目的 观察联合缩宫素与间苯三酚在基层医院分娩中疗效。方法 选用高明区人民医院2013年8月—2014年10月要求自然分娩的初产妇200例,随机分成两组,孕妇进入临产时,观察组予双管输液,予缩宫素2.5U+5%葡萄糖注射液静滴,另一静脉通路5%葡萄糖注射液250 mL+间苯三120 mg静滴;对照组仅予缩宫素2.5U+5%葡萄糖注射液静滴。比较两组产妇各产程时间、分娩方式、新生儿情况、产后出血量。结果 观察组第一产程、第二产程、第三产程时间均短于对照组(P＜0.01),剖宫产率3%及新生儿窒息率3%均低于对照组21%,和13%;P＜0.01;产后2小时出血量较对照组少(109.38±16.13)mL vs(185.00±30.71)mL, P＜0.01。结论 临产孕妇联合间苯三酚与缩宫素,可缩短产程,降低剖宫产率,降低新生儿窒息发生率,减少产后出血量,推荐基层医院使用。

Objective To investigate the effect of oxytocin combined with phloroglucinol in childbirth in primary hospital. Methods A total of 200 primiparas admitted to department of obstetrics in Gaoming people's hospital from August 2013 to October 2014　were selected as study subjects. The cases were randomly divided into observation group (100 cases) and control group (100 cases). In labor, cases in control group were given oxytocin 2.5 U and 5% glucose injection 500 mL, and were given 5% glucose injection 250 mL and phloroglucinol 120 mg by double tube intravenous infusion. Cases in observation group were only given oxytocin 2.5 U and 5% glucose injection 500 mL intravenous infusion. The duration of delivery、delivery mode、the condition of newborn and volume of bleeding after labor were compared between two groups. Results For the first、second and third stages of labor, duration of delivery in observation group were significantly shorter than that in control group (P＜0.01), Both cesarean delivery rate [3%(3/100)] and the incidence of neonatal asphyxia[3%(3/100)] in observation group were significantly lower than that in control group 21%(21/100)and 13%(13/100;P＜0.01). The volume of bleeding during two hours after labor in observation group was less than that in control group (109.38±16.13)mL vs 185.00±30.71 mL, P＜0.01. Conclusion In the stages of labor, the use of oxytocin combined with phloroglucinol can shorten the duration of delivery, reduce the cesarean delivery rate and the incidence of neonatal asphyxia and reduce the volume of bleeding after labor. It is worth recommending to use in primary hospital.

目的 比较肺炎支原体肺炎(MPP)、非MPP患儿和健康儿童的免疫球蛋白、补体水平,以探讨儿童MPP体液免疫指标的变化规律。方法 分别检测52例MPP、55例非MPP患儿和33例健康儿童的血清免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4),并比较儿童MPP急性期和恢复早期体液免疫指标。结果 MPP组急性期血清IgM、C3、C4水平高于非MPP组急性期和健康儿童(P<0.05)。儿童MPP恢复早期IgM水平高于急性期,C4水平低于急性期(P<0.05)。结论 与非MPP和健康儿童比较,MPP患儿存在明显体液免疫功能紊乱,从急性期到恢复早期,血清IgM逐渐升高,补体C4先升高后降低,自身免疫反应可能参与了儿童MPP的发病过程。

Objective To investigate the changes of serum immunoglobulins and complement in children with mycoplasma pneumoniae pneumonia (MPP). Methods 52 children with MPP, 55 children with non-MPP and 33 healthy children were enrolled. The levels of serum immunoglobulins (IgG, IgA and IgM) and complements (C3, C4) were detected. Results Compared with the non-MPP group and healthy control, the levels of IgM, C3 and C4 in MPP group during their acute phase were significantly higher (P<0.05). And among the MPP group the levels of IgM were hisher and C4 were lower than that in the acute phase. Conclusion Immune function disturbance exists in children with MPP. From acute to recovery stage, the level of IgM increased while C4 increased firstly and then decreased. Immune injury may be involved in the pathophysiology of childhood MPP.

目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.

目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。

Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.

目的 建立胎儿左、右肺面积及肺头比的正常参考值范围。方法 对501例正常单胎妊娠12～40周胎儿在标准四腔心切面应用手工描绘法分别描迹左肺、右肺面积,分别除以头围获得左、右肺头比。结果 获得正常妊娠胎儿左、右肺面积及肺头比各孕周参考值范围。胎儿左、右肺面积及肺头比均随孕周的增长而增大。结论 正常妊娠胎儿左、右肺面积及肺头比与孕周呈正相关。不同孕周LHR参考值的建立有利于临床评价膈疝及其他胸腔占位性疾病的预后。

Objective To establish reference intervals for fetal left and right lung areas and lung area to head circumference ratio (LHR). Methods In 501 cases of normal singleton pregnancy between 12 to 40 weeks, the left and right lung areas were measured respectively by ultrasound in the standard four chamber view, using manual tracing of the limits of the lungs. The left and right LHR were calculated when head circumferences were divided by the left and right lung area. Results Normal fetal reference intervals of left and right lung areas and LHR with gestational age were obtained. Fetal left and right lung areas and LHR increased with gestational age. Conclusion Fetal left and right lung areas and LHR values positively correlated with gestational age in normal pregnancy. Normal reference intervals of fetal LHR for every gestational age are valuable for evaluation of prognosis of fetal diaphragmatic hernia and other pulmonary peripheral space-occupying lesions.

目的 构建抑癌基因SEMA3B真核表达载体pcDNA3.1-SEMA3B,并检测其对肺癌A549细胞恶性生物学行为的影响。方法 应用PCR扩增SEMA3B全长cDNA片段,构建真核表达载体pcDNA3.1-SEMA3B。克隆PCR、双酶切法、基因测序验证过表达载体构建成功。将pcDNA3.1-SEMA3B真核表达载体和空载体pcDNA3.1分别转染入A549细胞中,应用qRT-PCR、Western blot检测SEMA3B mRNA、蛋白表达水平的变化;MTS法检测细胞增殖;流式细胞仪检测细胞凋亡、细胞周期;克隆形成实验检测细胞集落形成能力。结果 SEMA3B基因扩增片段与预测片段一致,克隆成功,且测序鉴定证实真核表达载体构建成功。转染pcDNA3.1-SEMA3B真核表达载体可上调SEMA3B mRNA、蛋白表达水平,且可抑制A549细胞的增殖,诱导凋细胞亡,细胞被阻滞在G1期,抑制细胞集落形成能力。结论 成功构建了SEMA3B基因真核表达载体,抑癌基因SEMA3B在肺癌恶性生物学进程中可能发挥重要作用。

Objective To construct the eukaryotic expression vector of the cancer suppressor gene, SEMA3B, and research the effects on malignant biological behavior of lung cancer A549 cells. Methods By reverse transcriptase-polymerase chain reaction (RT-PCR), the full length SEMA3B gene was amplified and then was inserted into pcDNA3.1. The recombinant plasmid pcDNA3.1-SEMA3B was confirmed correctly through double enzyme digestion and PCR identification, which was transfected into lung cancer A549 cells by lipid media transfection. The untransfected A549 and A549 transfected with pcDNA3.1 were used as controls. SMEA3B gene was detected by qRT-PCR and western blot. MTS assay, flow cytometry, and colony formation test were performed to evaluate the effect of overexpression of SEMA3B gene on A549 cell proliferation, apoptosis, cell cycle, and colony forming ability. Results The amplied fragment of SEMA3B gene by PCR was consistent with the anticipated result, the SEMA3B gene was cloned successfully. And the recombinant plasmid pcDNA3.1-SMEA3B was constructed successfully through gene sequence identification. After transfection of pcDNA3.1-SEMA3B, SEMA3B mRNA and protein expression levels were raised, and overexpression of SEMA3B gene in A549 cells significantly inhibited the proliferation of A549 cells, induced apoptotic cell death, blocked cell cycle in the G1 phase, and suppressed cell colony-forming ability. Conclusion The recombinant pcDNA3.1-SEMA3B is constructed successfully. SEMA3B gene can significantly inhibit the malignant biological behavior of lung cancer A549 cells.

目的 分析乳腺癌细胞中Snail与MTDH基因的作用,明确Snail是否通过结合于MTDH的启动子区域促进乳腺癌转移。方法 克隆、转染Snail基因至乳腺癌细胞,观察过表达Snail的乳腺癌细胞中MTDHmRNA及蛋白表达的变化;再使用免疫共沉淀法检测Snail与MTDH基因的共作用。结果 转染Snail基因进入乳腺癌MDA-MB-435细胞后,转染组、空白组和对照组中MTDHmRNA的表达水平分别为1.61±0.22、1.02±0.18、0.99±0.20,转染组高于空白组和对照组,差异有统计学意义(P<0.05),而后两组表达无差异(P>0.05);Westren blot检测结果显示,Snail可促进MTDH蛋白的表达;免疫共沉淀显示,Snail与MTDH在细胞内存在相互结合作用。结论 Snail在乳腺癌细胞中可通过结合于MTDH基因的启动子区域,促进MTDHmRNA转录及相关蛋白的表达,从而导致乳腺癌转移。

Objective To investigate the function of Snail to MTDH gene in breast cancer cells. Methods We observed the changement of MTDHmRNA and protein expression in breast cancer cell line MDA-MB-435 after transfected with Snail gene. Then, we used co-immunoprecipitation to determine the domain of Snail and MTDH binding in vitro. Results After transfected with Snail gene into MDA-MB-435 cell, the expression levels of MTDHmRNA in transfection group, blank group and control group were 1.61±0.22,1.02±0.18,0.99±0.20. The level of transfection group was significantly higher than the other groups(P< 0.05). Western blot showed that the expression of MTDH protein can be promoted by Snail. Co-immunoprecipitation showed that Snail and MTDH are binding interactions in breast cancer cell line MDA-MB-43. Conclusion Snail can promote transcription and expression of MTDH in breast cancer cells by binding to the promoter region of the MTDH gene resulting in metastasis of breast cancer.

目的 通过构建结构方程模型,分析某三级甲等综合医院腹股沟疝患者住院费用的影响因素,旨在为合理控制腹股沟疝单病种费用提供依据。方法 收集4 328份高州市人民医院2016—2022年主要诊断疾病名称为腹股沟疝且行腹股沟疝手术的患者的病历资料,预分析单个影响因素,采用AMOS28.0拟合构建模型。结果 结构方程模型拟合达到标准。性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝对总费用所产生的总效应数值分别为0.008、-0.044、0.062、0.014、-0.119、0.106、0.236;性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝通过住院时间间接对住院费用产生影响。结论 对住院费用产生的影响因素有性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝、住院时间,建议推行患者预住院模式及日间手术,在正式住院前完成相关检查,优化医疗服务流程,从而合理有效控制单病种住院费用。

Objective By utilizing a structural equation model, to analyze determinants that affect the hospitalization costs for individuals with inguinal hernia at a tertiary-level comprehensive medical center, offering insights for the potential management of costs associated with this specific ailment. Methods This study entailed the compilation of 4 328 patient files from individuals who received surgical treatment for inguinal hernia at a third-level general hospital over the period spanning 2016 to 2022. Preliminary analysis was conducted on isolated variables, followed by the development of a model using AMOS 28. 0 for fit assessment. Results The fitting of structural equation model reached the standard. The total effect values of gender, age, cost, number of hospitalizations, admission route, concomitant disease, unilateral and bilateral hernia on the total cost were 0. 008, -0. 044, 0. 062, 0. 014, -0. 119, 0. 106, 0. 236, respectively. Gender, age, cost, number of hospitalizations, admission route, concomitant disease, unilateral and bilateral hernia indirectly affected hospitalization expenses through hospitalization days. Conclusions Gender, age, cost, number of hospitalizations, of admission, concomitant diseases, unilateral and bilateral hernia, and length of hospital stay have an impact on hospitalization costs. It is suggested to implement the pre-hospitalization mode and day surgery, complete relevant examinations before formal hospitalization, and optimize the medical service process, so as to reasonably and effectively control the hospitalization cost of single disease.

目的 通过建立急性心力衰竭（AHF）患者服药依从性预测模型,提高AHF患者的服药依从性和临床管理效果。方法 纳入2021年1月—2023年12月在广州市番禺区何贤纪念医院住院治疗的580例AHF患者,通过收集患者的一般人口学资料、疾病相关资料及出院后6个月的服药依从性数据,应用Logistic回归模型分析患者服药依从性的影响因素,并基于影响因素建立预测模型。结果 患者服药依从性总体良好（75%）。依从性良好组与依从性差组的年龄、独居情况、合并基础病、服药种类、疾病了解评分、治疗信心评分和自我控制信心评分比较差异有统计学意义（P<0.05）。Logistic 回归分析显示危险因素包括年龄≥60岁（OR=1.774）、独居（OR=1.871）、合并基础病≥2种（OR=1.719）和服药种类≥7种（OR=1.456）。而疾病了解评分（OR=0.923）、治疗信心评分（OR=0.946）和自我控制信心评分（OR=0.901）是保护因素（P<0.05）。基于上述因素建立的预测模型,通过ROC曲线验证,曲线下面积为0.815（95%CI：0.780~0.850）,提示所构建的模型具有良好的区分度。对该模型的校准度进行评价,P=0.528,提示该预测模型拟合度良好。此外,该预测模型的一致性指数为0.738,说明模型的预测性能良好。绘制的决策曲线中,曲线位于极端线之上,当阈概率取值在9%~59%时,对应的净获益率为0~27%,提示建立的模型具有优秀的临床有效性。结论 AHF患者的服药依从性受到多种因素的影响,包括年龄、居住状态、合并基础病种类及服药种类等。

Objective To establish a predictive model for medication compliance among acute heart failure（AHF）patients in order to enhance their therapeutic compliance and optimize clinical outcomes. Methods A total of 580 AHF inpatients at He Xian Memorial Hospital in Panyu District, Guangzhou between January 2021 and December 2023 were enrolled. Demographic information, disease-specific data,as well as post-discharge medication compliance records within six-month were collected by investigators. Utilizing logistic regression analysis revealed several influential determinants affecting medication compliance which formed the basis for constructing our predictive model. Results Generally,patient compliance was good（75%）. The comparison between the good compliance group and the poor compliance group showed that there were significant differences in age, living alone,combined with underlying diseases, types of medication, disease understanding score, treatment confidence score and self-control confidence score（P<0. 05）. Logistic regression analysis showed that independent risk indicators including individuals aged ≥60 years（odds ratio[OR]=1. 774）, those living alone（OR=1. 871）, presence of two or more underlying diseases（OR=1. 719）, along with consumption of seven or more medications daily（OR=1. 456）. Conversely,disease awareness score（OR=0. 923）, treatment confidence score（OR=0. 946）, and self-control confidence score（OR=0. 901）were identified as independent protective factors. Validation using receiver operating characteristic curves demonstrated robust predictive performance with an area under curve value of 0. 815（95%CI：0. 780-0. 850）, affirming its efficacy. The calibration of the model was evaluated, with a P-value of 0. 528, indicating good fit of the predictive model. Additionally, the concordance index（C-index）of the model was 0. 738, suggesting its excellent predictive performance. The decision curve analysis revealed that the curve was above the extreme lines, with a net benefit rate ranging from 0 to 27% when the threshold probability falls between. Conclusions The medication compliance of AHF patients is influenced by various factors, including age, living arrangement, the number of underlying diseases, and the number of medications taken. Targeted interventions such as enhancing patient education, simplifying treatment regimens, and improving social support can effectively improve the medication compliance of AHF patients. The predictive model established in this study provides a scientific basis for clinicians to develop more precise and effective individualized intervention measures,thereby improving the prognosis and quality of life.

目的 深入了解河源市某综合医院职业暴露的真实情况,评估健康风险,从而提出有效的控制措施,并提升医院员工的职业防护意识,以保障他们的健康和安全。方法 采用回顾性调查,从暴露类型、环节、病原体种类、职业类别、工龄等方面,对河源市某综合医院在2022—2023年所发生的职业暴露事件进行统计分析。结果 在2022—2023年期间,该综合医院共计发生了93例血源性病原体职业暴露事件,以锐器伤为主,共80例,占86.02%;职业暴露最多的是护理人员,共发生61例,占65.59%;工作人员中工龄≤2年的职业暴露比例最多,共有71例,占76.34%;职业暴露的发生环节主要集中在处理丢弃锐器物以及进行检查、治疗、护理操作的过程中,均为30例,占32.26%;发生职业暴露的原因主要是缺少防护,出现34例,占36.56%;职业暴露主要发生在普通病房,为37例,占39.78%;其次为门急诊,均为15例,占16.13%;职业暴露发生的暴露源传染病病原体种类以不明病原体为主,为36例,占38.70%;其次是乙型肝炎病毒,为32例,占34.40%;所有发生职业暴露的员工均接受了全面的暴露风险评估、合理的预防性用药措施以及定期的健康监测。结论 医院管理部门需加强职业安全培训,特别是针对护理人员和低年资员工,严格执行标准操作规程,提供充足防护用品,改进医疗设备设计,建立完善的监测报告和保障体系,并强化监督和管理,以降低职业暴露风险,保障员工职业安全。

Objective To gain a deep understanding of the actual situation of occupational exposure in a general hospital in Heyuan City, assess health risks, propose effective control measures,and enhance the awareness of occupational protection among hospital staff to safeguard their health and safety. Methods A retrospective study was conducted to statistically analyze the occupational exposure events that occurred in a general hospital in Heyuan City from 2022 to 2023, in terms of exposure types, links, types of pathogens, occupational categories, and years of service. Results During the period from 2022 to 2023, a total of 93 cases of occupational exposure to blood-borne pathogens occurred in the general hospital, with sharp instrument injuries being the most common, accounting for 80 cases（86. 02%）; nurses accounted for the majority of occupational exposures, with 61 cases（65. 59%）; among the staff, those with a service time ≤ two years had the highest proportion of occupational exposures, with 71 cases（76. 34%）; the main occurrence of occupational exposures was in the processes of disposing of discarded sharp instruments and conducting inspections, treatments, and nursing operations, both accounting for 30 cases（32. 26%）; the main reason for occupational exposures was lack of protection, with 34 cases（36. 56%）; occupational exposures occurred mainly in general wards, with 37 cases（39. 78%）, followed by outpatient and emergency departments, both with 15 cases（16. 13%）; the types of infectious pathogens exposed in occupational exposures were mainly unknown, with 36 cases（38. 70%）, followed by hepatitis B, with 32 cases（34. 40%）; all staff who experienced occupational exposures received comprehensive exposure risk assessments,reasonable preventive medication measures, and regular health monitoring. Conclusions Hospital management departments need to enhance occupational safety training, particularly for nursing staff and junior-level employees, strictly enforce standard operating procedures, provide adequate protective equipment, improve medical device design, establish a comprehensive monitoring and reporting system, strengthen supervision, and manage to reduce the risk of occupational exposure and ensure the occupational safety of employees.