目的 分析总结12例原发性肺淋巴上皮瘤样癌(LELC)的临床病理特点。方法 回顾性分析12例肺LELC患者的临床病理资料。结果 12例肺LELC患者的组织学标本中,肿瘤细胞均明显表达HCK,原位杂交EBER阳性率为91.7%。全组中位生存期61.3个月,2年和5年生存率分别为84.6%和57.7%。结论 原发性肺LELC临床罕见,发病可能与EB病毒感染有关,经及时治疗有较好的预后。

Objective To investigate the pathological and clinical significance of 12 cases with primary Lymphoepithelioma-like carcinoma of the lung (LELC). Methods Retrospectively detectded and analyzed the clincalpathological feature of 12 cases of LELC of the lung. Results Histological study showed that tumor cells were significantly expressed HCK by immunohistochemistry staining and showed out 91.7% positive rate of EBER by situ hybridization. In this series, the median survival time was 61.3 months. The overall 2 and 5 year survival rates of the 12 cases were 84.6% and 57.7%. Conclusion Pulmonary LELC is very rare. It may be associated with Epstein-Barr virus infection, and has a batter prognosis after therapy.

目的 确定CD4⁺CD25⁺Treg调节性T细胞在重症肺炎克雷伯菌肺炎中的表达以及意义,探讨CD4⁺CD25⁺Treg在重症肺炎克雷伯菌肺炎的免疫抑制中的调控作用。方法 通过气管内滴注肺炎克雷伯菌菌液建立重症肺炎模型。采用流式细胞仪检测CD4⁺CD25⁺Treg细胞及酶联免疫吸附法(ELISA)等方法检测各种细胞因子。结果 重症肺炎克雷伯菌肺炎大鼠的脾脏和肺中CD4⁺CD25⁺Treg的数量增加。使用了CD25抗体(PC61)去除机体内源性的CD4⁺CD25⁺Treg,分别去除脾脏和肺的94%和90%的CD4⁺CD25⁺Treg。CD25抗体组在建模4 h,12 h及24 h后,肺部MPO及血清IL-1,IL-6,MIP-2较对照组高(P<0.05),肺和BLA比对照组高(P<0.05),CD25抗体组大鼠生存率比对照组低(P<0.05)。结论 内源的CD4⁺CD25⁺Treg对大鼠抑制重症肺炎克雷伯菌肺炎的过度免疫损害反应起到保护作用。

Objective To confirm the expression and meaning of the T regular cell in the severe Klebsiella pneumonia, and to evaluate the regular and control affect in the immunologic suppression of the severe Klebsiella pneumonia. Methods To build the severe pneumonia model by intratracheally inoculated with Klebsiella pneumoniae bacteria. To check sorts of inflammation factors by the methods of ELISA and flow cytometry. Results The quantity of the CD4⁺CD25⁺Treg in the splenic and lungs of the mice with severe Klebsiella pneumonia were increased. Anti-CD25Ab(PC61) was used to remove endogenousCD4⁺CD25⁺Treg. Anti-CD25 treatment remove 90% of CD4⁺CD25⁺Treg cells. The cytokine production(IL-1β,IL-6,MIP-2)in the anti-CD25-treated group were significantly increased. And it also increased significantly in the airway neutrophil infiltration, while the survival rate had been decreased. Conclusion Endogenous CD4⁺CD25⁺Treg can provide obvious protection effect to the restraining the over immunity damage of the severe Klebsiella pneumonia for the mice.

目的 探讨优质护理服务对促进心胸外科患者恢复和提高患者护理满意度的效果。方法 将478例患者按时段分为按常规护理的对照组和实施优质护理的实验组,观察患者住院天数、拔除胸腔引流管时间、早期离床活动时间、护患纠纷发生率及满意度。结果 实验组患者住院天数、拔除胸腔引流管时间、早期离床活动时间、护患纠纷发生率明显缩短/降低,满意度显著提高,与对照组比较均差异有统计学意义(P＜0.01)。结论 优质护理服务有利于心胸外科患者术后恢复、减少护患纠纷和提高护理满意度,值得推广。

目的 探讨二维超声联合三维超声检测不同孕期胎儿肢体畸形的临床价值。方法 回顾性分析我科2013年1月—2015年1月超声筛查的1352名孕15~34周的孕妇,运用二维及三维超声,采用连续顺序追踪超声法检测胎儿四肢,将产前诊断结果与引产或引产结果对照。结果 1352名孕妇胎儿畸形46例(3.40%,46/1352),总涉及肢体73处(近端肢体畸形65处,远端肢体畸形8处),其中四肢短小9例(骨发育不全2例,单纯四肢短小畸形5例,成骨发育不全2例),漏诊2例;足畸形16例34处,漏诊1例,残肢畸形15例;手畸形6例,漏诊1例。结论 孕中期二维连续顺序追踪超声法联合三维超声胎儿肢体畸形检出率高,对及早发现胎儿肢体畸形有一定的诊断价值。

目的 了解河源市无偿献血者的人群结构特征及其与血液检测结果的关系,为完善该地区安全血源招募和献血者筛查策略提供依据。方法 收集2014年1月1日—2014年12月31日该市15184例首次无偿献血者登记表及检测结果,统计分析无偿献血者的年龄、性别、职业、文化程度等分布情况及其血液检测结果不合格率。结果 该地区无偿献血者以男性(78.91%)、年龄以35岁以下(63.44%)、在职职员(34.08%)、大学专科以上文化程度(39.59%)为主体;献血模式以个人自愿(53.58%)和团体自愿(38.41%)为主。该市无偿献血者血液检测结果总体不合格率为4.29%,其中不同性别、年龄、职业、文化程度、献血模式的无偿献血者组间不合格率差异有统计学意义(χ²值分别为 19.079、38.103、61.042、41.191、44.079,P值均<0.05);多因素Logistic 回归分析显示性别、年龄、职业、文化程度和献血模式为血液检测结果不合格率的主要影响因素。结论 应根据无偿献血者人群结构特点有效开展献血知识宣传教育,认真做好献血前筛查。

目的 观察有创-无创序贯通气治疗慢性阻塞性疾病(COPD)急性加重并呼吸衰竭的疗效。方法 选取2013年3月—2015年3月在兴宁市人民医院呼吸科收治的COPD急性加重并II型呼吸衰竭、需行机械通气的患者80例,随机进行有创-无创序贯通气治疗组A和单一有创通气治疗组B,两组除了机械通气的方式不同之外,其他的常规治疗均相同,主要观察两组患者进行相关机械通气方式前后的呼吸、循环及血气指标的变化情况以及进行机械通气的总时间和住院时间及呼吸机相关肺炎(VAP)的发生例数。结果 治疗组患者的血气、呼吸及循环内的各项生化指标改善程度均与对照组无统计学意义(P>0.05),同时治疗组患者的VAP的发生率,总的住院时间,进行机械通气的总时间少于对照组患者,有统计学意义(P<0.05)。结论 采用有创-无创序贯通气治疗慢性阻塞性疾病(COPD)急性加重并呼吸衰竭综合治疗效果要好于采用单一有创通气治疗,值得临床推广应用。

目的 通过建立大鼠泛耐药铜绿假单胞菌肺炎模型,对其进行联合用药,观察疗效,以便为治疗泛耐株引起的感染提供理论基础。方法 选择体外药敏实验中各药物组合同时有效的一株铜绿假单胞菌建立小鼠肺炎模型,于感染后6小时给药,对照组腹腔注射0.5 mL生理盐水,治疗组分别用头孢他啶+阿米卡星+环丙沙星以及头孢他啶+阿米卡星+环丙沙星+氨氯地平两组用药方案连续治疗三天后,根据肺组织匀浆细菌计数及病理结果评价疗效。结果 体内药敏试验显示用药组不管有无氨氯地平干预,对细菌的清除作用与对照组比较差异有统计学意义(P﹤0.05),而两用药组之间比较,差异无统计学意义。结论 对泛耐药铜绿假单胞菌感染后肺炎模型,联合应用体外单药药敏试验耐药的抗菌药后对细菌仍有一定的清除作用,但加入氨氯地平干预未显示有明显的治疗效应。

目的 动态观察乳腺癌患者辅助内分泌治疗5年后的血脂及肝功能水平的变化,探求辅助内分泌治疗与高脂血症及脂肪肝发病率的关系。方法 56例乳腺癌患者实行辅助内分泌治疗,术后随访5年动态抽血测定其总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)及谷草转氨酶(AST)、谷丙转氨酶(ALT)、直接胆红素(DBIL)、总胆红素(TBIL)等参数的变化,B超监测其肝脏变化。结果 经过2年内分泌治疗TG由(1.203±0.723)mmol/L上升至(1.701±1.271)mmol/L,5年内分泌治疗后TG降至(1.389±0.706)mmol/L。经过2年内分泌治疗LDL由(2.497±0.990)mmol/L上升至(2.950±0.984)mmol/L,5年内分泌治疗后LDL为(2.867±0.886)mmol/L。结论 辅助内分泌治疗2年会导致其TG和LDL的升高,5年随访仅发现LDL升高,辅助内分泌治疗会增加乳腺癌患者诱发心血管疾病的风险。

目的 探讨连续护理在提高乳腺癌保乳患者生存质量中的应用效果,号召我院为病人提供持续性、连续性护理开展APN排班。方法 随机抽取2011年1月—2014年1月我院收治的117例乳腺癌患者的临床资料。观察两组患者术后生存质量、焦虑情况、抑郁情况、术后上肢水肿情况。结果 两组患者术后1周生存质量比较,差异无统计学意义(P＞0.05);观察组术后1个月、3个月、6个月、1年生存质量高于对照组,差异有统计学意义(P＜0.05)。两组患者术后1周焦虑情况比较,差异无统计学意义(P＞0.05);观察组术后1个月、3个月、6个月、1年忧郁情况优于对照组,差异有统计学意义(P＜0.05)。观察组患者术后上肢水肿情况优于对照组,差异有统计学意义(P＜0.05)。结论 连续护理在提高乳腺癌保乳患者生存质量中的应用效果较好,能够改善患者术后生存质量、焦虑抑郁情况、术后上肢水肿情况,值得临床推广。

Objective To explore the effects of continuous nursing intervention on the quality of life for breast cancer patients after breast conserving therapy. Methods 117 cases of patients with breast cancer were randomly divided into observation group(59 cases) and control group(58 cases). The control group were cared by routine postoperative care, including health education. On the basis of the control group, the observation group were cared by continuous nursing intervention, including cognitive intervention, psychological intervention, social support, life care, functional exercise, the prevention of complications and discharge instruction. The quality of life, anxiety situation, depression amd upper limb edema were compared in the two groups. Results There has no significant difference on the quality of life after 1 week in the two groups(P＞0.05); The quality of life after 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). There has no significant difference on the anxiety situation after 1 week in the two groups(P＞0.05); The anxiety situation after 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). The depression situation after 1 week, 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). The upper limb edema situation for the observation group were better than the control group(P＜0.05). Conclusion The effects of continuous nursing intervention on the quality of life for breast cancer patients after breast conserving therapy is good. It can improve the quality of life, situations of anxiety, depression and upper limb edema. It is worthy of clinical promotion.

目的 了解惠州市新生儿眼病的发病状况,探讨新生儿眼病筛查的临床模式。方法 回顾分析我院在2014年1月—2015年3月950例(1900只眼)高危新生儿的眼病筛查资料。结果 950例(1900只眼)新生儿中,检查出新生儿眼病10种,共200例,检出率21.05%;其中家族性渗出性视网膜病变(FEVR)5例(0.526%)、永存原始玻璃体增生症(PHPV)1例(0.105%)、先天性白内障1例(0.105%)、视网膜出血55例(5.789%)、生理性大视杯3例(0.316%)、新生儿鼻泪管阻塞5例(0.526%)、新生儿结膜炎100例(10.53%)、皮样脂肪瘤2例(0.211%)、新生儿泪囊黏液囊肿2例(0.211%)、早产儿视网膜病变26例(2.737%)。结论 新生儿眼病在临床中并不少见,而且部分眼病是可以早期筛查、早期治疗以避免盲的。

Objective To study the incidence of newborn eye diseases and to explore the clinical strategies for the screening of newborn ocular diseases. Methods A retrospective analysis was conducted on 950 newborns from January 2014 to March 2015. Results Among the 950 newborns who were enrolled the screening program,10 different eye diseases(involving 200 cases)were detected,with a prevalence of 21.05%. The eye diseases included familial exudative vitreoretinopathy in 5 cases(0.526%),persistent hyperplastic primary vitreous in 1 case(0.105%),congenital cataract in 1 case(0.105%),retinal hemorrhage in 55 cases(5.789%), physiologic large cup in 3 cases(0.316%),congenital lacrimal duct obstruction in 5 cases(0.526%),neonatal conjunctivitis in 100 cases(10.53%),dermolipoma in 2 cases(0.211%),congenital lacrimal sac mucocele in 2 cases(0.211%),retinopathy of prematurity in 26 cases(2.737%). Conclusion Neonatal eye diseases are not uncomon in clinical, and a part of the eye diseases can be early screening and early treatment to avoid blindness.