目的 探讨职业性噪声暴露对广州市黄埔区某企业噪声作业工人听力损失状况的影响。方法 观察2016年8月—2018年8月,广州市黄埔区某企业噪声作业工人年度职业健康体检1 600例为调查对象,对该群体的纯音听阈测试检查结果进行分析。结果 随工龄不同听力损失发生率相比,差异有统计学意义(P<0.05),还会随着工龄的增长而增加听力损失几率;佩戴听力防护用品工人听力损失发生率低于不佩戴听力防护用品的工人,差异有统计学意义(P<0.05)。结论 噪声作业工人工龄时间越长听力损失发生率越高,防护听力用品的使用可有效降低听力损伤发生率,故在噪声作业时,企业应做好听力损伤防护措施,保障工人身心健康。

目的 总结预防接种认知干预对儿童预防接种效果的影响。方法 对2018年5—9月在东莞企石镇接种百白破疫苗的儿童家属按接种时间顺序分为对照组254名、实验组248名,对照组家属按常规方法进行预防接种,实验组在常规接种基础上,结合不按时接种、延迟接种等问题对幼儿家属开展多种多样的百白破疫苗预防知识、不良反应观察处理、接种注意事项等知识宣教和培训干预,总结两组儿童在按时接种、延迟接种、疫苗接种知识、不良反应表现与处理、接种注意事项知识的掌握、服务满意度等情况。结果 实验组幼儿按时接种率比对照组高,延迟接种率比对照组低,结果有差异(P＜0.05);家属对疫苗接种知识、不良反应表现和处理、接种注意事项等知识的掌握比对照组高,结果有差异(P＜0.05)。结论 实施家属预防接种认知干预管理能提高家属掌握预防接种知识和不良反应护理知识;提高儿童疫苗接种率和及时接种率,提高预防接种服务管理效果。

Objective To summarize the effect of cognitive intervention on children's vaccination. Methods The family members of children vaccinated with DPT vaccine in Qishi Town of Dongguan City from May to September 2018 were divided into control group 254 and experimental group 248 according to the sequence of vaccination time. The family members of control group were vaccinated by routine methods. On the basis of routine vaccination, the experimental group carried out a variety of preventive knowledge and adverse reactions observation of DPT vaccine to the family members of children in combination with the problems of untimely vaccination and delayed vaccination. The knowledge propaganda and training intervention of treatment and vaccination precautions were summarized. The situation of two groups of children in timely vaccination, delayed vaccination, vaccination knowledge, adverse reaction performance and treatment, knowledge of vaccination precautions and service satisfaction were summarized. Results The vaccination rate of children in the experimental group was higher than that in the control group, and the delayed vaccination rate was lower than that in the control group. The results showed statistical difference (P＜0.05). The knowledge of vaccination, adverse reactions, treatment and matters needing attention of family members were higher than that in the control group, and the results showed statistical difference (P＜0.05). Conclusion Implementing cognitive intervention management of family vaccination may improve family members'knowledge of vaccination and nursing of adverse reactions, improve children's vaccination rates and timely vaccination rates, and improve the management effect of vaccination service.

目的 探讨导致口服华法林患者国际标准化比值异常增高(INR>4.5)的原因。方法 选择148例做过心瓣膜置换术,出院后口服华法林抗凝,复查时国际标准化比值(INR>4.5)异常增高的患者。通过对其用药量以及服用其它药物(包括西药和中药)、营养品、食物等情况进行调查,分析导致口服华法林患者INR异常增高的有关因素,同时对PT检测过程中检验前、检验中的质量控制进行调查,排除检测过程中的影响因素,最后综合分析导致心瓣膜置换术后口服华法林患者INR异常增高的原因。结果 导致口服华法林患者INR异常增高的原因主要是药量过多,占全部调查的47.29%,其中医嘱剂量过多的为39.18%,遗忘重复服药或不理解医嘱的比例为8.10%;其次是受药物相互影响的比例为43.25%,其中受西药影响的比例为33.11%,受中药物影响的占10.14%;药物外影响的因素比例为9.47%,其中受饮食影响的比例为4.06%;受物理治疗影响的比例为5.41%。结论 导致口服华法林患者INR异常增高最主要的原因是用药量过多以及受其他药物的相互影响,同时受饮食及物理治疗的影响。

Objective To investigate the cause of abnormality increase of international normalized ratio (INR) (INR>4.5) in the patients who oral application Warfarin. Methods 148 patients were taken who had cardiac valve replacement operation and oral application warfarin post-discharge as subjects. Their INR abnormality increased when taking reexamination. Through the research of the drugs, the dose (including both Chinese crude drug and western medicine), the nourishments and the foods that the patients took, we find out factors that resulted in INR abnormality increase, while to investigate the quality control of laboratory department and analyze the process before and after PT test, to find out factors that affect the test. Finally, to analyze the causes of INR abnormality increase in patients took warfarin after cardiac valve replacement operation. Results The main reason for the abnormal increase in INR in patients with oral warfarin was the excessive dose, accounting for 47.29% of all surveys, of which 39.18% were excessively prescribed, and the proportion of patients who forgot to repeat or did not understand the doctor's order was 8.10%; The proportion of drug interaction was 43.25%, of which 33.11% were affected by western medicine, 10.14% were affected by Chinese medicine, 9.47% were affected by external medicine, and 4.06% were affected by diet; The proportion of treatment effects was 5.41%. Conclusion The main reason for the abnormal increase in INR in patients with oral warfarin is the excessive use of drugs and the interaction of other drugs, as well as the effects of diet and physical therapy.

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 分析在中耳胆脂瘤患者中耳内窥镜的价值。方法 回顾性分析61例单侧中耳胆脂瘤患者的临床资料,均接受手术治疗,其中有31例实施耳内窥镜下手术,记为A组;有30例实施常规鼓室成形术,记为B组。对比2组术前和术后1个月气骨导差和气道听阈变化,临床效果和术后并发症。结果 术后1个月A组气骨导差和气道听阈分别为(8.5±1.5)dB、(21.2±2.4)dB,均较术前下降(t=38.195,P<0.001;t=27.739,P<0.001),B组分别为(13.4±2.3)dB、(25.6±2.7)dB,均较术前下降(t=23.510,P<0.001;t=21.575,P<0.001),且术后1个月A组气骨导差和气道听阈均低于B组(t=9.888,P<0.001;t=6.732,P<0.001);A组与B组临床效果分布对比差异有统计学意义(Z=6.102,P=0.014),且A组总有效率为100.00%,高于B组的83.33%(χ²=5.628,P=0.018);A组总并发症发生率为3.23%,低于B组的20.00%(χ²=4.223,P=0.040)。结论 在中耳胆脂瘤患者手术中应用耳内窥镜治疗能够显著改善气骨导差和气道听阈,较常规鼓室成形术效果更佳,安全性更高。

Objective To analyze the value of middle ear endoscopy in patients with middle ear cholesteatoma. Methods The clinical data of 61 patients with unilateral middle ear cholesteatoma were retrospectively analyzed. All of them underwent surgery. Among them, 31 underwent otoendoscopic surgery, which was recorded as group A; 30 underwent conventional tympanoplasty, which was recorded as group B. The changes of air-bone conduction, airway auditory threshold, clinical effect and complications were compared between the two groups before and 1 month after operation. Results One month after operation, the difference of air-bone conduction and airway auditory threshold in group A were (8.5±1.5) dB and (21.2 ±2.4) dB, were lower than those before operation (t=38.195, P<0.001;t= 27.739,P<0.001), group B were (13.4±2.3) dB and (25.6±2.7) dB, respectively, lower than those before operation (t= 23.510,P<0.001;t=21.575,P<0.001), one month later, the air-bone conduction and airway hearing threshold in group A were lower than those in group B (t=9.888,P=0.000;t=6.732,P<0.001); The difference was statistically significant in clinical effect distribution between group A and group B (Z=6.102,P= 0.014), and the total effective rate of group A was 100.00%, which was higher than that of group B 83.33% (χ²= 5.628,P=0.018); the total incidence of complications in group A was 3.23%, lower than that in group B 20.00% (χ²= 4.223,P=0.040). Conclusion Endoscopic ear surgery may improve the air-bone conduction and airway auditory threshold in patients with middle ear cholesteatoma, which is more effective and safe than conventional tympanoplasty.

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 探讨脑动静脉畸形(AVM)破裂出血发生的危险因素。方法 回顾性研究2014年—2018年我院收治的AVM病例42例,根据有无破裂出血,分为出血组和非出血组,对AVM破裂出血发生的相关因素进行统计学分析。结果 通过相关性及逐步回归分析,表明AVM破裂出血的独立危险因素为: 深部静脉引流和低龄患者。结论 对于引流静脉为深部静脉引流类型和低龄的AVM患者,应积极尽早治疗。

Objective To analyze the risk factors related to cerebral arteriovenous malformation(AVM)with hemorrhage. Methods The clinical data of 42 patients with AVM between 2014 and 2018 were respectively studied. According to the presence of rupture, the cases were divided into bleeding group and non-bleeding group. The factors associated with the occurence of AVM rupture were statistically analyzed. Results The correlation and logistic regression analysis suggested that the deep venous drainage and young patients were the independent risk factors for AVM rupture. Conclusion The young patients and the patients with deep venous drainage should be operated as soon as possible to avoid hemorrhage.

目的 探讨红细胞分布宽度(RDW)与稳定性冠心病的冠脉病变严重程度的关系,评价RDW对稳定性冠心病的预测价值。方法 收集我院2016年11月—2018年11月期间因胸痛住院的患者330例,根据冠脉造影确诊稳定性冠心病组200例,除外冠心病130例为对照组。比较2组RDW水平的差异,分析RDW与冠脉病变严重程度(Gensini评分)的相关性及稳定性冠心病的独立危险因素。结果 稳定性冠心病组RDW水平高于对照组(P<0.05),稳定性冠心病组RDW与 Gensini评分之间存在正相关(r=0.217,P=0.002);多因素logistic回归分析显示RDW(OR=2.950,95%CI: 1.986~4.381,P<0.001)是稳定性冠心病的独立危险因子。结论 RDW与稳定性冠心病的冠脉病变严重程度呈正相关,RDW是稳定性冠心病的独立危险因素,为稳定性冠心病的诊断提供一定预测价值。

Objective To investigate the relationship between the distribution width of red blood cells (RDW) and the severity of coronary artery disease in stable coronary artery disease(SCAD), and to evaluate the predictive value of RDW for SCAD. Methods Patients who were hospitalized for chest pain from November 2016 to November 2018 were enrolled (n=330). According to coronary angiography,200 patients were divided into SCAD group (n=200),except for the SCAD group, the remaining 130 cases were the control group(n=130). The differences of RDW levels between the two groups were compared, and the correlation between RDW and severity of coronary artery disease (Gensini score) and independent risk factors for SCAD were analyzed. Results The RDW level in the SCAD group was higher than that in the control group (P<0.05). There was a positive correlation between the RDW and Gensini scores in the SCAD group (r=0.217,P=0.002). Multivariate logistic regression analysis showed RDW (OR=2.950, 95% CI: 1.986~4.381, P<0.001) is an independent risk factor for SCAD. Conclusion RDW is positively correlated with the severity of coronary artery disease in SCAD. RDW is independent risk factor of SCAD and provides predictive value for the diagnosis of SCAD.

目的 探讨Meis1在人子宫内膜细胞中的表达及其受雌、孕激素调控的规律。方法 通过免疫细胞化学和western blot的方法检测雌、孕激素对体外培养的在子宫内膜基质细胞(ESC)及Ishikawa细胞中Meis1的表达及调控。结果 Meis1在ESC和Ishikawa细胞均有表达,且均表达于细胞核中;在ESC中,E2、P4和 E2＋P4三组中Meis1平均蛋白表达水平均高于对照组(P<0.05)。Meis1在E2、P4和 E2＋P4组之间的表达水平亦差异有统计学意义(P<0.05),表达强度E2＋P4组>P4组>E2组;在Ishikawa细胞中,E2、P4和 E2＋P4使Meis1表达增强,表达强度P4组>E2＋P4组>E2组,但与对照组比较无差异(P>0.05),E2、P4和 E2＋P4各组间亦无差异(P>0.05)。结论 转录因子Meis1在ESC和Ishikawa细胞中受到雌、孕激素的调控,可能在子宫内膜容受性分子网络的构建中发挥着重要的作用。

Objective To investegate the expression and regulation discipline of Meis1 in human ESC and Ishikawa cells in vitro by estrogen and progesterone stimuli. Methods Immunocytochemistry and western blot were used to detect the expression and regulation discipline of Meis1 in human normal endometrial cells. Results Meis1 expressed both in endometrial stromal cells (ESC) and in ishikawa cells, and both situ in nucleus. In ESC, the expression of Meis1 was up-regulated by E₂/P₄ and E₂＋P₄, and the up-regulated effect may be superposition by E₂＋P₄, the differences between the groups were statistically difference(P<0.05). In Ishikawa cells, western blot showed that the expression of Meis1 was up-regulated by E₂/P₄ and E₂＋P₄. The differences weren't statistically significant when compared with the control group or between themselves(P>0.05). Conclusion The expression of transcription factor Meis1 is regularly regulated by estrogen and progesterone, which may be a key role during the formation of endometrial receptivity molecular network.