目的 探讨不同年龄段皮罗序列征患儿血气分析的特点、手术后机械通气时间和住院时间。方法 收集新生儿及非新生儿III度皮罗序列征(PRS)患儿各30例,PRS患儿入院后通过桡动脉进行采集血标本进行血气分析,比较2组血标本的 pH 值、PCO₂ 、PO₂ 、HCO^-₃、BE、乳酸、AG、A-aDO₂的特点、手术后机械通气时间及住院时间。结果 新生儿组PCO₂、HCO^-₃、BE、乳酸及A-aDO₂高于非新生儿组,非新生儿组PO₂及AG高于新生儿组。2组pH值、PO₂、AG均在正常范围,机械通气及住院时间与乳酸呈正相关,与年龄呈负相关。结论 不同的年龄阶段,PRS患儿的动脉血气分析的结果不同,高乳酸与低年龄PRS患儿手术后机械通气时间及住院时间长。

Objective To investigate the characteristics of arterial blood gas analysis, time of mechanical ventilation and hospital stay in different age patients with Pirre Robin sequence (PRS). Methods Sixty children with III-grade PRS were divided into two groups according to their age, as neonate group and non-neonate group. The blood samples were collected from radial artery after admission for blood gas analysis, the characteristics of pH value, partial pressure of carbon dioxide (PCO₂), partial pressure of blood oxygen (PO₂), bicarbonate ion (HCO^-₃), base excess (BE), lactic acid (Lac), anion gap (AG) , alveolar artery oxygen pressure difference (A-aDO₂) , postoperative mechanical ventilation time and hospital stay were compared between the two groups. Results The levels of PCO₂, HCO^-₃, BE, Lac and A-aDO₂ in neonate group were higher than those in non-neonate group, and the levels of PO₂ and AG in non-neonate group were higher than those in neonate group. The pH value, PO₂ and AG of the two groups were in the normal range. Post-operative mechanical ventilation time and hospital stay were positively correlated with Lac and negatively correlated with age. Conclusions In different age groups, the results of arterial blood gas analysis in PRS children were different, and the time of mechanical ventilation and hospital stay were longer in higher Lac level and younger patients with PRS.

临床研究中,我们会经常遇到多重检验的问题。当同时检验多个假设时,如何控制犯Ⅰ类错误的概率,保证结果的准确性,是研究者面对的首要问题。然而未对多重检验进行校正的文章比例仍较大。本文从简单的单个检验假设出发,回答为什么需要进行多重校正,何时进行多重校正,同时介绍总体错误率(FWER)和错误发现率(FDR)两种重要的错误率以及在此基础上的Bonferroni和Benjamini-Hochberg校正方法,从而避免因多重检验问题带来的混乱。

In clinical research, we often encounter the problem of multiple testing. When testing many hypotheses at the same time, how to control the type I error to ensure the accuracy of the results is the primary problem faced by researchers. However, the proportion of articles that didn't correct the multiple testing remains substantial. Starting with the simple hypothesis of a single test, this article provides an introduction to multiple testing issues, answers why and when multiple corrections are needed, introduces two important error rates which are family-wise error rate (FWER) and false discovery rate (FDR), and the Bonferroni and Benjamini-Hochberg correction methods based on them, thereby avoiding confusion caused by multiple testing.

纳米材料作为一种新兴材料,在疾病诊断与治疗中拥有极大的应用潜力。为平衡纳米材料的生物活性和生物毒性之间的关系,清楚了解纳米材料在体内的清除机制和清除速率至关重要。其中,肾脏,作为人体重要的清除器官,直接影响纳米材料从血液清除到尿液的速率,进而影响其在生物体内的血液循环、肿瘤靶向效率和体内滞留等系列问题,最终影响其临床应用。基于近年来已报道的关于纳米材料与肾脏相互作用的诸多研究,本文系统介绍了肾脏结构、纳米材料在肾脏中的传输机制、理化性质对其肾脏清除效率的影响以及纳米材料在肾脏疾病诊疗中的应用。本文有望为精准纳米医学的发展以及纳米材料未来的临床转化起到促进作用。

Nanomaterials, as emerging materials, show great promise for the detection, diagnosis and treatment of diseases. Fully understanding their elimination pathway and clearance efficiency is important to better balance the bioactivity and biotoxicity of nanomaterials. Kidneys, as a major organ, play a key role in the clearance of nanomaterials from blood to urine. The clearance rate of nanomaterials in the kidneys directly affects their blood circulation, retention in the body and tumor targeting efficiency as well as final clinical applications. Based on current understanding of nano-bio interactions of nanomaterials in the kidneys, in this review, we introduced the kidney structure and elimination mechanism of nanomaterials in the kidneys. Then, how the physicochemical properties of nanomaterials affect their renal clearance efficiency are summarized. Finally, their applications in the kidney disease detection and treatment are presented. The basic understanding of nano-bio interactions of nanomaterials in the kidneys would promote the development of precise nanomedicine and their future clinical translation.

目的 统计分析茂名市2016—2021年各种成分血临床供血情况,分析不同成分ABO血型供血特点,总结供血趋势,为今后采供血工作提供参考。方法 通过血液信息管理系统和统计“血库库存监控”中血库预警情况,统计分析茂名市2016—2021年各类成分血临床供应情况。结果 2016—2021年茂名市中心血站临床供血总量1 635 494.5 U,年平均增长率10.74%;红细胞类、血浆类、冷沉淀和浓缩血小板临床供应量年平均增长速度分别为11.58%、8.68%、5.88%、19.41%,各血型占比均为O型>A型>B型>AB型;2018年后机采血小板临床供应量逐年增长;AB型浓缩血小板报废占比最大。结论 2016—2021年茂名市中心血站临床血液供应量逐年增长,O型用血在茂名地区所占比例最大,AB型所占比例最小。在未来采供血工作中,结合临床不同血型成分血使用特征,注意不同血型血液库存,优化血库库存警戒线,防止过多血液过期报废。

Objective To statistically analyze the clinical supply of various blood components in Maoming City from 2016—2021, analyze the characteristics of various ABO blood components supply, and summarize the trend of blood supply as a reference for future blood collection. Methods Using the blood information management system and the early warning situation of the blood bank in “blood bank inventory monitoring”, the clinical supply of various blood components from 2016 to 2021 was statistically analyzed. Results The total supply amount of clinical blood from Maoming Central Blood Bank in 2016-2021 was 1635 494.5 U, with an average annual growth of 10.74%; the percentage of each blood components (red cell, plasma, cryoprecipitate and pooled platelets) was O>A>B>AB, with an average annual growth rate of 11.58%, 8.68%, 5.88% and 19.41%.After 2018, the clinical supply of mechanically collected platelets increased year by year.Scrapped pooled platelets of AB type accounted for the largest proportion. Conclusions Clinical blood supply in Maoming central blood bank was increasing yearly from 2016 to 2021, with the largest proportion of blood type O in Maoming region and the smallest proportion of blood type AB.In the future blood collection and supply, we will pay attention to blood products for different blood types in stock by taking into account the different blood types usage,pay attention to the blood stocks of different blood types, optimize the alarm threshold of blood bank stocks, to prevent overmuch blood from expiring and being scrapped.

目的 探讨专项调查重点科室医务人员手卫生依从性及知识知晓情况结合院感信息系统在降低医院感染中的应用效果。方法 选取2018年1月—2020年12月本院重点科室收治的患者527例,根据入院时间进行分组,对照组采取常规院感管理,观察组采取基于院感信息系统的管理方式,并对重点科室的100名医务人员手卫生依从性及相关知识知晓情况进行专项调查,比较2组医务人员手卫生依从性、手卫生知识知晓程度及医院感染率的差异。结果 观察组医务人员执行各项操作的手卫生依从性、手卫生知识评分均高于对照组(P<0.05);观察组患者医院感染率低于对照组(P<0.05)。结论 采用专项调查重点科室医务人员手卫生依从性及知识知晓结合院感信息系统,能有效提高医务人员的手卫生依从性及相关知识知晓程度,降低医院感染的发生风险。

Objective To discuss the effect of applying special investigation on the hand hygiene compliance and knowledge of medical staff in key departments combined with nosocomial infection information system in reducing nosocomial infections. Methods A total of 527 patients admitted to the key departments from January 2018 to December 2020 were selected, and were grouped according to the time of admission.The control group received routine nosocomial infection management, and the observation group received the management based on nosocomial infection information system.A special survey of hand hygiene compliance and related knowledge was carried out on 100 medical staff in those department, and the differences in hand hygiene compliance, hand hygiene knowledge and nosocomial infection rates between the two groups were compared. Results The hand hygiene compliance and hand hygiene knowledge scores of the medical staff in the observation group were significantly higher than those in the control group (P<0.05). The infection rate of observation patients was lower than control patients (P<0.05). Conclusions The use of special survey on hand hygiene compliance and knowledge of medical staff in key departments combined with nosocomial infection information systems can effectively improve medical staff's hand hygiene compliance and related knowledge, reduce the risk of nosocomial infections, which is worthy of promotion.

目的 探讨暴露喉返神经的甲状腺手术后患者发生声音嘶哑的原因。方法 选取于2019年1月—2020年12月间在我院接受甲状腺手术且在术中暴露喉返神经的患者,对出现术后声音嘶哑的19例患者进行为期12个月的临床随访,观察研究对象术后声音嘶哑的发生特点、持续时间并进行直接喉镜及颈部超声检查。结果 发生声音嘶哑的19例患者中,5例存在术中喉返神经损伤情况,其余14例患者术中喉返神经暴露及保护良好。直接喉镜检查示,该14例患者中,4例存在声带充血水肿现象,1例发生勺状软骨半脱位。术后1周左右的超声检查显示,该14例患者中有11例存在不同程度的创腔内积液。结论 虽常规暴露喉返神经减少了术后声嘶的发生率,但术中喉返神经损伤仍然是造成患者术后声嘶的原因之一。此外,术后创腔积液、麻醉插管导致的声带损伤及其他插管相关并发症等非直接手术因素也是造成这些患者术后声嘶的重要原因,应引起临床重视。

Objective To explore the cause of hoarseness of voice in patients after thyroidectomy with recurrent laryngeal nerve exposure. Methods The patients from January 2019 to December 2020 underwent thyroidectomy with exposure of recurrent laryngeal nerve during operation were selected. There were 19 cases of hoarseness of voice after operation followed up for 12 months. Postoperative observations included the characteristics of the hoarseness of voice, duration, and direct laryngoscope neck ultrasonography. Results A total of 19 patients had voice hoarseness, only 5 of them had recurrent laryngeal nerve injury during operation, the other 14 patients had good exposure and protection of recurrent laryngeal nerve. Direct laryngoscope showed that 4 of 14 patients had vocal cord edema and 1 had subluxation of arytenoid cartilage. About 1 week after operation, ultrasound examination showed that 11 of 14 patients had varying degrees hydrops of wound cavity. Conclusions Although the routine exposure of recurrent laryngeal nerve reduces the incidence of postoperative hoarseness of voice, the injury of recurrent laryngeal nerve is still a cause of postoperative hoarseness of voice. In addition, non-operative direct factors, such as fluid accumulation in the operative field, vocal cord injury caused by anesthetic intubation and other intubation related complications, are also important reasons for postoperative hoarseness of voice in these patients, which we should pay more attention to.

目的 探索胸部CT值在胸腔积液鉴别诊断的价值。方法 81例胸腔积液患者纳入本研究,胸腔积液分为渗出液、漏出液、恶性胸腔积液及良性胸腔积液。建立平均CT值的ROC曲线,计算曲线下面积。结果 81例胸腔积液患者中59例为渗出液,22例为漏出液;恶性胸腔积液33例,良性胸腔积液48例。渗出液组平均CT值(16.68±6.76)Hu高于漏出液组(5.50±3.42)Hu(P<0.000 1)。ROC曲线分析结果显示,胸腔积液平均CT值对区分渗出液和漏出液具有较高的准确性(曲线下面积为0.944 5)。当最佳界值为≥9.99 Hu时,其敏感度为88.14%,特异度为90.91%;恶性胸腔积液组平均CT值(15.38±7.29)Hu与良性胸腔积液组平均CT值(12.45±8.03)Hu没有差异(P=0.098 1)。结论 在胸腔积液的鉴别诊断过程中,胸部CT的CT值在鉴别漏出液及渗出液中有一定的价值,但尚不能用于鉴别良性及恶性胸腔积液。

Objective To explore the value of chest CT value in the differential diagnosis of pleural effusion. Methods A total of 81 patients with pleural effusion were included in this study, including exudate, transudate, malignant pleural effusion and benign pleural effusion.The ROC curve of average CT value was established and the area under the curve was calculated. Results Among 81 patients with pleural effusion, 59 cases were exudative, 22 cases were transudative, 33 cases were malignant pleural effusion and 48 cases were benign pleural effusion.The mean CT value of the exudate group, (16.68±6.76) Hu, was significantly higher than (5.50±3.42) Hu of the transudate group (P<0.000 1).ROC curve analysis showed that the mean CT value of pleural effusion had high accuracy in distinguishing exudate from transudate (area under the curve was 0.9445).When the cut-off value for exudative effusion was over 9.99 Hu, the sensitivity and specificity were 88.14% and 90.91%, respectively.The mean CT value of malignant pleural effusion group, (15.38±7.29) Hu, was not significantly different from (12.45±8.03) Hu of benign pleural effusion group (P=0.098 1). Conclusions In the differential diagnosis of pleural effusion, the chest CT value can be used to identify transudate and exudate, but not benign and malignant pleural effusion.

目的 探讨关节外伤(扭伤和劳损)和痛风发作有无相关性。方法 选取自2017年1月—2020年5月间在我院中西医结合骨科门诊就诊的关节扭伤和劳损及痛风患者,采用《2015年美国风湿病协会/欧洲抗风湿联盟痛风分类标准》的痛风诊断标准,纳入76例门诊患者。采用SPSS 22.0软件进行Logistic回归分析。对单因素分析具有统计学意义(P<0.05)的因素,建立痛风主要危险因素的多元Logistic回归模型。结果 单因素Logistic回归分析中,性别、关节扭伤和劳损因素差异有统计学意义(P<0.05);多因素Logistic回归分析中,性别,关节扭伤和劳损因素差异有统计学意义(P<0.05)。结论 性别、关节扭伤和劳损是引起痛风发作的的危险因素。

Objective To explore the correlation between joint trauma (sprain or strain) and gout attack. Methods Patients with joint sprain, strain and gout treated in the orthopedic clinic of integrated traditional Chinese and Western medicine in our hospital from January 2017 to May 2020 were selected, 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative was adopted as diagnosing standard, 76 outpatients were included.Logistic regression analysis was carried out by SPSS 22.0 software.For the factors with statistical significance (P<0.05) in univariate analysis, a multivariate logistic regression model was established for the main risk factors of gout. Results In univariate logistic regression analysis, gender, sprain and strain were statistically significant (P<0.05).In multivariate logistic regression analysis, gender, joint sprain and strain were statistically significant (P<0.05). Conclusions Gender, joint sprain and strain can significantly increase the risk of gout attack.

目的 研究白藜芦醇通过抑制T样受体4/核因子-κB(TLR4/NF-κB)通路对呼吸道合胞病毒(RSV)毛细支气管炎小鼠的保护作用。方法 选取30只小鼠随机分为对照组、RSV组、给药组,建立RSV毛细支气管炎小鼠模型,检测小鼠肺组织中TLR4、NF-κB的变化;利用肺组织HE染色、ELISA法检测白藜芦醇给药前后气道炎症病变、IL-6、TNF-α因子水平,Western Blot法及实时定量PCR法检测TLR4、 NF-κB蛋白及基因表达等相关变化。结果 与对照组相比,RSV组小鼠组肺组织中TLR4、NF-κB水平升高,肺组织切片HE染色显示气道炎症细胞浸润加剧,ELISA检测炎性因子IL-6、TNF-α升高;而给药组处理后,肺组织TLR4、NF-κB的表达下调,病理改变减轻,炎性因子IL-6、TNF-α下降。结论 白藜芦醇可通过抑制TLR4/NF-κB通路抑制炎性因子的释放,从而减轻毛细支气管炎小鼠的气道炎症反应。

Objective To study the protective effect of resveratrol on lung tissue of respiratory syncytial virus(RSV) bronchiolitis mice by regulating TLR4/NF-κB pathway. Methods Thirty mice were randomly divided into control group, RSV group and resveratrol group. The mice models of RSV bronchiolitis were established, and the changes of TLR4 and NF-κB levels in lung tissues of mice were detected. HE staining and ELISA were used to detect airway inflammation, IL-6 and TNF-α levels before and after resveratrol administration. TLR4 and NF-κB protein and gene expressions were detected by Western Blot and real-time quantitative PCR. Results Compared with the control group, the levels of TLR4 and NF-κB in the lung tissues of mice with bronchiolitis were significantly increased. Airway inflammatory cell infiltration was aggravated in HE staining of lung tissue sections, and inflammatory factors IL-6 and TNF-α were significantly increased showing by ELISA. The expressions of TLR4 and NF-κB in resveratrol group were down-regulated after treatment. Conclusions Resveratrol can inhibit the release of inflammatory factors by inhibiting the TLR4/NF-κB pathway, play a protective role in mice with bronchiolitis.

目的 探索心脏康复干预对房颤合并高血压患者的血脂血压变化、运动耐量、心脏功能、肺功能等指标的影响。方法 选取房颤合并高血压患者96例,随机分为常规治疗组和心脏康复(CR)组,每组各48例患者。常规治疗组给予规范的药物治疗,CR组在规范药物治疗的基础上予运动干预6个月,对比治疗前后2组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)水平,左心房直径(LA)、左心室射血分数(LVEF)、左心室舒张末内径(LVEDd),无氧阈值(AT)、峰值公斤摄氧量(PeakVO₂/kg)、峰值通气量(VEpeak)、每搏输出量(SV)、峰值氧脉搏(PeakO₂pluse),收缩压(SBP)与舒张压(DBP)变化情况,6分钟步行距离(6MWD),以及Borg劳累评估量表评分、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果 2组患者治疗6个月时,TC、TG、LDL-C水平以及SBP、DBP均下降(P<0.05),但2组之间比较,3项血脂指标无统计学差异(P>0.05),而CR组血压显著下降(P<0.05) 。2组患者治疗6个月时,LA、LVEDd减小(P<0.05),而LVEF无变化(P>0.05),CR组LA较常规治疗组缩小(P<0.05)。治疗6个月时,CR组AT、PeakVO₂/kg、VEpeak、SV和PeakO₂plus水平均升高(P<0.05),而常规治疗组的上述相关指标无明显变化(P>0.05)。治疗6个月时,2组患者6分钟步行距离均增加,CR组较常规组增加(P<0.05)。治疗6个月时,CR组Borg劳累评估量表评分、SAS评分及SDS评分均下降,而常规治疗组上述3项评分较治疗前无变化(P>0.05),与常规治疗组比较,CR组上述3项评分降低(P<0.05)。结论 以中等强度运动干预为主导的心脏康复治疗能够降低房颤合并高血压患者的血脂水平、控制血压状态、改善左心房及左心室结构重构,还可以增加该群体的运动耐力及心肺功能、减少消极情绪并提高生活质量。

Objective To evaluate the impact of cardiac rehabilitation on blood lipid level,blood pressure control,exercise endurance,cardiac function, quality of life and lung function in patients with hypertension and atrial fibrillation (AF). Methods This prospective cohort study enrolled 96 patients with AF and hypertension, who were randomly and evenly assigned to the conventional group and the cardiac rehabilitation (CR) group, both treated for at least 6 months. Research indicators included the levels of triglycerides (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C); left atrial diameter (LA), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), anaerobic threshold (AT), peak oxygen uptake volume per kilogram (PeakVO₂/kg), peak ventilation volume (VEpeak), stroke volume (SV), peak oxygen pulse (PeakO₂pluse), changes in blood pressure, 6 minutes walking distance, Borg Fatigue Scale score, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores. Results At the 6th month of the treatment, the levels of TG, TC, LDL-C, systolic blood pressure (SBP), diastolic blood pressure (DBP) were significantly reduced (P<0.05) in both groups. However, there was no statistical difference among the three blood lipid indicators between the conventional group and the CR group after treatment (P>0.05). Blood pressure dropped significantly(P<0.05) in both groups, especially in the CR group. Meanwhile, after treatment, LA and LVEDd decreased significantly (P<0.05) in both groups, except LVEF. LA decreased significantly (P<0.05) in CR group, compared with conventional group. In addition, AT, PeakVO₂/kg, VEpeak, SV and PeakO₂pluse levels were significantly elevated (P<0.05) in CR group compared with the conventional group after the treatment. There was no significant difference (P>0.05) in the indicators above in the conventional group. Six minutes walking distance were significantly increased (P<0.05) in both groups at 6th month of treatment, compared with the conventional group, the CR group increased more (P<0.05). Borg Fatigue Scale score, SAS score and SDS score were significantly reduced (P<0.05) in CR group at 6th month of treatment, however, there was no statistical difference (P>0.05) in the conventional group compared with that before treatment. The scores above were significantly reduced (P<0.05) in CR group compared with the conventional group after the treatment. Conclusions Cardiac rehabilitation therapy dominated by moderate-intensity exercise intervention can reduce the blood lipid level of atrial fibrillation and hypertension patients, control the blood pressure, improve the left atrial and left ventricular structure reconstruction, increase the exercise endurance, improve cardiopulmonary function, reduce negative emotions and improve the quality of life.