR) quality and rescuer fatigue of external chest compression-only CPR by a manual leverage device(LDCPR). Methods All 12 volunteers (medical staffs: male 6 and female 6) were randomized to standard CPR by hand(STCPR)group (n=6)or LDCPR group(n=6). At STCPR group, continuous external chest compression-only was performed for 6 minutes to simulate in hospital cardiopulmonary resuscitation on a manikin; at LDCPR group, compression-only was performed for 6 minutes by a leverage device on a manikin. We measured blood pressure of the volunteers before and after performing each CPR technique, volunteers self-report fatigue scale and continuously monitored heart rate (HR) of the volunteers during each CPR technique by smart ring. CPR quality measures included chest compression rate and depth. Results During continuous external chest compression-only CPR, compressor's heart rate and fatigue scale were rising continuously, and percent of compress depth >5 cm were declining, too.Compressor's heart rate and fatigue scale were higher in the STCPR group than in the LDCPR group (P<0.05) during the fourth to sixth minutes CPR (P<0.05). Percent of compress depth > 5 cm was higher in the LDCPR group than in the STCPR group (P<0.05) during the fourth to sixth minutes of CPR (P<0.05).Compress rate had not differed between the 2 groups during CPR. Conclusion In the manikin study, manual leverage external chest compress device may reduce fatigue scale and improve long term compression quality during in-hospital cardiopulmonary resuscitation.

目的 观察比较术中及术前化疗干预对进展期胃恶性肿瘤手术患者p53、ki-67表达及预后的影响,为临床化疗时间的选择提供理论依据。方法 自2014年8月—2015年5月,我院共收入胃恶性肿瘤患者40例,将40例患者随机分为两组,每组各20例,保证两组患者在性别、年龄、胃癌分期等方面可比,无统计学差异(P＞0.05),标记为Ⅰ组和Ⅱ组。Ⅰ组20例患者于术前进行化疗干预,Ⅱ组在术中给予化疗干预。观察比较两组患者p53、ki-67表达状况及预后。结果 Ⅰ组及Ⅱ组治疗后p53及ki-67均比治疗前升高,差异有统计学意义(P<0.05)。但是治疗后,Ⅰ组和Ⅱ组的p53表达状况组间差异不明显,无统计学意义(P>0.05)。治疗前后,AI差异有统计学意义(P<0.05)。Ⅰ组效果明显好于Ⅱ组,两者差异有统计学意义(P <0.05)。术后六个月、一年随访时发现两组复发率、死亡率差别不大,无统计学意义(P>0.05),术后两年随访发现Ⅱ组复发率、死亡率明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论 术中化疗的疗效优于术前化疗,患者预后较术前化疗好。

Objective To observe the effect of intraoperative and preoperative chemotherapy on the expression of p53, Ki-67 and prognosis in patients with advanced gastric cancer. Methods 40 cases of advanced gastric cancer in our hospital from Aug 2014 to May 2015 were enrolled in the study, and were divide into 2 groups randomly. In group I, 20 patients received chemotherapy intervention befoerer operation, and the other group received chemotherapy intervention during operation. The expressions and prognosis of p53 and Ki-67 were observed and compared between the two groups. Results Group Ⅰ and group Ⅱ after treatment, p53 and Ki-67 were higher than that before treatment, with statistical significance(P<0.05). However, there was no significant difference in the expression of p53 between group Ⅰ and group Ⅱ after treatment, and there was no significant difference(P>0.05). Before and after treatment, the difference of AI was significant, with statistical significance (P<0.05). The effect of group Ⅰ was obviously better than that of group Ⅱ, the difference was statistically significant(P<0.05). Six monthse after the operation and one year follow-up found two groups of recurrence rate and mortality rate had no significant difference(P>0.05). After two years follow-up found the group Ⅱ recurrence rate, mortality was lower than in group Ⅰ (P<0.05). Conclusion The effect of intraoperative chemotherapy is better than that of preoperative chemotherapy, and the prognosis is better than that of preoperative chemotherapy.

目的 研究多排螺旋CT低剂量扫描在浸润型肺结核化疗期间复查的应用价值。方法 选取100例浸润型肺结核化疗期病人为研究对象,对选取100例患者行常规剂量胸部CT扫描后再行低剂量扫描。比较常规剂量组和低剂量组CT扫描的图像质量及疗效评估。结果 两组扫描肺窗图像质量比较无统计学差异(P＞0.05);两组肺窗薄层多平面重建图像质量比较无统计学差异(P＞0.05); 两组软组织窗图像质量有统计学意义(P< 0.05)。观察组ED、DLP和CTDIvol等指标低于对照组(P＜0. 01),即观察组受检者CT扫描辐射剂量低于对照组(P＜0.01)。结论 多排螺旋CT低剂量胸部扫描用于浸润型肺结核的复查,可以获得与常规剂量接近的肺窗图像质量,满足肺结核病灶的分析评估,并可有效减少胸部CT扫描中的辐射剂量;既能满足肺结核复查的疗效评估,又提高了肺结核CT复查的安全性,还有效节约检查成本。

Objective To study the application of low-dose scan of multidetector row CT(MDCT)in the chemotherapy of infiltrative tuberculosis. Methods 100 patients with infiltrative pulmonary tuberculosis who were under treatment were selected. All patients accepted conventional-dose and low-dose scan of MDCT. The image quality and treatment effect of two groups were compared. Results The image quality on lung window of two groups did not differ significantly(P＞0.05). The image quality on lung window with multiplanar reconstruction of two groups also did not differ significantly(P＞0.05). The image quality on soft-tissue window differed significantly (P<0.05). The ED, DLP and CTDIvol of the low-dose group were significantly lower than those of the conventional-dose group. Conclusion For MDCT follow-up examination of patients with infiltrative tuberculosis, the image quality on lung window with low dose is similar to the image quality with conventional dose. It may effectively reduce the exposure dose of CT examination. This cost-effective modality not may can meet the curative effect evaluation of TB, but also can improve the security of the follow-up examination of patients.