目的 观察紧密连接蛋白在高尿酸血症致大鼠肾损害模型中的表达变化以及非布司他的干预疗效。方法 将SD大鼠分为正常组,高尿酸血症组(模型组),非布司他组(干预组);氧嗪酸联合尿酸诱导制作高尿酸血症大鼠模型,给予非布司他进行干预,分别于6周后检测各组大鼠血中尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)水平,免疫组化及RT-PCR方法检测紧密连接蛋白包括膜周蛋白-1(ZO-1)、跨膜蛋白(occludin) 的表达变化,采用Masson染色检测大鼠肾间质病理改变。结果 6周时,模型组、干预组ZO-1、occludin表达较正常组降低(均P<0.05);干预组ZO-1、occludin表达较模型组增加,差异有统计学意义(均P<0.05),与正常组相比,模型组、干预组RIF指数均增高(均P<0.05),干预组RIF指数低于模型组,高于正常组(均P<0.05)。结论 紧密连接蛋白表达的降低在高尿酸血症肾间质纤维化发展过程中起着举足轻重的作用,并与血尿酸水平及肾功能损害密切相关。非布司他通过降低血尿酸水平,能改善紧密连接蛋白的表达,延缓肾功能损害,起到肾保护作用。

Objective To observe the expression of tight junction protein in hyperuricemia induced renal damage model in rats and the intervention effect of febuxostat. Methods SD rats were randomly divided into three groups: normal control group, model control group, febuxostat treatment group. Hyperuricemia was induced in rats with oxonic acid per time for three times per day, by gavage and combined with uric acid added in drinking water, while febuxostat were administered by gavage in febuxostat treatment group.The blood of rats were collected to analyse the differences of control, model and treatment group on changes of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA). Immunohistochemistry was used to assay ZO-1 and occludin protein expression and quantitive real time PCR to detect the expression of ZO-1 and occludin in renal tissue of renal interstitial fibrosis model rats induced by hyperuricemia. Paraffin section of kidney was maked and then performed Masson staining to make sure the model is successful. Results At 6 weeks, the expressions of ZO-1 and occludin in the model group and treatment group were lower than those in the normal group (all P<0.05). The expressions of ZO-1 and occludin in the treatment group were higher than those in the model group (all P<0.05). Compared with the normal group, the RIF index in the model group and treatment group were higher (all P<0.05), and the RIF index in the treatment group was lower than that in the model group and higher than that in the normal group (all P<0.05). Conclusion The downregulated expression of ZO-1 and occludin plays a crucial role during the development of hyperuricemia in renal interstitial fibrosis, and are closely related to UA level and renal function impairment. Febuxostat may improve the expression of tight junction by downregurating UA, reduce renal fuction impairment and play a role in renal protection.

目的 利用高精确的外照射治疗技术,即图像引导放射治疗/容积旋转调强放疗(IGRT/VMAT) 时,使用千伏锥形束CT (kV-CBCT)定位来获得最佳的宫颈癌治疗获益。方法 205例接受IGRT/VMAT治疗的宫颈癌患者纳入实验组。每周做一次kV-CBCT定位后,将这些图像与计划CT扫描图像匹配后记录摆位误差。总共研究了1 025个kV-CBCT图像。采取同时期常规X片定位的90例宫颈癌患者作为对照组。根据定位中的摆位误差计算计划靶区(PTV)的边界。结果 实验组前后、上下和左右方向的摆位误差分别为(1.8±1.1)mm、(2.8±2.2)mm和(1.7±1.4)mm,对照组分别为(2.8±2.1)mm、(3.9±2.2)mm和(2.7±2.4)mm,两组差异具有统计学意义(P<0.05)。实验组前后、上下和左右方向的CTV-PTV边界分别为5.27 mm、8.54 mm和5.23 mm,对照组分别为8.47 mm、11.29 mm和8.43 mm。结论 在采用高精度技术治疗宫颈癌时,每周kV-CBCT是一种令人满意的精确定位方法,有助于减少CTV-PTV边界。

Objective To obtain the best cervical cancer treatment benefit through kilovoltage cone-beam CT (kV-CBCT) positioning, by using high-precision external beam therapy technology, that is, image-guided radiation therapy/volumetric modulated arc therapy (IGRT/VMAT). Methods Two hundred and five patients with cervical cancer treated with IGRT/VMAT were included in the experimental group. After kV-CBCT positioning once a week, these images were matched with the planned CT scan images and the setup errors were recorded. A total of 1 025 kV-CBCT images were studied. Ninety patients with cervical cancer positioned by conventional X-ray during the same period were selected as the control group. The boundary of the planned target volume (PTV) was calculated based on the setup errors. Results In the experimental group, the setup errors in the anteroposterior, superoinferior and mediolateral direction were (1.8±1.1) mm, (2.8±2.2) mm, and (1.7±1.4) mm, respectively. And in the control group, the setup errors were (2.8±2.1) mm, (3.9±2.2) mm, and (2.7±2.4) mm, respectively. The differences between the two groups were statistically significant (P<0.05). In the experimental group, the CTV-PTV boundaries in the anteroposterior, superoinferior and mediolateral direction were 5.27 mm, 8.54 mm, and 5.23 mm, respectively. And in the control group, the CTV-PTV boundaries were 8.47 mm, 11.29 mm, and 8.43 mm, respectively. Conclusion When using high-precision technology to treat cervical cancer, weekly kV-CBCT is a satisfactory and accurate positioning method, which helps to reduce the CTV-PTV boundary.

目的 观察乳腺癌术后辅助化疗联用槐耳颗粒对内分泌激素及生存期的影响。方法 选取我院肿瘤科于2016年7月—2019年7月进行乳腺癌治疗术的80例乳腺癌患者,将患者按照随机数表法分为观察组与对照组,两组各40例。两组患者均给予预防性止吐等常规治疗,对照组予以表柔比星联合紫杉醇静脉注射,观察组在对照组的基础上给予槐耳颗粒,两组患者均治疗6个月,对比两组患者治疗3个月后血清黄体生成素(LH)、卵泡雌激素(FSH)、雌二醇(E₂),对比两组患者生存时间、无疾病进展生存期及1年生存率。结果 观察组与对照组LH、FSH、E₂水平对比均P＜0.05。在治疗后通过电话、视频等对所有患者进行随访,随访期间两组患者均无失访,生存时间、无疾病进展生存期、1年生存率对比均有P＜0.05。结论 在乳腺癌术后辅助化疗期联用槐耳颗粒可有效改善内分泌激素指标,并使生存时间获益。

Objective To observe the effect of adjuvant chemotherapy combined with Huaier granule on endocrine hormone and survival time after breast cancer operation. Methods A total of 80 cases of breast cancer patients underwent breast cancer treatment in the oncology department of our hospital from July 2016 to July 2019 were selected and divided into two groups according to the random number table method. The control group and the observation group had 40 cases each.Two groups of patients were given preventive anti-nausea and other conventional treatment, the control group was treated with epirubicin and paclitaxel intravenous injection, the observation group was treated with Huaier granuleon the basis of treatment of the control group, two groups of patients were treated for 6 months.The serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol (E₂) were compared between the two groups after 3 months of treatment. The survival time, progression free survival and 1-year survival rate of the two groups were compared. Results The levels of LH, FSH and E₂ in the comparison between two groups were all P<0.05.After treatment, all patients were followed up by telephone or video. During the follow-up period, there was no loss of follow-up in the two groups. The survival time, progression free survival and 1-year survival rate of the two groups were all P<0.05. Conclusion Huaier granule can effectively improve endocrine hormone indexes and survival time in adjuvant chemotherapy period after breast cancer surgery.

目的 分析异种脱细胞基质在腮腺手术中的应用价值。方法 分析97例在我科行腮腺手术的患者,其中观察组52例在腮腺全部或者部分切除后术腔植入异种脱细胞基质生物膜,另外对照组45例术后术腔未放置任何移植物以及其他自体组织填充于术腔,只给予逐层缝合,对比两组患者手术时间、术后引流总量、引流管拔除时间、术后疼痛程度以及涎腺瘘的发生率。结果 两组患者手术时间无差异,观察组的术后引流总量、引流管拔除时间、术后疼痛程度以及术后涎腺瘘的发生率均少于对照组。结论 异种脱细胞基质置入腮腺术后术腔内,可减少术腔引流管放置的时间,减轻患者术后的不适感,降低涎腺瘘的发生率,病人可获益。

Objective To evaluate the effect of heterogeneous acellular dermal matrix in parotidectomy. Methods Ninety-seven patients underwent parotidectomy in our hospital were divided into two groups, including 52 cases implanted biofilm of heterogeneous acellular dermal matrix in parotid gland cavity after total or partial resection as observation group, and 45 cases of postoperative cavitywere not filled graft or other autologous tissue, only given demixing suture as control group. The operation time, total amount of postoperative drainage, drainage tube removal time, postoperative pain degree and the sialosyrinx incidence were compared between two groups after surgery. Results There was no statistical difference in the operation time between the two groups. The total amount of postoperative drainage, the drainage tube removal time, the postoperative pain degree and sialosyrinx incidence in the observation group were all lower than those in the control group. Conclusion Heterogeneous acellular dermal matrix implantation is an effective method to reduce the time of placing the drainage tube in the operative cavity, relieve the postoperative discomfort, and reduce sialosyrinx incidence after parotidectomy, which can benefit the patients.

目的 探讨微量喂养对早产儿早期喂养不耐受喂养结局的影响。方法 选择我院2019年1月—2020年6月胎龄≤34周、出生后1周内反复出现喂养不耐受的早产儿78例,采用随机数字表法分为微量喂养组(38例)和中断喂养组(40例),比较两组患儿喂养不耐受的改善及喂养结局的差异性。结果 相对于直接中断喂养,微量喂养3～5天的患儿喂养不耐受改善率更高、体质量增长速度更快、更早达完全肠内喂养时间、静脉营养时间和住院时间也缩短了。而且胆汁淤积症发生率也低于中断喂养组,差异具有统计学意义,两组坏死性小肠结肠炎发生率比较无差异。结论 对于胎龄≤34周、生后1周内反复出现喂养不耐受的早产儿,在排除了外科或败血症早期表现的情况下,相对于中断喂养,选择微量喂养可改善患儿的喂养结局,而且不会增加坏死性小肠结肠炎的发生。

Objective To investigate the effect of minimal feeding on the outcome of early feeding intolerance in premature infants. Methods Seventy-eight premature infants with gestational age＜34 weeks and recurrent feeding intolerance within 1 week after birth in our hospital from January 2019 to June 2020 were selected. They were randomly divided into minimal feeding group (38 cases) and interrupted feeding group (40 cases) to compare the improvement of feeding intolerance and the difference of feeding outcome between the two groups. Results Compared with discontinuation of feeding, the rates of feeding intolerance improvement were higher in children who were given minimal feeding for 3-5 days,and they had faster weight gainand, the time to complete enteral feeding got earlier, intravenous nutrition time and hospitalization time were also shortened. Moreover, the incidence of cholestasis was also lower than that of the interrupted feeding group, and the difference was statistically significant. There was no difference in the incidence of necrotizing enterocolitis between the two groups. Conclusion For premature infants with gestational age＜34 weeks and feeding intolerance happened within 1 week after birth, excluding the early manifestation of surgery or sepsis, minimal feeding can improve the feeding outcome of the infants compared with discontinuation of feeding, without increasing the incidence of necrotizing enterocolitis.

目的 分析慢性肾衰竭患者接受肾衰康方治疗对其血清微炎症状态的影响及肾功能的保护作用。方法 将2020年1月—2020年12月作为研究时间段,选取期间广东祈福医院接诊的50例慢性肾衰竭患者,另将随机数字表法作为分组依据,将全部病例分为对照组(行常规治疗,纳入25例)、观察组(加用肾衰康方治疗,纳入25例),对组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标展开分析。结果 组间中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗前无明显差异,P>0.05;观察组中医症状评分、血清微炎症状态、肾功能指标、氧化应激指标在治疗后优于对照组,P<0.05。结论 肾衰康方对改善慢性肾衰竭患者血清微炎症状态、氧化应激水平、临床症状均有较好效果,且能保护肾功能,值得推广。

Objective To analyze the effect of Shenshuaikang decoction on serum microinflammation and renal function in patients with chronic renal failure. Methods From January 2020 to December 2020, 50 patients with chronic renal failure treated by Clifford Hospital were selected, and the random number table method was used for grouping. All cases were divided into control group (n=25) and observation group (n=25). The TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index were analyzed. Results There were no significant differences in TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index between the two groups before treatment, P>0.05; the TCM symptom score, serum microinflammatory state, renal function index and oxidative stress index of the observation group were better than those of the control group after treatment, P<0.05. Conclusion Shenshuaikang decoction has good effect on improving serum microinflammation, oxidative stress level and clinical symptoms of patients with chronic renal failure, and also can protect renal function, which is worthy of promotion.

目的 探讨内镜黏膜下剥离术(ESD)治疗结直肠高级别上皮内瘤变(HGIN)的安全性及临床疗效。方法 回顾性分析2016年1月—2019年6月在南方医科大学附属小榄医院经肠镜活检诊断为结直肠HGIN并接受ESD治疗的56例患者的临床资料,记录每例病变的术后病理、整块切除率、治愈性切除率、手术并发症和随诊结果。结果 病灶平均直径为(2.28±0.76) cm。53例经ESD术完整切除,3例术中改用内镜下黏膜分片切除术切除,整块切除率为94.64％ (53/56)。术后病理51例HGIN,2例HGIN伴黏膜内癌,2例浸润性癌,术前活检与术后病理总符合率为92.86%(52/56),治愈性切除率为96.43%(54/56)。术中出血发生率为89.29%(50/56),术后迟发性出血发生率为3.57%(2/56)。术中穿孔发生率为5.36%(3/56),无术后迟发性穿孔病例。中位随访期为17个月,期间共1例患者复发。结论 ESD术治疗结直肠HGIN安全有效,但需警惕浸润性癌的可能。ESD术具有较高的术中出血和穿孔的风险,术者需具备熟练的操作技术及处理手术并发症的经验。

Objective To investigate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) for colorectal high-grade intraepithelial neoplasia (HGIN). Methods Data of 29 patients diagnosed as colorectal HGIN and underwent endoscopic submucosal dissection (ESD) from January 2016 to June 2019 were retrospectively analyzed. Postoperative pathology, total en bloc resection rate, curative resection rate, complication and follow-up results were recorded. Results The mean diameter of the lesions was (2.28±0.76) cm. A total of 53 cases were successfully treated by ESD, 3 cases were changed using endoscopy piecemeal mucosal resection, the en bloc resection rate was 94.64% (53/56). Postoperative diagnosis confirmed 52 cases of HGIN, 2 cases of HGIN with intra-mucosal cancers and 2 case of invasive cancer,the overall consistency rate between preoperative biopsies and postoperative pathological diagnosis was 92.86% (52/56), the curative resection rate was 96.43% (54/56). The incidence of intro-operative bleeding and postoperative delayed bleeding was 89.29% (50/56) and 3.57% (2/56) respectively. The incidence of intro-operative perforation was 5.36% (3/56) and no delayed perforation occurred. The median follow-up period was 17 months and one case recurred. Conclusion ESD is a safe and effective treatment for colorectal HGIN, but invasive cancer must be cautioned. ESD has high risk of intro-operative bleeding and perforation, therefore, the surgeon must have skilled operation and treatment experience for complications.

目的 分析献血者乙型肝炎病毒(HBV)核酸检测非重复反应性确认及追踪结果。方法 对1 200例于我站无偿献血者的血液样本进行非重复反应性确认,补充乙肝“两对半”检测,并对其部分单项核酸检测反应的患者予以回访结果追踪。结果 1 200份无偿献血血液样本单项核酸检测有反应性者150份(12.50%)。150份单项核酸检测有反应性样本经重新病毒核酸检测后,仍有58例样本有反应性(38.67%)、92例样本为非反应性(61.33%)。其中有18例献血者实际召回抽血,完成两次追踪,第一次追踪60~125天,第二次追踪间隔天数在160~356天,第一次追踪HBV DNA有反应(+)8例,第二次追踪仍存在反应(+);7例HBV DNA有反应者存在抗-HBc阳性(+)。核酸反应检测HBV-DNA阳性值10~17有37.25%,高于核酸反应检测值<10的4.17%(P<0.05)。结论 部分单项核酸检测反应无偿献血者存在一定的输血传播HBV风险,多为HBV隐匿性感染,此时需要重视其输血情况,屏蔽单项核酸反应性献血者。

Objective To analyze the results of nonrepetitive reactivity of HBV nucleic acid detection in blood donors. Methods 1 200 blood samples from our station were confirmed by nonrepetitive reaction, supplemented with the “two to half” test of hepatitis B, and some patients with single nucleic acid detection were followed up. Results One hundred and fifty samples (12.50%) were reactive in single nucleic acid detection in 1 200 blood samples. After the virus nucleic acid detection, 58 samples were reactive (38.67%), 92 were nonreactive (61.33%). 18 donors were actually recalled and drew blood, completed two tracking. The first tracking time was 60-125 days, the second time interval was 160-356 days. In the first tracking 8 cases had HBV DNA reaction (+) , which still had reaction in the second tracking; 7 HBV DNA positive donors had HBC antibody (+).The proportion of HBV-DNA positive with 10-17 value in mucleic acid reaction test(37.25%) was higher than that with value below 10(4.17%,P＜0.05). Conclusion Some donors with single nucleic acid detection reaction have a certain risk of transmission of HBV, most of them had hidden infection of HBV. At this time, we should pay attention to the blood transfusion and avoid the single nucleic acid reactive donors.

目的 探讨肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值。方法 选取2018年1月—2020年1月我院收治的64例肝硬化患者(肝硬化组),并纳入同期来我院接受健康体检者64例(对照组),应用全自动血凝仪对肝硬化患者临床凝血指标检测。再将肝硬化组患者分为出血组与无出血组,比较对照组与肝硬化组、出血与无出血组、不同肝功能分级患者血小板参数与PT检测结果。结果 与对照组比较,肝硬化组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与肝硬化无出血组比较,肝硬化出血组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与Child-Pugh A级患者比较,肝硬化Child-Pugh B级与C级患者PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05)。结论 在肝硬化患者病情评价中凝血功能检验发挥重要作用,可为患者临床治疗提供有效理论依据,诊断准确率较高,有利于临床治疗措施制定。因此,凝血功能检验应在肝硬化疾病诊断中广泛应用。

Objective To explore the application and clinical value of automatic blood coagulation apparatus in clinical coagulation function test of patients with cirrhosis. Methods A total of 64 patients with cirrhosis admitted to our hospital from January 2018 to January 2020 (cirrhosis group) were selected, and 64 healthy subjects admitted to our hospital during the same period (control group) were included. The clinical coagulation indexes of patients with cirrhosis were detected by automatic blood coagulation apparatus. Patients in cirrhosis group were divided into bleeding group and non-bleeding group; platelet parameters and PT test results were compared between control group and cirrhosis group, bleeding group and non-bleeding group, and patients with different liver function grades. Results Compared with the control group, the levels of PDW, PT, MPV and INR in cirrhosis group were higher, and the levels of PCT and PLT were lower (P＜0.05). Compared with liver cirrhosis non-bleeding group, the levels of PDW, PT, MPV and INR were higher in liver cirrhosis with bleeding group, and the levels of PCT and PLT were lower (P＜0.05). Compared with Child-Pugh A patients, the levels of PDW, PT, MPV and INR in Child-Pugh B and C patients with cirrhosis were higher, and the levels of PCT and PLT were lower (P＜0.05). Conclusion The test of coagulation function plays an important role in the evaluation of patients with cirrhosis, and can provide effective theoretical basis for the clinical treatment of patients with high diagnostic accuracy, which is conducive to the formulation of clinical treatment measures. Therefore, the test of coagulation function should be widely used in the diagnosis of cirrhosis.

目的 探讨超声引导下宫颈癌根治术的应用效果及对患者远期生存率的影响。方法 选取本院2015年1月—2017年12月共收治的70例宫颈癌患者作为研究对象,将2016年7月—2017年12月纳入的患者作为观察组,2015年1月—2016年6月纳入的患者作为对照组,各35例,给予对照组患者常规腹腔镜根治术,给予观察组患者超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗。对比两组患者的治疗效果、远期生存率与复发率以及术后6个月、1年、2年、3年的FACT-G评分情况。结果 两组疾病控制率对比无差异(97.14% vs 85.71%,P＞0.05);观察组的治疗总有效率为高于对照组的(85.71% vs 60.00%,P＜0.05);观察组和对照组患者1年生存率对比无差异(P＞0.05),观察组2年、3年生存率高于对照组(P＜0.05),观察组和对照组1年局部复发率对比无差异(P＞0.05),观察组的2年、3年局部复发率低于对照组(P＜0.05);观察组术后6个月、1年、2年、3年的FACT-G评分高于对照组(P＜0.05)。结论 应用超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗宫颈癌能够提升患者的治疗效果,减少疾病复发和提高远期生存率,提升患者的生存质量,值得临床应用推广。

Objective To investigate the application effect of ultrasound-guided radical hysterectomy for cervical cancer and its influence on the long-term survival rate of patients. Methods A total of 70 patients with cervical cancer admitted from January 2015 to December 2017 were selected as the research subjects, and the patients enrolled from July 2016 to December 2017 were selected as the observation group, patients from January 2015 to June 2016 as the control group, each with 35 cases. The control group was given conventional laparoscopic radical hysterectomy, and the observation group was given ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation technology. The treatment effect, long-term survival rate, recurrence rate and FACT-G scores 6 months, 1 year, 2 years and 3 years after operation were compared between the two groups. Results There were no significant differences in disease control rates between the two groups (97.14% vs 85.71%, P>0.05); the total effective rate of treatment in the observation group was higher than that in the control group (85.71% vs 60.00%, P<0.05). There was no significant difference in the 1-year survival rate between the observation and the control group (P>0.05). The 2-year and 3-year survival rate of the observation group were higher than that of the control group (P<0.05). There was no significant difference in comparison of 1-year local recurrence rate between the observation group and the control group (P>0.05). The 2-year and 3-year local recurrence rate of the observation group were lower than that of the control group (P<0.05). FACT-G scores in the observation group after surgery at 6 months, 1 year, 2 years, and 3 years were significantly higher than the control group (P<0.05). Conclusion The application of ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation in the treatment of cervical cancer can improve the treatment effect, reduce disease recurrence rate, increase long-term survival rate, and improve the quality of life of patients, which is worthy of clinical application and promotion.