目的 分析25羟维生素D[25(OH)D]在新疆汉族及维吾尔族老年男性2型糖尿病(T2DM)合并骨质疏松(OP)患者中的水平及与骨密度(BMD)的相关性。方法 收集住院的汉族、维吾尔族老年男性T2DM患者281例,根据民族及骨密度值将其分为汉族非骨质疏松(NOP)组127人(A组)、汉族骨质疏松(OP)组21人(B组)、维族NOP组103人(C组)、维族OP组30人(D组),记录四组患者的25(OH)D水平并进行比较,分析25(OH)D与BMD的相关性。结果 同一民族中,B组的25(OH)D低于A组(P<0.05),D组的25(OH)D低于C组(P<0.05); T2DM合并OP患者中,D组的25(OH)D低于B组(P<0.05); 相关性分析显示,25(OH)D与BMD呈正相关。结论 维吾尔族老年男性T2DM合并OP患者较汉族患者的25(OH)D水平低,25(OH)D水平低的T2DM患者更易合并OP,25(OH)D检测有助于识别T2DM患者合并OP的风险。

Objective To analysis the level of 25 hydroxy vitamin D[25(OH)D] in Xinjiang Han and Uyghur elderly male patients with T2DM and osteoporosis, and the correlation between 25(OH)D levels and bone mineral density(BMD). Methods We collected 281 cases of T2DM patients from Hans and Uyghurs, divided them into four groups according to the nationality and BMD: Han non-osteoporosis(NOP) group including 127 cases(group A), Han osteoporosis(OP) group 21 cases(group B), Uyghur NOP group 103 cases(group C), Uyghur OP group 30 cases(group D). Recorded and compared their 25(OH)D levels, and analyzed the correlation between 25(OH)D levels and BMD. Results In the same nationality,the level of 25(OH)D in group B were lower than those in group A(P<0.05), and group D were lower than those in group C(P<0.05); In T2DM patients combined with OP, the levels of 25(OH)D in group D were lower than those in group B(P<0.05); Correlation analysis showed that 25(OH)D was positively correlated with BMD. Conclusion The level of 25(OH)D in elderly male patients with T2DM combined with osteoporosis, those of Uyghurs are lower than those of Hans. T2DM patients with lower 25(OH)D level are more likely to combine OP. The 25(OH)D level test may help to identify the risk of combining OP in T2DM patients.

目的 探讨粪菌移植(FMT)在两种肠镜下盲肠置管术的临床应用。方法 将2016年1月—2017年6月在我院通过肠镜下盲肠置管术进行粪菌移植的200例患者,随机分为A组和B组,各100例。A组采用直接肠镜置管法完成置管,B组采用二次肠镜置管法完成置管,对两组操作的置管成功率、置管时间、平均疼痛评分、并发症等情况进行对比。结果 与A组相比较,B组到达盲肠时间略长但无统计学意义(14.95min vs 15.26min,P=0.68)、疼痛评分低(5.7 vs 4.8,P<0.05)、更低的并发症发生率(6 % vs 23 %,P<0.05)。结论 在粪菌移植内镜下盲肠置管术患者中,采用通过采用二次肠镜置管法与直接肠镜法相比较完成置管手术时间无统计学差异,但置管成功率高、患者的痛苦小、风险低,值得临床推广。

Objective To investigate the clinical application of fecal microbiota transplantation (FMT) in two kinds of colonoscopic cecal catheterization. Methods From January 2016 to June 2017, 200 patients who took colonoscopic cecal catheterization for fecal microbiota transplantation in our hospital were randomly divided into group A and group B, with 100 patients in each group.Group A used direct colonoscopy catheterization to complete catheterization, group B was treated by the second colonoscopy catheterization. The success rate of catheterization, catheterization time, average pain score and complication were compared between the two groups. Results Compared with group A, the time to reach the cecum in group B was slightly longer but not statistically significant (14.95min vs 15.26min,P=0.68). It had lower pain score (5.7 vs 4.8, P<0.05), lower complication rate. Conclusion Among the patients with colonoscopic cecal catheterization for fecal microbiota transplantation, there was no significant difference in the time of catheterization between the second colonoscopy and the direct colonoscopy, but it has the high success rate of catheterization and low pain, low risk, worthy of clinical promotion.

目的 探讨MDS、MDS/AML及原发AML基因突变频谱的异同点及其临床意义。方法 选取98例MDS患者、32例MDS/AML患者及234例原发AML患者为研究对象,利用二代测序技术检测基因突变。结果 MDS组中突变率较高的基因突变为TET2(16.7%,16/96)、U2AF1(12.0%,6/50)、SF3B1(11.8%,9/76);MDS/AML组中突变率较高的基因突变为TP53(33.3%,2/6)、DNMT3A(30%,6/20)、IDH2(21.1%,4/19);原发AML组中突变率较高的基因突变为FLT3-ITD(18.0%,42/233)、NPM1(16.3%,38/233)、DNMT3A(14.9%,14/94)。DNMT3A(P=0.006)、IDH2(P=0.004)及NPM1(P=0.002)等基因突变在MDS与MDS/AML两组间的突变率有统计学差异;FLT3-ITD(P=0.001)、NPM1(P=0.002)、CEBPA(P=0.011)及IDH2(P=0.019)等基因突变在MDS与原发AML两组间的突变率有统计学差异;所有受检基因突变在MDS/AML与原发AML两组间的基因突变的突变率无统计学差异(P＞0.05)。结论 MDS、MDS/AML及原发AML基因突变的突变频谱具有相似性及异质性,从MDS到MDS/AML、原发AML基因突变的变化不仅影响疾病转归及预后而且可帮助鉴别MDS/AML和原发AML。

Objective To explore the similarities and differences of spectrum of gene mutations in patients with myelodysplastic syndrome, MDS/AML and de novo acute myeloid leukemia and their clinical significance. Methods 98 patients with MDS, 32 patients with MDS/AML, 234 patients with de novo AML were selected. Gene mutations were detected by second generation sequencing. Results The most frequent mutations in MDS were as follows:TET2(16.7%, 16/96), U2AF1(12.0%, 6/50), SF3B1(11.8%, 9/76); The most frequent mutations in MDS/AML were TP53(33.3%, 2/6), DNMT3A(30%, 6/20), IDH2 (21.1%, 4/19);The most frequent mutations in de novo AML were FLT3-ITD(18.0%, 42/233), NPM1(16.3%, 38/233), DNMT3A(14.9%, 14/94); DNMT3A(P=0.006),IDH2(P=0.004) and NPM1(P=0.002) were statistical difference between MDS and MDS/AML; FLT3-ITD(P=0.001),NPM1(P=0.002),CEBPA(P=0.011) and IDH2(P=0.019) were statistical difference between MDS and de novo AML;There were no siatistical significance (P>0.05) in the frequency of all detected gene mutations between MDS/AML and AML. Conclusion The spectrum of gene mutation of MDS, MDS/AML and primary AML have similarities and heterogeneity.The changes of gene mutations from MDS to MDS/AML and de novo AML not only affect disease outcome and prognosis, but also help to identify MDS/AML and de novo AML.

目的 探讨拔岗晋级结合激励机制在护士岗位管理的实践和体会。方法 在护士岗位管理中运用拔岗晋级结合激励机制,收集实施岗位管理前后1年护士满意度、患者满意度、护士职业获益感、护士职业投入、离职率资料,进行统计学分析。结果 实施后护士满意度、患者满意度、护士职业获益感、护士职业投入较实施前提高(P<0.05),离职率下降(P<0.05),差异有统计学意义。结论 建立在拔岗晋级及激励机制上的护士岗位管理能提高护士满意度,降低护士离职率,稳定护士队伍,能够提高护士职业获益感、护士职业投入,从而提高护士工作的主观能动性和工作积极性,为高质量护理服务和优质护理服务长效机制的建立奠定了基础,促进优质护理服务的可持续发展,提高护理管理效能。

Objective To explore the application and experience of job promotion combing with excitation mechanism in nurses position management. Methods We used job promotion combing with excitation mechanism in nurses position management to compare the satisfaction rate, perceived career benefit, work engagement and separation rate of nurses. Results After the application, the satisfaction rate, perceived career benefit and work engagement of nurses were increased, while separation rate of nurses was decreased(P<0.05), the difference has statistical significance. Conclusion The application may increase the satisfaction rate, perceived career benefit and work engagement of nurses, and decrease the separation rate of nurses, elevate the subjective initiative and work enthusiasm. Nursing quality is improved continuously. The management efficacy is promoted.

目的 通过对未进行过商业基因检测(NCGT)社区居民和直接面向消费者的基因测试(DCGT)消费群体的调查,分析市场基因测试产品的消费构成和消费者社会特征与基因检测消费的相关因素。方法 采用分层随机抽样方法对广州市居民和直接面向消费者的基因检测非患者居民进行面访式调查,采用Logistics回归分析商业基因测试的相关社会学因素。结果 NCGT社区居民中其家庭成员进行过胎儿产前筛查基因检测的比例(26.3%)较高、DCGT人群因常规健康体检包含基因检测项目而进行基因测试的比例(44.8%)最高,儿童天赋基因的测试比例(23.3%)也相对较高,两个群体均认为基因检测的目的主要是预防疾病,信任的检测机构为医院。DCGT行为相关的社会学特征有婚姻(已婚vs未婚:OR=5.591,P<0.001)、学历(专科以上vs专科及以下:OR=0.071,P<0.001)、年龄(30～49岁组vs其他组:OR=0.223,P<0.001)、工作(全职vs其他:OR=4.660,P<0.001)、公费医疗(OR=1.183,P=0.021)和商业保险(OR=2.121,P=0.004)。结论 公众将基因测试看成是预防疾病和控制遗传性疾病的公共卫生手段,需要在医院将基因检测和个性化治疗对应起来。

Objective By investigating consumer groups that have no-commercial genetic testing (NCGT) community residents and direct-to-consumers genetic testing (DCGT), to analysze the consumer composition of market genetic testing products and the factors related to consumer social characteristics. Methods A stratified random sampling method was used to conduct a face-to-face survey of residents and non-patients of genetic testing in Guangzhou residents. The logistic regression analysis was used to analyze the sociological factors of commercial genetic testing. Results The proportion of children in the NCGT community who had prenatal screening for prenatal screening (26.3%) was higher, and the proportion of DCGT populations that were genetically tested for routine health checkups containing genetic testing (44.8%) was the highest. The proportion of test genes (23.3%) is also relatively high. Both groups believe that the purpose of genetic testing is mainly to prevent diseases, and the testing institutions for their trust are hospitals. The sociological characteristics associated with DCGT behavior are marriage (married vs unmarried: OR=5.591, P<0.001), education (specialist vs. specialist and below: OR=0.071, P<0.001), age (30~49 years vs others, OR=0.223, P<0.001), work (full-time vs other: OR=4.660, P<0.001), public medical care (OR=1.183, P=0.021) and commercial insurance (OR=2.121, P=0.004). Conclusion The public regards genetic testing as a public health tool for preventing diseases and controlling hereditary diseases, and it is necessary to correlate genetic testing with personalized treatment in hospitals.

目的 探讨肺结核合并肺癌患者的CT影像特征,为临床疾病诊断提供参考依据。方法 选取2015年—2018年我院收治的肺结核合并肺癌患者50例作为观察组,另选取同期于我院治疗的单纯肺结核患者50例为对照组。观察两组患者临床症状及CT影像表现并作出对比分析。结果 两组患者临床症状及体征相比,差异无统计学意义(P>0.05);观察组患者分叶征、毛刺状结节比例高于对照组患者,差异有统计学意义(P<0.01),观察组患者实质内空洞比例低于对照组患者,差异有统计学意义(P＜0.01),两组患者肿物及条索影发生比例相比差异无统计学意义(P>0.05)。结论 肺结核合并肺癌患者的CT影像学特征主要在分叶征、毛刺状结节和空洞症,临床应根据这些特征并结合其他检查进行定性诊断。

Objective To investigate the CT images of patients with pulmonary tuberculosis complicated with lung cancer and provide reference for the diagnose. Methods 50 cases of pulmonary tuberculosis and lung cancer treated in our hospital in 2015~2018 in January were selected as observation group, and 50 cases of simple pulmonary tuberculosis treated in our hospital for the same period were selected as control group. The clinical symptoms and CT imaging findings of the two groups were observed and compared. Results There was no significant difference in clinical symptoms and signs between the two groups (P>0.05), and the proportion of lobular sign and burr nodular nodules in the observation group was higher than that of the control group (P<0.01), and the proportion of parenchymal cavities in the observation group was lower than that of the control group (P<0.01). There was no significant difference between the two groups in the incidence of tumor and streak shadow (P>0.05). Conclusion The CT imaging features of patients with pulmonary tuberculosis and lung cancer are mainly lobular sign, burr like nodules and cavities, which should be qualitatively diagnosed according to these features combined with other tests.

目的 了解广东地区糖尿病足患者创面病原菌分布及耐药性变迁。方法 回顾性分析A组(2010年1月—2014年12月就诊的糖尿病足患者)和B组(2015年1月—2018年1月就诊的糖尿病足患者)研究者创面病原菌分布及耐药性变迁。结果 B组中创面G⁺菌及G^-菌均有下降趋势且G^-菌下降较快,细菌种类明显增加,真菌及混合感染明显上升,A组以金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌感染为主;B组以金黄色葡萄球菌、奇异变形杆菌、铜绿假单胞菌及真菌感染为主;B组相对于A组的细菌耐药性增加。结论 近年来糖尿病足患者病原菌种类明显增加且混合感染及真菌感染上升,且其耐药性增加,因此早期经验用药而后根据药敏选择抗菌药物治疗是糖尿病足感染治疗的关键。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in diabetic foot wounds in Guangdong area. Methods Patients with diagnosis of diabetic foot between group A (from Jan 2010~Dec 2014 ) and group B (from Jan 2015 to Jan 2018) were retrospectively analyzed. We studied the bacteria distribution and drug resistance of pathogenic changes of group A and group B. Results In group B, both G+ and G- bacteria had a decreased trend while G- bacteria decreased rapidly, but the species of bacteria increased obviously just as fungi and mixed infection increased obviously. Bacteria infection in group A were mainly about Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli wihle group B were Staphylococcus aureus, Proteus mirabilis, Aeruginosa and Fungal infection; the resistance of group B to A was lower. Conclusion In recent years, kinds of pathogenic bacteria of diabetic foot were significantly increased and the mixed infection and increased fungal infection as well as its drug resistance increased, so the early experience of medication choice of antibiotics based on drug sensitivity and treatment are the key to the treatment of diabetic foot infection.

目的 探究纽扣钢板内固定方法治疗新鲜Rockwood Ⅲ型以上肩锁关节脱位的效果。方法 选取2013年1月—2017年12月在我院诊断并治疗的肩锁关节脱位(Rockwood Ⅲ型以上)60例,随机分为观察组(30例)与对照组(30例),观察组采用纽扣钢板内固定方法,对照组采用锁骨钩钢板方法。对比两组治疗前后肩功能指标(Constant-Murley)、手术的治疗疗效指标(Karlsson)的优良率,以及手术时间和术中出血量。结果 治疗前两组的Constant-Murley评分无差异(P＞0.05),治疗后两组评分均提高(P＜0.05),其中观察组高于对照组(P＜0.05);观察组的Karlsson评分优良率、术中出血量均优于对照组(P＜0.05),观察组的手术时间高于对照组(P＜0.05)。结论 纽扣钢板内固定能够有效恢复患者正常肩部功能,具有良好的治疗效果,同时对患者造成的创伤较小。

Objective To observe the effect of button plates in treatment of Rockwood Ⅲ and greater acromioclavicular dislocation. Methods From January 2013 to December 2017, 60 Rockwood Ⅲ and greater acromioclavicular dislocation patients in our hospital were randomly divided into observe group(30 cases)and control group (30 cases), the observe group received button plates treatment, the control group received clavicula hook plate treatment. The shoulder function(Constant-Murley)of two groups before and after treatment were compared, and the effect of operation(the good rate of Karlsson), surgical time and intraoperative bleeding of two groups were also compared. Results There were no difference in shoulder function between two groups before treatment(P＞0.05). The indices were increased after treatment(P<0.05), and the indices in the observe group were higher than that of control group(P＜0.05), The good rate of Karlsson index, intraoperative bleeding of observe group were better than that of control group(P＜0.05).The surgical time of observe group were better than that of control group(P＜0.05). Conclusion Button plate's internal fixation nay better improve the shoulder function; it has better therapeutic effect, and smaller trauma to patient.

目的 探讨利拉鲁肽与二甲双胍对新诊断2型糖尿病患者骨代谢的影响。方法 选取2016年1月—2017年6月在我院就诊并确诊为新诊断2型糖尿病患者50例,按照随机数字表法将研究对象随机分为利拉鲁肽组及二甲双胍组,每组各25人。两组患者均单药治疗24周后比较两组患者骨密度、骨代谢指标变化情况。结果 两组患者骨密度、血清ALP以及BGP、PINP水平治疗前后相比,无改变(P>0.05);而利拉鲁肽组患者的β-CTx水平较治疗前降低(P<0.05);两组患者治疗后FPG、2hFPG、HOMA-IR、HbA1c均较治疗前下降(P<0.05),而空腹胰岛素较治疗前上升(P<0.05);利拉鲁肽组患者治疗24周后BMI值低于治疗前(P<0.05)。结论 利拉鲁肽与二甲双胍对新诊断2型糖尿病患者骨密度的影响均不明显,两种药物可有效降低血糖,改善胰岛素抵抗,利拉鲁肽在使用过程中可明显降低患者血清β-CTx水平,但其是否存在骨质保护作用仍需进一步研究。

Objective To explore the effect of liraglutide and metformin on bone metabolism in newly diagnosed type 2 diabetic patients. Methods From January 2016 to June 2017, 50 patients with type 2 diabetes mellitus admitted to our hospital were selected. According to the random number table method, the subjects were randomly divided into liraglutide group and metformin group, 25 in each group. Changes in bone mineral density and bone metabolism were compared between the two groups after 24 weeks of monotherapy. Results That there was no significant change in bone mineral density, serum ALP, TPINP,and BGP levels before and after treatment (P>0.05). The β-CTx levels in patients in the liraglutide group were lower than that before treatment (P<0.05); FPG, 2hFPG, HOMA-IR, and HbA1c levels in the two groups were lower than that before treatment (P<0.05). Fasting insulin was higher than that before treatment (P<0.05); BMI was lower in the liraglutide group after 24 weeks of treatment than that before treatment (P<0.05). Conclusion The effects of liraglutide and metformin on the bone mineral density of patients with newly diagnosed type 2 diabetes are not obvious. Liraglutide may reduce serum β-CTx levels during use. We need to have further study whether it has a bone protection.

目的 探究和分析本组腹主动脉瘤腔内治疗病例并发症发生的原因及预防、处理策略。方法 对本团队在2014年1月—2017年12月实施的37例腹主动脉瘤腔内修复手术病例进行回顾性分析。结果 共有11例发生并发症,其中3例为术中I型内漏、1例术后支架移位致Ⅰ型内漏、1例术后Ⅲ型内漏、1例术中Ⅳ型内漏,全部经处理后内漏消失;术后髂动脉支架内血栓1例,经取栓后血流恢复;术后股动脉狭窄闭塞1例,经取栓并行股动脉人工血管置换后血流恢复;术后移植物反应1例,对症处理后症状消失出院;2例双侧髂内动脉栓塞致术后盆腔疼痛,随访疼痛消失,无跛行。结论 腹主动脉瘤腔内修复治疗本身存在内漏、血栓、血管入路损伤、移植物反应等相关并发症。术前正确评估并严格掌握适应症以及具有成熟的操作经验,是减少并发症发生的关键。

Objective To discuss and analyze the occurrence causes, prevention and treatment methods of complications in the endovascular repair of patients with abdominal aortic aneurysm. Methods Totally 37 cases of patients with abdominal aortic aneurysm underwent endovascular repair in our hospital from January 2014 to December 2017 were retrospectively analyzed. Results The complications were occurred in 11 cases, which including intra-operative typeⅠendoleak in 3 cases, postoperative typeⅠendoleak caused by stent displacement in 1 case; intra-operative type Ⅲ endoleak in 1 case; postoperative type Ⅳ endoleak in 1 case. all of the endoleak events disappeared after dealing. There was postoperative iliac artery stent thrombosis in 1 case, the blood flow was restored after thrombectomy; postoperative femoral artery stenosis or occlusion in 1 case, the blood flow was restored after thrombectomy and femoral artery artificial vascular replacement; postoperative host versus graft reaction in 1 case, no stent infection was found; and postoperative bilateral pelvic pain caused by internal iliac artery embolization in 2 cases, the pain disappeared during the follow-up visit, and the patients were free from lameness. Conclusion The complications related to endoleak, thrombosis, vascular approach injury and host versus graft reaction are existing with the endovascular repair itself of abdominal aortic aneurysm. The correct preoperative evaluation as well as strict control of indications and mature operational experience are the key to reduce the occurrence of complications.