目的 利用基质辅助激光解吸电离飞行时间质谱系统(VITEK-MS)对体液培养阳性瓶进行直接鉴定,探索快速诊断临床致病菌的新策略。方法 收集体液培养阳性瓶,不经琼脂平板培养,直接利用VITEK-MS进行鉴定,并与传统生化鉴定的方法进行比较分析。结果 50例体液培养阳性瓶中,传统细菌鉴定法检出47株阳性菌,3例阴性;而VITEK-MS直接鉴定法检出31株阳性菌,同样3例阴性。VITEK-MS直接鉴定法灵敏度达65.96%,特异度为100%,临床符合率为68%。鉴定时间从24小时缩短到2小时。结论 利用VITEK-MS质谱系统直接鉴定体液培养阳性标本中的病原菌,能有效缩短细菌鉴定时间,准确快速地诊断临床致病菌。

Objective To find a fast method for detection of pathogens in positive culture bottles by using the VITEK-MS system. Methods VITEK-MS microbial identification system was used to directly identify the bacteria in the positive culture bottles, without culture on agar plates. The identification results were further compared with those by the traditional biochemical identification. Results Forty-seven bacterial strains were identified by traditional biochemical methods among 50 positive culture bottles, and 3 of them were negative. Of these 50 samples, thirty-one bacterial strains were identified by VITEK-MS and 3 were also negative. The sensitivity and specificity for direct VITEK-MS identification were 65.96% and 100%, and the clinical coincidence rate was 68%. The turn around time for identification was reduced from 24 to 2 hours. Conclusion Direct identification of bacterial pathogens in positive culture bottles by VITEK-MS could reduce turn around time, and lead to accurate and fast diagnosis.

目的 探讨Foxp3-924(rs2232365)基因位点多态性与产后抑郁的相关性。方法 选取211例在越秀区光塔街社区卫生服务中心分娩的产妇进行回访研究,所有产妇均经PCR-SSP技术对Foxp3-924(rs2232365)基因位点分型。结果 对比产后抑郁组与对照组产妇Foxp3-924各种基因型频率,结果显示均无差异(P>0.05)。结论 产后抑郁和Foxp3-924(rs2232365)位点基因多态性无较大关联。

Objective To investigate the distribution of-924(rs2232365) genotypes and to explore the correlation between gene loci polymorphism and postpartum depression. Methods In puerpera in Yuexiu district Guangta street community health center, there were 211 cases of childbirth study visits, who were confirmed by PCR-SSP technique Foxp3-924 (rs2232365) gene locus genotyping. Results Compared postpartum depression group and control groupFoxp3-924 various genotypes, it showed no great difference (P> 0.05). Conclusion It has no greater relevance between postpartum depression and Foxp3-924 (rs2232365) polymorphism loci.

目的 探讨医护一体化伤口管理模式在腰椎疾患术后伤口换药中的应用效果。方法 2014年3月—2014年8月对90例行脊柱内固定术后的腰椎疾患患者采用随机数字法将其分为管理组和对照组,管理组的患者术后换药实施医护一体化伤口管理模式,对照组采用传统方法进行伤口换药,对患者的伤口感染率、住院时间、等待换药时间、再次换药率、耗损费用及患者对医护人员满意的及自身舒适度进行统计学分析。结果 两组患者在伤口感染率无统计学差异,但医护一体化伤口管理模式应用的管理组在住院时间、等待换药时间、再次换药率、耗损费用及患者对医护人员满意的及自身舒适度效果优于传统伤口管理,差异有统计学意义(P<0.05)。结论 医护一体化伤口管理是通过医护的合作完成,在等待换药的时间、再次换药耗损费用、患者自身舒适度对及医护人员满意度优于传统换药组,创新了护理服务范畴,值得进行推广。

目的 通过对2011—2014年发生在本院的医疗纠纷进行统计分析,为医院持续PDCA改善服务质量,制定管理措施,减少医疗纠纷的发生提供理论依据。方法 对医务部医患关系办公室的纠纷登记数据汇总分析。结果 医疗纠纷的发生呈逐年下降趋势,但在接诊患者超过一定数量时出现反弹;外科部、内科部、产科部为纠纷多发部门;急诊科、新生儿科为纠纷高发科室;超过60%的医疗纠纷与医患沟通不足有关。结论 通过PDCA医疗质量管理,可以减少医疗纠纷的发生,医院在接诊量过大时应采取应对措施;医疗纠纷的多发部门、科室有规律性,应对纠纷重点部门加强管控;加强医患有效沟通是减少医疗纠纷发生的重要措施。

目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.

目的 探讨老年2型糖尿病患者牙周病发生情况及相关因素,为开展综合预防和治疗措施提供参考。方法 选取到我院住院治疗的老年2型糖尿病患者273例,检查其牙周病患病情况,同时收集年龄、性别、文化程度、体重指数、病程、吸烟、空腹血糖、糖化血红蛋白、刷牙习惯等资料,比较牙周病患病组与未患病组之间上述资料的差异,探讨导致牙周病发生的影响因素。结果 273例研究对象中患有牙周病154例(56.41%),其中,牙龈炎60例,牙周炎94例。牙周病组平均存留牙数(18.54±6.31)颗,未患牙周病组平均存留牙数(21.62±7.48)颗(t=3.679,P<0.001)。年龄较大(P<0.001)、病程较长(P<0.001)、吸烟(P<0.001)、空腹血糖(P<0.001)和糖化血红蛋白(P<0.001)水平较高是老年2型糖尿病患者发生牙周病的危险因素,而文化程度高(P=0.017),刷牙>1次/d(P<0.001),竖刷(P=0.004),使用牙线(P=0.004)是其保护因素。结论 老年2型糖尿病患者中牙周病患病率较高,临床上应做好三级预防措施,降低牙周病发生风险因素的暴露。

Objective To explore the periodontal disease occurrence and its factors for elderly type 2 diabetes patients, providing reference for comprehensive prevention and treatment measures. Methods 273 cases of elderly in-patients with type 2 diabetes in our hospital were enrolled. We checked their periodontal disease conditions, collected information including age, sex, educational level, body mass index, disease duration, smoking, fasting blood glucose, glycosylated hemoglobin, brushing habits. These values were compared between periodontal disease group and no periodontal disease group. Results People with periodontal disease in 273 cases of the object of study included 154 patients (56.41%), among them, gingivitis 60 cases, 94 cases of periodontitis. The teeth number was (18.54±6.31) for periodontal disease group on average, with (21.62 ±7.48) for no periodontal disease group (t=3.679, P<0.001). Older (P<0.001), longer course of disease (P<0.001), smoking (P<0.001), higher fasting blood glucose (P<0.001) and higher glycosylated hemoglobin (P<0.001) were risk factors of periodontal disease for elderly patients with type 2 diabetes. And well-educated (P=0.017), brushing teeth frequency > 1 / d (P<0.001), vertical brush mode (P=0.004), the use of dental floss (P=0.004) were the protective factors. Conclusion Periodontal disease prevalence is high in elderly patients with type 2 diabetes. The three level preventive measures should be strengthened to reduce the exposure of the periodontal disease risk factors.

目的 探讨2型糖尿病肾病(DN)患者肾组织中STOML2的表达及作用。方法 免疫组化检测临床2型糖尿病肾病患者肾组织STOML2的表达及定位,采用慢病毒转染方法建立稳定过表达STOML2的HK-2细胞系,并应用Western blot检测肾小管上皮细胞钙粘蛋白(E-cadherin)、Fibronectin和STOML2的表达。结果 STOML2在DN患者肾组织的肾小管上皮细胞胞浆中表达明显升高。在高糖刺激HK-2细胞建立的EMT模型中,STOML2呈时间依赖表达上调。STOML2稳定高表达时,E-cadherin表达下调,而Fibronectin明显上调,即能促进肾小管上皮细胞发生EMT。结论 STOML2可能通过促进肾小管上皮细胞向间充质细胞分化,进而参与糖尿病肾病肾脏纤维化的发生发展。

Objective To investigate the expression and role of STOML2 in renal tissue of patients with type 2 diabetic nephropathy. Methods To detect he expression and localization of STOML2 in clinical renal tissue in patients with type 2 diabetic nephropathy by immunohistochemistry, and use lentiviral transfection method to establish a stable cell line of over-expressing STOML2, lastly apply western blot to detect the expression of E-cadherin, Fibronectin and STOML2 in renal tubular epithelial cells. Results STOML2 was significantly increased in renal tubular epithelial cytoplasm of patients with DN. In the EMT model of HK-2 cells stimulated by high glucose, STOML2 was increased in a time dependent. Overexpression of STOML2 led to E-cadherin down-regulated, while Fibronectin up-regulated, which promoted the occurrence of EMT in renal tubular epithelial cells. Conclusion STOML2 may be involved in the development and progression of renal fibrosis in diabetic nephropathy by mediating epithelial- mesenchymal transition of renal tubular epithelial cells.

目的 分析影响广州青少年自杀行为的因素。方法 选取100例自杀行为青少年为观察组,选100例健康青少年为对照组,对比两组青少年家庭结构、家庭教育方式、自身人格特征等指标。多因素Logistic回归分析其自杀行为危险因素。结果 观察组青少年抑郁量表、焦虑量表、攻击性人格及冲动性人格量表分值均高于对照组高;单亲家庭或父母常年在外、家庭教育方式不当、学校无健康心理教育课、抑郁或焦虑、冲动或攻击性人格、负面事件、消极应对是青少年自杀行为独立危险因素,P均＜0.05。结论 家长及学校应正确引导青少年处事方式,积极面对生活,打消自杀意念。

Objective To analyze the factors influencing the suicide behavior of adolescents in Guangzhou. Methods The 100 cases of adolescent suicide behavior were selected as the observation group, 100 healthy adolescents were selected as control group, compared with two groups of adolescent family structure, family education, personality traits and other indicators. Multivariate logistic regression analysis of risk factors was taken for suicidal behavior. Results In the observation group adolescent depression scale, anxiety scale, attack impulse personality and personality amount scores were higher than those in the control group, single parent family or parents staying outside, improper family education, school health psychological education, depression or anxiety, impulsivity, or aggressive personality, negative events, negative coping were independent risk factors for adolescent suicide, P<0.05. Conclusion Parents and schools should have guide to adolescents, toface life positively, and give up thought of suicide.

目的 对不同周龄的KO小鼠与WT小鼠进行悬尾实验进行观察,探讨KO小鼠与WT小鼠的行为差别。方法 采用健康的试验动物180只分两组:①KO组(4、6、8周龄,各周龄30只,雌雄各半,共90只)②WT组(4、6、8周龄,各周龄30只,雌雄各半,共90只);通过悬尾实验观察性别,年龄对不动时间的影响。结果 同龄KO雌性小鼠比雄性小鼠的静止时间差别不大;随着年龄增大,静止时间增长。 同龄同性别的KO鼠比WT鼠的不动时间长。P<0.05;同龄雄性小鼠比雌性小鼠的不动时间短; 随年龄增长各种系小鼠不动时间增长,KO鼠的不动时间比WT鼠长,P<0.05。结论 KO小鼠存在抑郁行为表型。

Objective To observe tail suspension test in Fmr1 gene knockout mice and to explore whether there are differences in mobility of KO and WT mice. Methods 180 test mice were divided into two groups: ① KO group (4,6,8 weeks old, each age group of mice is 30, male and female in half, a total of 90) ② WT group (4,6, 8 weeks old, each group of mice is 30, male and female on half, a total of 90). Through forced swimming test and tail suspension test to observe gender, age effect on immobility time. Results With the same age of the same sex,the KO mice's immobility time was longer than WT mice's. P<0.05. With the same age,the male mice's immobility time was shorter than female mice's. With the age increase, the immobility time of KO mice was longer than WT mice. P<0.05. Conclusion Fmr1 gene knockout mice have anxiety and depressive behavior.

目的 观察多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗幽门螺杆菌(Hp)感染消化性溃疡的临床疗效和不良反应。方法 选取于2013年7月—2015年7月收治的98例Hp感染消化性溃疡患者,根据不同的治疗方式,随机将其分为治疗组和对照组,每组各49例,治疗组患者给予多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗;对照组给予克拉霉素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗, 两组患者连续服用10天后,均口服泮托拉唑40 mg,每天1次,总疗程为4周。疗程结束4周后,予胃镜复查和Hp检查,观察两组患者的临床疗效、溃疡愈合率、Hp根除率及不良反应。结果 治疗组与对照组患者的临床效果总有效率分别是95.91％、81.63％;治疗组与对照组患者的溃疡愈合率分别是83.67％、61.22％ ;治疗组与对照组患者的Hp根除率分别是89.79％、65.30％;治疗组患者的临床疗效总有效率、溃疡愈合率和Hp根除率均明显优于对照组,差异均有统计学意义(P<0.05),两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗Hp感染消化性溃疡疗效显著、溃疡愈合率高、Hp根除率高、且安全无明显不良反应,值得临床广泛推广使用。