目的 建立兔腰椎间盘严重退变骨水泥成形术模型并进行鉴定。方法 选用新西兰白兔6只,手术干预前摄腰椎正侧位X线片并进行MRI扫描Pfirrmann分级,之后通过腹外斜肌与腰大肌间隙入路手术去除兔腰2~3椎间盘髓核组织及部分纤维环模拟腰椎间盘严重退变状态。饲养6周后相应腰椎节段椎间盘进行MR扫描Pfirrmann分级,确认相应腰椎节段椎间盘符合严重退变影像表现后再次手术显露相应椎间隙并注入骨水泥。1周后再次摄腰椎正侧位X线片并行MRI扫描Pfirrmann分级,终末处死并解剖动物检查椎间盘内骨水泥填充情况。结果 兔腰椎间盘退化模型建立6周后磁共振Pfirrmann分级为Ⅴ级。椎间隙骨水泥注射后1周其术后磁共振Pfirrmann分级为Ⅳ。骨水泥注射模型1周后拍摄手术节段X线片显示骨水泥较好地填充于腰2~3间隙,椎间隙高度接近正常状态。终末处死并解剖动物发现腰椎节段椎间盘内骨水泥填充良好无脱落或松动。结论 通过腹外斜肌与腰大肌间隙入路,手术去除椎间盘髓核组织及部分纤维环6周后,往椎间隙内注入骨水泥,可获得较为可靠的新西兰大白兔腰椎间盘严重退变骨水泥成形术的动物模型。

Objective To establish and identify the rabbit model of lumbar disc with severe degeneration．Methods Six New Zealand white rabbits were selected,lumbar X-ray and Pfirrmann grade by MR scan were performed before surgical intervention．Along the space of obliquus externus abdominis and psoas major,the front edge of L2 to L3 was exposed．Then,the nucleus pulposus and part of annulus fibrosus were removed to imitate severe degeneration of lumbar disc．After 6 weeks of rearing,the operated lumbar disc was graded by MR scan,confirming that the lumbar disc met the image of severe degeneration,and then exposed the intervertebral space and injected bone cement．One week later,the anterior lumbar X-ray and the MRI scan for Pfirrmann grading were taken．The animals were sacrificed and dissected to check the bone cement filling in the intervertebral disc．Results The rabbit MR Pfirrmann grade of intervertebral disk was V after 6 weeks of first operation．One week after intervertebral cement injection,the MR Pfirrmann grade was Ⅳ．The surgical segment X-ray was taken one week after the cement injection,which showed that the cement was well filled in the L2-L3 gap and the vertebral space height was close to normal．Animals were sacrificed and dissected,the lumbar intervertebral disc was well filled with cement without shedding or loosening．Conclusions A reliable animal model of lumbar disc with severe degeneration in New Zealand white rabbits can be obtained by injecting cement into the intervertebral space after 6 weeks of removal of the intervertebral disc nucleus pulposus and part of the annulus fibrosus through the obliquus externus abdomins and psoas major intervertebral space．

目的 探索老龄化形势下广州市白云区西部卒中防治工作的新模式。方法 通过完善组织结构、管理架构、建立稳定高效运行的(1+1+N)紧密型医联体模式,创建优质高效的卒中救治区域联盟,实现高质量的基层首诊,双向转诊,快速响应的卒中绿道急救和全程管理。结果 初步完成构建广州市白云区西部区域性卒中救治中心,区域内卒中患者及时救治,溶栓效率,血管再通等均有显著提升,整体提升白云区西部医疗机构的卒中救治水平。结论 区域性的协同救治是提高卒中救治水平的重要举措。(1+1+N)紧密型医联体模式能提高卒中患者救治率,具有可行性和必要性。

Objective To explore the effectiveness of a new stroke prevention and treatment pattern in the western part of Baiyun District, Guangzhou city, under an aging situation. Method We aim to build a high-quality and efficient stroke treatment regional alliance based on a (1+1+N) compact medical consortium, expecting to improve the overall abilities of stroke treatment in the western part of Baiyun District through high-quality primary care, two-way referrals, rapid response to stroke greenway emergency and full-process management. Results We have initially established a regional stroke treatment center in the western part of Baiyun District, Guangzhou. Stroke patients in that region can be treated in time, and the efficiency of thrombolysis and vascular recanalization have been significantly improved. Conclusion Regional coordinated treatment is an effective measure to reduce the disability and fatality rate of stroke. The (1+1+N) compact medical consortium model can improve the treatment effect in stroke patients, which is feasible and necessary.

目的 探讨老年吸入性肺炎的危险因素,建立风险预测模型,以期降低老年吸入性肺炎的发病率。方法 选取2017年8月28日—2020年 10月30日广州市第一人民医院老年病科住院治疗的老年肺炎患者205例,按照是否发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,对比2组患者的各项指标,分析老年吸入性肺炎的危险因素,建立风险预测模型,采用ROC曲线对模型进行预测效果检验。结果 多因素Logistic回归分析结果显示,脑梗塞、帕金森、留置胃管、长期卧床为老年吸入性肺炎的危险因素(P<0.05)。模型公式为Logit(P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀。该模型ROC曲线下面积为0.894。结论 本研究中的模型预测效果良好,可为医护人员预测老年患者发生吸入性肺炎的概率,及时采取相应的预见性护理及干预性治疗。

Objective To explore the risk factors of aspiration pneumonia in the elderly and establish the risk prediction model, in order to reduce the incidence of aspiration pneumonia in the elderly. Methods A total of 205 elderly patients with pneumonia who were hospitalized in the department of geriatrics, Guangzhou First People's Hospital from August 28, 2017 to October 30, 2020, were divided into aspiration pneumonia group and non-aspiration pneumonia group according to whether aspiration pneumonia occurred. The indicators of the two groups of patients were compared, the risk factors of aspiration pneumonia in the elderly were analyzed, the risk prediction model was established, and the prediction effect of the model was tested by receiver operating characteristic curve. Results Multivariate Logistic regression analysis showed that cerebral infarction, Parkinson's disease, indwelling nasogastric tube, and being bedridden were risk factors for aspiration pneumonia in elderly patients (P<0.05). The model formula was Logit (P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀. The area under receiver operating characteristic curve of this model was 0.894. Conclusion The prediction effect of the model in this study was good, which could predict the probability of aspiration pneumonia in elderly patients for medical staff, and to timely take the corresponding predictive care and interventional treatment.

目的 探究m6A甲基化基因与卵巢癌生存预后的关系,为卵巢癌的靶向治疗、预后评估提供科学依据。方法 从TCGA及GTEx数据库中下载卵巢癌组织与正常组织mRNA表达数据进行组间差异分析,通过LASSO回归筛选与卵巢癌生存相关基因,进一步使用逐步Cox回归分析构建风险评分预测模型,根据风险评分中位数将患者分为高风险组和低风险组并使用ROC曲线下面积评价模型的预测能力。相关性分析构建与m6A基因的共表达调控网络,GO功能富集和KEGG通路分析初步探讨潜在的生物作用机制。结果 在癌组织与正常组织中发现20个m6A甲基化基因差异表达,逐步Cox回归分析筛选出3个基因(HNRNPA2B1,ZC3H13,WTAP)用于构建风险评分模型,高风险组患者的生存期较低风险组患者明显缩短(P=0.001 9),死亡风险显著增加(HR=2.643, P＜0.01),风险评分模型结合患者年龄、临床分级和分期后,1、3、5年的AUC为0.74、0.64、0.64。生物信息学分析结果提示m6A相关基因参与RNA的剪接、定位、转运、代谢调控、蛋白水解、细胞周期、核糖体合成等生物学过程。结论 成功构建卵巢癌m6A甲基化基因预后风险评估模型且该模型具备一定的预测效能。

Objective To explore the relationship between m6A methylated genes and prognosis of ovarian cancer, so as to provide scientific basis for targeted therapy and prognosis assessment of ovarian cancer. Methods The mRNA expression data of ovarian cancer tissues and normal tissues were downloaded from TCGA and GTEx databases for difference analysis between two groups. The genes related to ovarian cancer survival were screened by LASSO regression, and the risk score prediction model was further constructed by step Cox regression analysis. The patients were divided into high-risk group and low-risk group according to the median risk score, and the ROC was used for analysis. Correlation analysis was performed to construct an expression regulatory network with m6A genes, and GO function enrichment and KEGG pathway analysis were performed to preliminarily explore the potential biological mechanism. Results 20 m6A methylation genes were found in differential expression between cancer tissue and normal tissue, three genes (HNRNPA2B1, ZC3H13, WTAP) were used to construct the model through step Cox regression analysis. Patients' survivals of high-risk group were shortened than that of the low-risk group obviously (P=0.001 9), the risk of death significantly was increased (HR=2.643, P<0.01). After risk score model combined with patient age, clinical classification and stage, the AUC of 1, 3, 5 years was 0.74, 0.64 and 0.64. Bioinformatics analysis indicated that those m6A genes were involved in RNA splicing, localization, transport, metabolic regulation, proteolysis, cell cycle, ribosome synthesis and other biological processes. Conclusion The prognostic risk assessment model of m6A methylated genes for ovarian cancer was successfully constructed and the model had certain predictive efficacy.

目的 通过建立特征参数曲线模型分析在不同CT扫描条件下对肺结节鉴别诊断的量化意义。方法 回顾性分析2018年9月—2019年10月我院收治的肺结节患者的CT胸部平扫图像为研究对象,纳入标准为结节直径≥3 mm,无其他病史。在筛选出的96例样本中,符合条件的样本68例(男性39例,女性29例),按扫描剂量的不同将研究对象分为低剂量观察组(管电压120 kV,管电流20 mA)和常规剂量组(管电压120 kV,管电流150 mA),每组各34例;通过测量并计算扫描长度、有效剂量、样本体型、信噪比相关参数,观察不同管电流与有效辐射剂量之间的相关性以及图像质量;运用PACS人工智能软件以及人工综合提取肺结节特征信息(直径、体积、密度纹理、边缘细节、内部结构)并记录数据,进而通过公式计算出肺结节质量;应用U检验分析比较不同管电流下各参数的组间差异,经过单元逻辑对确定的重要参数体积与质量纳入多元逻辑分析,建立特征参数曲线模型并测量曲线下面积及勾画ROC;使用卡方分析评价不同管电流下建立特征参数曲线模型对肺结节定量诊断分析的差异并同时比较不同管电流下的图像质量。结果 研究中发现,样本接受的有效辐射剂量在管电压一定的条件下,随管电流的增加而线性增加;样本肥胖患者(BMI≥23.9)的CT图像在使用低剂量扫描中呈现出明显噪声,影响组织间观察,而BMI标准(18.5≤BMI≤23.9)的样本的CT图像中,肺结节的信噪比与管电流变化未出现明显趋势阈值,差异无统计学意义(P＜0.05);通过特征参数曲线模型显示,肺结节的体积与质量均质性曲线显示出其变化趋势与管电流变化成相关性,且稳定性和一致性较好,故此二要素为模型主要分析成分,观察组ROC曲线显示其曲线下面积为0.826高于常规组ROC曲线显示其曲线下面积为0.747。结论 与常规剂量相比,低剂量CT扫描模式下建立特征参数曲线模型对肺结节鉴别诊断更有可量化意义。

Objective The quantitative significance of differential diagnosis of pulmonary nodules under different CT scanning conditions was analyzed by establishing characteristic parameter curve model. Methods CT plain chest scan images of patients with pulmonary nodules treated in our hospital from September 2018 to October 2019 were analyzed retrospectively. The inclusion criteria were nodule diameter ≥3 mm and no other medical history. Of the 96 selected samples, 68 met the criteria (39 males and 29 females).According to the different scanning dose, the subjects were divided into low dose observation group (tube voltage 120 kV, tube current 20 mA) and conventional dose group (tube voltage 120 kV, tube current 150 mA).There were 34 cases in each group, and the correlation between different tube current and effective radiation dose and image quality were observed by measuring and calculating the relevant parameters of scanning length, effective dose, sample shape and signal-to-noise ratio. PACS artificial intelligence software and artificial synthesis were used to extract the characteristic information (diameter, volume, density texture, edge details, internal structure) of pulmonary nodules and record the data. Furthermore, the mass of pulmonary nodules was calculated by formula, the differences of parameters under different tube currents were compared by U test, the volume and mass of important parameters determined by unit logic were incorporated into multivariate logic analysis. The curve model of characteristic parameters was established, the area under the curve was measured and ROC was sketched. Chi-square analysis was used to evaluate the difference of characteristic parameter curve model for quantitative diagnosis of pulmonary nodules under different tube currents, and to compare the image quality under different tube currents at the same time. Results In the study, it is found that the effective radiation dose received by the sample increases linearly with the increase of tube current under the condition of constant tube voltage. The CT images of obese patients (BMI≥23.9) showed obvious noise when using low dose scan, which affected the inter-tissue observation. However, in the CT images of the samples with BMI standard (18.5 ≤ BMI ≤ 23.9), there was no obvious trend threshold between the signal-to-noise ratio and tube current of pulmonary nodules, and the difference was not statistically significant (P<0.05).The characteristic parameter curve model showed that the volume and mass homogeneity curve of pulmonary nodules showed the change trend was correlated with the change of tube current, and the stability and consistency were good, so the two elements were the main analytical components of the model. The ROC curve of the observation group showed that the area under the curve was 0.826, which was higher than that of the conventional group, the area under the curve of the ROC curve was 0.747. Conclusion Compared with conventional dose, the establishment of characteristic parameter curve model under low dose CT scan mode is more quantifiable for differential diagnosis of pulmonary nodules.

目的 探讨“分-全带教”在提高门诊实习生处方审核能力的应用效果。方法 对2016届实习生进行“分-全带教”,在实习初期、后期组织实习生对100张门诊处方进行处方审核,登记审核结果。结果 实施“分-全带教”后,处方成功审核例数实习初期的163例(27.17%)提高到后期的487例(81.17%)。结论 应用“分-全带教”模式,有利于门诊实习生掌握处方审核技巧,在提高实习生处方审核能力中有良好应用前景。

Objective To make a discussion of the application result of point-all teaching model in improvement of prescription review ability of interns at outpatient service process. Methods To implement point-all teaching model on interns enrolled in 2016. To ask them to review 100 outpatient prescription at the beginning and ending of the internship respectively and record the results of their review. Results After the implementation of point-all teaching model, the correct review of the prescription has been improved from 163 (27.17%) at the beginning to 487 (81.17%) at the ending. Conclusion The point-all teaching model is conducive for interns at outpatient department to master the technique for review, so it is promising in the improving the prescription review ability of interns.

目的 探讨以家庭为中心的患教模式对糖尿病患者代谢控制水平的影响。方法 选取168例2016年9月—2017年8月在我院治疗的糖尿病患者,根据不同的健康教育模式干预将其分为观察组和对照组,每组各84例。对照组患者采用传统的综合患教模式,观察组患者在对照组的基础上采用以家庭为中心的患教模式,比较两组患者的自我管理水平及血糖、血脂控制效果。结果 干预后,观察组自我管理总得分、饮食控制、运动锻炼、血糖监测、足部护理、高低血糖处理均优于对照组(P＜0.05);观察组的FBG、PBG、HbA1C、TC、TG、LDL-C水平均低于对照组(P＜0.05)。结论 以家庭为中心的患教模式可辅助患者规范自己的行为,加强自我管理,改善血糖控制水平。

Objective To study the effects of two health education models on the level of metabolic control in diabetic patients. Methods 168 patients with diabetes admitted to our hospital from September 2016 to August 2017 were selected as subjects. According to different health education model interventions, they were divided into observation group and control group, with 84 cases in each group. The patients in the control group adopted a comprehensive health education model, and the patients in the observation group adopted a family-centered health education model based on the control group. The self-management level and blood glucose and blood lipid control effects of the two groups were compared. Results After intervention, the observation group self-management total score, diet control, exercise, blood glucose monitoring, foot care, high and low blood glucose treatment were better than that of control group (P<0.05); observation group FBG, PBG, HbA1C, TC, TG, LDL-C level were lower than that of the control group (P<0.05). Conclusion A family-centered health education model may help patients regulate their behavior, strengthen self-management, and improve their blood sugar control levels.

目的 探讨鼻咽癌个案管理模式,并评价临床中运用的效果。方法 回顾性将2017年8月—2018年4月93例新确诊的鼻咽癌患者作为对照组,按鼻咽癌患者的一般护理常规进行护理。2018年5月—2019年8月新确诊的鼻咽癌患者96例为实验组,实施个案管理比较两种方法的临床运用效果。结果 与对照组比,实验组诊断期完成检查时间和首次住院天数短、既定治疗计划完成率和治疗期间复诊依从性高,Ⅳ度骨髓抑制发生率低,差异均有统计学意义(P<0.05)。结论 鼻咽癌个案管理模式可为患者提供全程、连续性、高品质的护理,提高患者复诊依从性、提高治疗计划完成率,提高医疗护理质量,值得临床推广应用。

Objective To explore the case management mode of nasopharyngeal cancer (NPC) and evaluate the effect of clinical application. Methods 93 patients newly diagnosed NPC from August 2017 to April 2018 were used as the control group,and the general nursing routine was followed. 96 patients newly diagnosed NPC from May 2018 to August 2019 were taken as the experimental group,and accepted case management. Results Compared with the control group,the test time of the experimental group was shorter,the first hospital stay was shorter,the completion rate of treatment was higher,the patient's compliance of follow-up during treatment was better,incidence of grade Ⅳ myelosuppression was lower.The difference was statistically significant (P< 0.05). Conclusion The case management mode of NPC may provide seamless and high-quality nursing for NPC patients,improve the completion rate of treatment,improve the patient's compliance of follow-up and improve the quality of medical care,which is worthy of clinical application.

目的 探究分析基于互联网平台的健康管理模式对2型糖尿病患者血糖管理的效果及其临床价值。方法 选择2018年3月—2019年3月期间到我院进行治疗的120例2型糖尿病患者作为研究对象,用电脑随机法分为对照组和实验组各60例,对照组患者对其进行常规的护理干预,实验组患者给予基于互联网平台的健康管理模式,测试他们接受护理管理前后的血糖情况,邀请所有患者填写焦虑、抑郁自评量表评分并比较两组患者的心理状态评分,比较两组患者的生活质量和护理满意度。分析它们的护理要点及其结果。结果 实验组患者的护理后的血糖低于对照组;实验组患者焦虑自评量表(SAS)、抑郁自评量(SDS)表得分分别为(45.2±4.3)分和(42.8±6.3)分,这两个表均低于对照组的(56.3±7.5)分、(58.1±3.9)分;实验组患者的生活质量高于对照组;护理满意度高于对照组,差异有统计学意义(P＜0.05)。结论 应用基于互联网平台的健康管理模式有利于提高糖尿病患者血糖控制效果,对改善患者负面情绪、提高其生活质量及维持良好的护患关系也具有积极意义。

Objective To explore the effect and clinical value of health management model based on internet platform on blood glucose management in patients with type 2 diabetes(T2DM). Methods 120 patients with T2DM who came to our hospital for treatment from March 2018 to March 2019 were selected and they were randomly divided into the control group and the experimental group with 60 cases each. The patients in the control group were given routine nursing intervention. The patients in the experimental group were given health management mode based on the internet platform to test their blood glucose before and after receiving nursing management. All patients were invited to filled in the self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The blood glucose level, the psychological state, the self-rating scales and nursing points in the two groups were investigated and compared after intervention. Results The blood glucose of the experimental group was lower than that of the control group, the scores of SAS and SDS were (45.2 ± 4.3) (42.8 ± 6.3) respectively, both of which were lower than those of the control group (56.3 ± 7.5) and (58.1 ± 3.9); the quality of life of patients in the experimental group was higher than that in the control group; nursing satisfaction was higher than that in the control group, the difference was statistically significant (P<0.05). Conclusion The application of health management model based on internet platform is conducive to improving the effect of blood glucose control in diabetes patients, relieving their negative emotions, improving their quality of life and maintaining a good nurse-patient relationship.

目的 探讨医护合作护理程序教育模式在轻度认知功能障碍血透患者中的应用效果。方法 对65例患者实施医护合作护理程序教育模式,2个月后对患者的健康教育知识掌握程度、自体动静脉内瘘自我护理能力、维持性透析依从性、满意度进行测评。结果 医护合作护理程序教育模式后患者的健康教育知识掌握程度为92.31%、自体动静脉内瘘自我护理能力为27.11±3.26、维持性透析依从性是48.22±4.67、护理满意度是92.31%,均比护理程序教育前提高,护理程序教育前后比较差异均有统计学意义(P＜0.01)。结论 医护合作护理程序教育模式能提高患者的认知能力、自我护理能力和满意度,减少并发症,利于患者生活质量的提高。

Objective To explore the effect of the application of nursing process education model under doctor-nurse cooperation in hemodialysis patients with mild cognitive impairment.Methods 65 patients received nursing process education model under doctor-nurse cooperation. After 2 months, these patients were assessed in terms of the level of knowledge about health education, autologous arteriovenous fistula self-care ability, compliance of maintenance dialysis and satisfaction.Results After the nursing process education model under doctor-nurse cooperation, the percentage of patients who became proficient at knowledge about health education was 92.31%, that of patients who showed autologous arteriovenous fistula self-care ability was 27.11±3.26, that of the patients who became compliant to maintenance dialysis was 48.22±4.67, and nursing satisfaction was 92.31%. These performances improved significantly, comparing to those before the nursing process education model under doctor-nurse cooperation. The differences between before and after the model have statistical significance (P<0.01).Conclusion The nursing process education model under doctor-nurse cooperation may improve patients' cognitive ability, self-care ability and satisfaction. It also reduces complications and helps patients to increase the quality of life.