目的 观察乳腺癌组织中沉默信息调节因子(SIRT1)的表达并探讨其临床意义。方法 选取70例乳腺癌组织和20例乳腺纤维腺瘤组织,应用免疫组化法观察SIRI1在两组中的表达,并分析其与临床病理参数、预后之间的关系。结果 SIRT1在乳腺癌组织中和乳腺纤维腺瘤组织中的阳性表达分别为:62.9%(44/70)、35%(7/20),P＜0.05;SIRT1的表达与乳腺癌的病理分期及淋巴结转移有关,P＜0.05;SIRT1表达阳性和阴性患者2年无疾病进展生存率分别为40.6%和73.7%,P＜0.05。结论 乳腺癌组织中SIRT1的阳性表达率较高,并与乳腺癌的发生、发展、侵袭、转移、预后有关。

Objective To investigate the sirtuin (SIRT1) expression in breast cancer and its relationship with clinicopathological parameters in breast tissue. Methods We used immunohistochemical staining (Envision two-step) to detect the expression of 70 cases of breast cancer and 20 cases of breast fibroadenoma of SIRT1. Results The positive expression of sirt1 in breast cancer and breast fibroadenoma tissues were 62.9 % (44/70) and 35 % (7/20),P<0.05. The expression of sirt1 was correlated with the pathological stage and lymph node metastasis of breast cancer, P<0.05. The 2-year survival rates of sirt1 positive and negative patients were 40.6 % and 73.7 %, respectively, P<0.05. Conclusion The positive expression rate of sirt1 in breast cancer is higher, and is related to the occurrence, development, invasion, metastasis and prognosis of breast cancer.

成人急性呼吸窘迫综合征死亡率居高不下,而当前治疗手段大多以对症支持为主且效果欠佳。通过早期识别ARDS高危患者,及早施加干预措施阻断疾病进展是目前研究的新方向。较之传统机械通气模式,气道压力释放通气因其特有的肺保护作用备受国内外学者关注,APRV下肺泡持续开放并保持稳定可减少肺损伤发生,将APRV应用于ARDS预防理论上前景可观,本文将围绕早期实施APRV对预防ARDS应用价值展开论述。

The mortality of adult acute respiratory distress syndrome(ARDS) remains high. Supportive care measures are main treatments to ARDS currently while the effect is poor. Early application of airway pressure release ventilation in patients who are at high risk for ARDS is a new direction of research. Compared with traditional mechanical ventilation, more and more scholars both at home and abroad pay attention to the airway pressure release ventilation APRV because of its unique lung protection. Under APRV the alveoli maintain stable continuously which may reduce the incidence of lung injury. Applying APRV to ARDS prevention is promising theoretically. This paper will focus on the value of preemptive airway pressure ventilation for high-risk ARDS patients.

目的 探讨二孩政策后二次妊娠孕妇产前不良情绪及影响因素。方法 选取2016年2月—2017年1月我院收治二次妊娠待产孕妇93例作为研究组,选取同期收治初产妇50例作为对照组,采用汉密顿焦虑量表(HAMA)和抑郁状态采用抑郁自评量表(SDS)评估比较两组产期焦虑、抑郁情绪,同时按照HAMA、SDS评分结果将研究组患者分为A组(合并不良情绪)和B组(未合并不良情绪),采用单因素和多因素Logistic回归分析方法分析影响二次妊娠孕妇产前不良情绪危险因素。结果 研究组HAMA、SDS评分均高于对照组(P＜0.05)。妊娠合并症、不适应医院环境、未参加孕妇学校及胎儿异常均为影响二次妊娠孕妇产前不良情绪危险因素。结论 二孩政策后二次妊娠孕妇产前易合并不良情绪,影响产前不良情绪危险因素较多,产前应针对性进行预防和干预。

目的 探讨高速改良涡轮手机拔除下颌阻生第三磨牙的临床疗效。方法 回顾性分析2013年12月—2016年12月于本科室拔除下颌阻生第三磨牙600例临床案例,按拔除方式不同,将其分为高速涡轮手机组和传统凿骨劈冠组,各300例。其中高速涡轮手机组给予高速涡轮手机拔除法拔除下颌第三磨牙,传统凿骨劈冠组给予传统凿骨劈冠拔除法拔除下颌第三磨牙。统计分析两组患者拔出后疗效情况、拔除使用时间、以及拔除后疼痛度及张口受限度情况。结果 高速涡轮手机组患者拔牙优良率明显高于传统凿骨劈冠组,差异有统计学意义(P<0.05),而疗效差发生率明显低于传统凿骨劈冠组,差异有统计学意义(P<0.05);高速涡轮手机组患者拔牙时间在30min内人数明显多于传统凿骨劈冠组,差异有统计学意义(P<0.05),而在30min以上的人数明显少于传统凿骨劈冠组,差异有统计学意义(P<0.05);高速涡轮手机组患者拔牙后疼痛度1级和张口受限度1级人数明显多于传统凿骨劈冠组,差异有统计学意义(P<0.05),而术后疼痛度2级、3级和张口受限度2级、3级均明显少于传统凿骨劈冠组,差异有统计学意义(P<0.05)。结论 高速改良涡轮手机拔除下颌阻生第三磨牙具有创口小,伤口愈合较良好,用时短以及能促进患者术后舒适。

通过文献检索,对2001—2016年我国学者在国内发表的有关人工髋关节置换后假体周围骨折的Vancouver分型及其治疗方法进行汇总、归纳和分析, 总结分析国内初次生物型人工髋关节术后假体周围骨折病例的Vancouver分型及其不同治疗方法的优良率,为临床决策中选择适合的手术方法提供一定的参考借鉴。共有 117 篇文献入选,统计结果显示入选病例数前三位的省份分别是河南220例占13.3%,上海173例占10.5%,江苏163例占9.9%;Vancouver分型中A型骨折201例占12.2%,B型骨折1226例占74.4%,C型骨折221例占13.4%。AG型骨折行记忆合金环抱器或钢丝环扎+植骨治疗,AL型骨折行翻修+锁定钢板+钢丝或翻修+锁定钢板+植骨治疗,疗效显著;B1、B2、B3型骨折分别采用加压钢板+植骨、翻修+钢板+钢丝+植骨、翻修+记忆合金环抱器+植骨治疗,术后平均优良率可达100%;C 型骨折治疗方法较多,如LISS钢板+植骨、锁定钢板+钢丝、股骨髁钢板+钢缆+植骨、动力髋钢板+钢丝,疗效均较满意。我国人工髋关节置换术地区间开展不平衡,应根据Vancouver 分型,综合考虑患者骨折类型、骨折位置、假体稳定性、骨量丢失情况等提出个体化的治疗方案,提高临床疗效。

目的 了解广州市社区医务人员对颈动脉狭窄防治知识的认知程度、认知途径及对相关健康教育的需求情况。方法 对37家社区卫生服务中心194名广州市社区医务人员进行问卷调查,分析调查结果。结果 社区医务人员中52.58%能够指出颈动脉狭窄与脑卒中的关系,但对症状性颈动脉狭窄定义、颈动脉狭窄的外科治疗方法知晓率偏低(14.95%、18.56%),97.94%能够指出颈部彩超是颈动脉狭窄最常用的筛查方法,但对彩超结果判读、干预方法指导等方面内容掌握率偏低。对颈动脉狭窄知识来源目前最主要的是用药指南和药品说明书(33.89%)认为最有效获得颈动脉狭窄知识的途径是专题继续教育培训班(26.12%)。结论 社区医务人员已经形成了脑卒中和颈动脉狭窄的基本观念,但是不能达到足够的“深度”,通过开展多种形式继续教育,增进社区医务人员对颈动脉狭窄认知的广度和深度,引导和拓宽获得知识的途径将是必要和有效的。

Objective To understand the knowledge and needs of carotid stenosis prevention among community health workers in Guangzhou. Methods A Kirkpatrick model-based questionnaire survey was conducted among 194 health workers in community health service center in Guangzhou. Results 52.58% of the community medical staff could point out the relationship between carotid stenosis and stroke, but few of them could accurately point out the definition and surgical treatment of symptomatic carotid stenosis(14.95%,18.56%). 97.94% of them could pointed out that the most commonly used screening methods for cervical carotid stenosis, but most of them didn't know how to interpret the inspection result of color doppler ultrasound. Medication guide were the main knowledge source of carotid stenosis(33.89%) and post-graduate training was the most promising approach(26.12%). Conclusion Community health workers have formed the basic concept of stroke and carotid stenosis, but it was limited in extent. It is necessary to carry out various forms of continuing education to improve the level of awareness of community health workers on carotid artery stenosis.

目的 探讨维持性腹膜透析患者高尿酸血症的临床特点及相关影响因素。方法 收集152名腹膜透析患者,根据血尿酸情况将患者分为高尿酸血症组和正常血尿酸组,分析其临床资料。结果 高尿酸血症112例(73.7%)。高尿酸血症组的血钾、高血压史、血尿素氮、血清肌酐、血磷、iPTH、甘油三脂水平均较正常尿酸组升高(P均＜0.05);而年龄、血钠、血红蛋白、血白蛋白、前白蛋白、血钙、血清铁、总蛋白、hsCRP、空腹血糖、血总胆固醇、血高密度脂蛋白胆固醇、血低密度脂蛋白胆固醇、KT/V、PET无统计学差异(P均＞0.05)。血尿酸水平与血钾、血尿素氮、血磷呈正相关(P＜0.05)。结论 腹膜透析患者高尿酸血症发生率高,血尿酸与血钾、血尿素氮、血磷密切相关,及时纠正高尿酸血症可以改善预后。

Objective To investigate the clinical characteristics and its related influence factors of hyperuricemia in peritoneal dialysis patients. Methods A total of 152 peritoneal dialysis patients were enrolled. Patients were classified into hyperuricemia and normal serum uric acid (SUA)groups. Factors associated with hyperuricemia were analyzed. Results Hyperuricemia occurred in 112 cases(73.7%). There were significant differences in serum potassium, the incidence of hypertension, blood urea nitrogen, serum creatinine, serum phosphorus, parathyroid hormone, triglyceride between hyperuricemia and normal SUA groups(P<0.05). There was no significant difference in age, serum sodium, hemoglobin, serum albumin, prealbumin, serum calcium, serum iron, total protein, high sensitive C-reactive protein, serum glucose, total cholesterol, high density lipoproteins, low density lipoproteins, KT/V and PET(P>0.05). SUA levels was positively correlated with serum potassium, blood urea nitrogen and serum phosphorus(P<0.05). Conclusion Hyperuricemia was common in peritoneal dialysis patients, serum potassium levels is correlated with serum potassium, blood urea nitrogen and serum phosphorus. The timely treatment of hyperuricemia may improve the prognosis of peritoneal dialysis patients.

目的 观察镜像视觉反馈和改良强制性运动治疗对脑卒中偏瘫患者上肢功能的影响。方法 前瞻性纳入2013年12月—2016年10月在我院收治的、临床资料完整的脑卒中偏瘫患者117例,随机将患者分4组:A组30例,B组29例,C组28例和D组30例,所有患者均接受常规综合康复治疗,连续治疗4周。在常规综合康复治疗的基础上,B组和C组分别增加镜像视觉反馈训练和改良强制性运动治疗,D组则同时另加镜像视觉反馈和改良强制性运动治疗。主要观察指标包括治疗前、后的Fugl-Meyer量表(FMA)、上肢功能测试(upper extremity function test, UEFT)和改良Barthel指数(MBI)的评分。结果 4组患者治疗后的FMA、UEFT和MBI评分分别为:A组(26.37±3.44)、(43.30±3.46)、(56.27±4.76),B组(29.17±2.82)、(45.41±3.40)、(58.72±4.48),C组(29.46±3.16)、(45.71±2.37)、(58.82±3.89),D组(31.93±2.74)、(48.83±3.57)、(62.17±4.51),与治疗前组内相比,配对t检验显示差异有统计学意义(P＜0.05);单因素方差分析发现,D组明显优于A、B、C 3组,差异有统计学意义(P＜0.05);B、C 2组均优于A组,差异有统计学意义(P＜0.05);B、C 2组间比较,差异无统计学意义(P＞0.05)。结论 在常规综合康复训练基础上,单独联合镜像视觉反馈或改良强制性运动治疗均能改善脑卒中偏瘫患者上肢运动功能和日常生活自理能力,但同时联合应用两种疗法,疗效更佳。

Objective To investigate the effects of mirror visual feedback (MVF) and modified constraint-induced movement therapy (mCIMT) on upper extremity function in post-stroke hemiplegics. Methods 117 patients with hemiplegia post-stroke were collected prospectively from December 2013 to October 2016, and randomly divided into the following four groups: group A (n=30), group B (n=29), group C (n=28) and group D (n=30). All patients were trained with conventional comprehensive rehabilitation therapy for four weeks, while the group B and group C were respectively trained with MVF and mCIMT based on conventional comprehensive rehabilitation therapy. Finally, the group D was simultaneously trained with MVF and mCIMT. The investigation duration was set as four weeks for all groups. The Fugl-Meyer Assessment (FMA) score, Upper Extremity Function Test (UEFT) score, and Modified Barthel Index (MBI) score were used as main index of clinical effects. Results After treatment, the scores of FMA, UEFT and MBI were respectively (26.37±3.44),(43.30±3.46),(56.27±4.76) in group A, (29.17±2.82), (45.41±3.40), (58.72±4.48) in group B, (29.46±3.16), (45.71±2.37), (58.82±3.89) in group C, (31.93±2.74), (48.83±3.57), (62.17±4.51) in group D.Comparing with the scores before treatment, the paired-sample t test showed that there were significant differences (P<0.05). The single factor variance test showed that the scores of the group D were significant better than those scores in group A, group B and group C (P<0.05); furthermore the scores of the group B and group C were significant better than the group A (P<0.05). However, there were no difference at those scores between the group B and group C (P＞0.05). Conclusion Based on conventional comprehensive rehabilitation, single combined with MVF or mCIMT may significantly improve the function of upper limb and activities of daily living (ADL) in post-stroke patients with hemiplegia. However, simultaneous combined with MVF and mCIMT will be more effective than the single one.

目的 通过监测供精人工授精技术(artificial insemination by donor,AID)助孕后妊娠患者,了解其子代出生缺陷和遗传代谢病情况,为建立规范的监测子代出生缺陷的机制提供理论依据。方法 随访供精人工授精技术助孕后妊娠分娩的患者,收集其子代临床资料,部分新生儿采集足跟血制成滤纸干血斑标本,进行串联质谱分析,筛查遗传代谢病,可疑对象进行重复检测和专科咨询检查。结果 收集分析2007年—2016年通过AID出生的4 261例子代临床资料,360例新生儿采集足跟血进行 50种遗传代谢病检测。子代出生缺陷率1.24%(不包括230例轻度地方病地中海贫血症、24例G6PD缺乏症和两病共患5例),360例中未发现重度地中海贫血症、先天性甲状腺低下症、苯丙酮尿症等其他遗传代谢病。本中心建立宣传教育新生儿遗传代谢病筛查和转诊制度。结论 供精人工授精技术助孕后妊娠出生的子代出生缺陷和遗传代谢病发病率低,冻存精子进行供精人工授精助孕,是一种较安全获得健康子代的辅助生殖技术。

目的 探究S100B蛋白、神经元特异性烯醇化酶与新生儿低血糖脑损伤的诊治相关性。方法 收集2014年1月—2016年12月来我院就诊出现低血糖脑损伤的新生儿116例,设为患病组,首先根据临床表现,分为两组,有低血糖症状组(n=54)和无低血糖症状组(n=62)。两组患儿均给予常规药物治疗,有效患者82例,为有效组,无效患者34例,为无效组。同期收集健康足月的新生儿53例,为健康对照组。患儿均于治疗前、后检测血清S100B蛋白、神经元特异性烯醇化酶水平,健康对照组新生儿也于同一时间点进行相同检测。观察各组新生儿血清S100B蛋白、神经元特异性烯醇化酶水平变化,并探究其水平变化与诊断及治疗效果的相关性。结果 低血糖症状组和无低血糖症状组患儿的血糖水平均低于和健康对照组(P<0.05);低血糖症状组患儿的低血糖扶持续时间高于无低血糖症状组(P<0.05)治疗后,各组的NSE和S100B的蛋白水平差异无统计学意义(P>0.05)。患儿血清NSE和S100B与血糖水平呈负相关(r=-0.131、-0.124、P<0.05),与低血糖持续时间呈正相关(r=0.135、0.129,P<0.05)。结论 血清NSE及S100B与患儿血糖水平相关,可作为新生儿低血糖脑损伤的早期诊断指标。血清NSE及S100B水平与治疗效果存在相关性并为负相关,血清水平越低,患者治疗效果越好。