目的 探讨血碱性磷酸酶水平对维持性透析患者血管钙化与骨质疏松的评估价值。方法 纳入我院186例维持性透析患者,记录相关临床资料并完善实验室检查,以X线片评价血管钙化情况,双能X线吸收法检查骨密度。对上述资料进行双变量相关分析、ROC曲线分析等统计学处理。结果 血碱性磷酸酶水平与股骨颈骨密度负相关,与腹主动脉钙化评分正相关。腹主动脉钙化评分与骨密度负相关。ALP对骨质疏松及严重腹主动脉钙化诊断的ROC曲线下面积分别为0.777及0.701。结论 碱性磷酸酶是评估透析患者血管钙化骨质疏松的良好指标。

Objective To explore evaluation value of alkaline phosphatase in vascular calcification and osteoporosis in maintenance dialysis patients. Methods 186 patients in maintenance dialysis were enrolled in this study. The related clinical data was recorded. The examination of X-ray (lateral abdomens) was done to estimate vascular calcification in patients. Bone mineral density was measured by dual energy X-ray absorptiometry. The results above were analyzed by bivariate correlation analysis and receiver operator characteristic curve. Results By bivariate correlation analysis,serum alkaline phosphatase level was negatively associated with femoral neck bone mineral density, and was positively associated with abdominal aortas calcification scores. Abdominal aortas calcification scores were negatively associated with femoral neck bone mineral density. ROC curve revealed AUCs were respectively 0.777 and 0.701 for serum alkaline phosphatase level in diagnosis of osteoporosis and severe abdominal aortas calcification. Conclusion Alkaline phosphatase may be a good index to evaluate calcification and osteoporosis in maintenance dialysis patients.

目的 探讨我院17年间前列腺癌患者的临床特征如发病年龄、前列腺特异性抗原(PSA)、Gleason评分、分期及穿刺阳性率等的变化。方法 采用回顾性分析,对广州市第一人民医院2000—2016年泌尿外科1 231例穿刺活检的患者及564例前列腺癌患者资料进行分析,按患者的诊断时间分为A组(2000—2005年)、B组(2006—2009年)、C组(2010—2012年)、D组(2013—2014年)、E组(2015—2016年),对各组的年龄、PSA、Gleason评分、分期及穿刺活检阳性率进行统计学分析,看各组间的各项指标差异是否有统计学意义。结果 5组年龄均值(73.36,73.74,72.05,73.40,72.96岁)、PSA均值(208.95,190.25,173.19,283.54,148.69 μg/L)及穿刺活检阳性率均值(48%,43%,37%,44%,39%)差异均无统计学意义(P均>0.05)。5组Gleason均值为6.80,6.73,7.12,6.93,7.32,A、B组和E组Gleason评分差异有统计学意义(P均<0.05),其余各组Gleason评分差异均无统计学意义(P均>0.05)。TNM分期转化得分5组均值为5.96,6.80,7.05,7.31,6.83, A和C组、D组、E组差异均有统计学意义(P均<0.05),其余各组TNM分期转化得分差异均无统计学意义(P均>0.05)。结论 17年间前列腺癌患者诊断时的年龄、PSA水平及穿刺活检阳性率没有显著变化。

Objective To investigate changes of inpatients with prostate cancer in the last 17 years such as age of onset, prostate specific antigen (PSA), Gleason score, prostate cancer staging and positive rate of prostate biopsy. Methods A retrospective analysis was conducted in 1 231 cases of biopsy patients of urology and 564 patients with prostate cancer who were hospitalized in the First People's Hospital of Guangzhou from 2000 to 2016. According to the time of diagnose. All the patients were divided into five groups: group A(2000-2005),group B(2006-2009),group C(2010-2012), group D(2013-2014)and group E(2015-2016). The age, PSA, Gleason score, staging and positive rate of prostate biopsy were compared to realize whether the indicators of the differences between groups was statistically significant. Results In five groups, means of age, PSA, Gleason score and prostate biopsy positive rate are respectively 73.36,73.74,72.05,73.40,72.96 years; 208.95,190.25,173.19,283.54,148.69 μg/L;6.80,6.73,7.12,6.93,7.32; 5.96,6.80,7.05,7.31,6.83 and 48%,43%,37%,44%,39%. There was no significant difference in age, PSA and positive rate of prostate biopsy (P>0.05). The Gleason scores of group A and group E, group B and group E were statistically significant (P<0.05), while the other groups had no significant differences in Gleason score (P>0.05). There werestatistical significancein TNM staging score between group A and group C,group D, group E(P <0.05),while the other groups had nostatistical significance (P>0.05). Conclusion There are no change of prostate cancer patients in diagnosis of age, PSA levels and positive rate of prostate biopsy in the past 17 years.

目的 探讨高压氧对FVB小鼠旷场行为的影响。方法 对9只4周龄高压氧组FVB小鼠进行2个疗程共21天高压氧干预;对13只4周龄对照组FVB小鼠不做任何处理,正常饲养。21天后对2组小鼠进行旷场实验,观察高压氧对FVB小鼠旷场行为的影响。结果 高压氧组小鼠在中央区停留时间(3.73±3.69,17.97±6.82,t=-5.564,P=0.000)和运动路程较对照组小鼠减少(189.65±199.32,525.67±244.22,t=-3.298,P=0.040),在外周区停留时间增加(296.07±3.69,281.79±6.79,t=5.597,P=0.000);进入中央区、外周区次数及穿越各区总次数都减少(3.11±3.10,8.20±4.80, t=-2.770,P=0.014;3.11±3.10,9.10±4.79,t=-3.264,P=0.005;6.22±6.20,17.30±9.59,t=-3.018,P=0.008);2组小鼠总路程和平均速度无差异(8766.57±3362.90,8320.47±1692.47, t=0.359,P=0.726;73.05±28.02,69.34±14.10,t=0.359,P=0.726)。结论 高压氧改变FVB小鼠的旷场行为的表型,使小鼠趋避性增加,对环境的认知能力及焦虑程度增强,探索性下降。

Objective To explore the effect of hyperbaric oxygenation(HBO)on behaviors of FVB mice in the open field test. Methods 9 mice of four-week-old in the HBO group were treated with hyperbaric oxygenation for a total of 21 days during two courses while 13 control mice of four-week-old did not do any treatment. After 21-day normal breeding, the mice of two groups were tested with open field test. Then, researchers observed the effect of hyperbaric oxygenation on mice behaviors after open field test. Results Compared to 13 control mice, residence time (3.73±3.69,17.97±6.82,t=-5.564,P=0.000) and the range of movement (189.65±199.32,525.67±244.22,t=-3.298,P=0.040)in central region decreased while the residence time in external region increased (296.07±3.69,281.79±6.79,t=5.597,P=0.000). The times of entering the central region and external region and crossing both of the regions decreased (3.11±3.10,8.20±4.80, t=-2.770,P=0.014;3.11±3.10,9.10±4.79,t=-3.264,P=0.005;6.22±6.20,17.30±9.59,t=-3.018,P=0.008). There was no difference in the total range of movement and the average velocity (8766.57±3362.90,8320.47±1692.47, t=0.359,P=0.726;73.05±28.02,69.34±14.10,t=0.359,P=0.726). Conclusion Hyperbaric oxygenation may change the behaviors of FVB mice in open field test to enhance its phobotaxis, anxiety degree and the cognitive ability in environment and inhibiting its exploration ability.

随着时代的发展,医学模式更具综合性,预防医学专业特性不仅体现其医学范畴,其综合性特点日益突出。因此预防医学专业医学生综合素质及创新能力的培养显得愈发重要。为了提高预防医学学生的综合素质及创新能力,我们从预防医学理论教学及实验教学开展了教学改革探讨。

目的 通过评估非直属附属医院临床教学质量的影响因素,探讨保障非直属附属医院同质化教学的方法。方法 将实习同学分为院校组和混合组两组,运用德尔菲法调查法对非直属附属医院临床教学过程中所遇到的困难进行分析,并提出教学改革的意见和评价。结果 得出的调查结论对教师、学生、医院教学管理人员和学校教学管理人员都提出了更高的要求,可以为达到同质化教学提供参考。结论 有针对性的开展临床教学工作,变被动教学为主动的教与学,使临床教学达到同质化,从而达到更佳的教学效果。

Objective To explore the methods of guaranteeing homogeneity teaching in Non-affiliated hospitals by assessing the factors affecting the quality of clinical teaching in Non-affiliated hospitals. Methods Divide the students into two groups:college group and mixed group,to meet the process of clinical teaching in Non-affiliated hospitals in difficulty were analyzed by using the Delphi survey method, and put forward opinions and evaluation. Results the survey findings put forward higher requirements for teachers, students, hospital teaching administrators and school teaching administrators, which can provide references for achieving homogeneity teaching. Conclusion targeted clinical teaching should be carried out to change passive teaching into active teaching and learning, so that clinical teaching can be homogenized, so as to achieve better teaching effect.

目的 探讨多种教学模式在加强医学生人文素养、沟通意识和沟通能力中的作用。方法 考察多种教学模式培养的临床学生(教学组)和传统模式培养的临床学生(对照组)在人文关怀、沟通技巧、职业素养、医患关系等方面的理论知识和病史询问为主的实践考核情况,并进行对比。结果 多种教学模式培养的临床学生在人文关怀、沟通技巧、职业素养、医患关系方面的理论成绩分别为(21.03±2.00、20.78±2.11、21.01±2.12、20.91±2.07),病史询问成绩为(16.03±2.13)分,传统模式培养的临床学生在人文关怀、沟通技巧、职业素养、医患关系方面的理论成绩分别为(20.29±2.26、19.84±2.33、20.24±2.49、20.05±2.32),病史询问成绩(14.89±2.43)分,均较多种模式培养组分数低,两组对比差异均有统计学意义(P<0.05)。结论 在神经病学教学中采用多种教学模式对提高学生沟通能力及人文素养有良好的效果。

目的 探讨品管圈活动在提高神经外科卧床患者便秘预防措施落实率中的的应用效果。方法 成立品管圈,确定以“提高神经外科卧床患者便秘预防措施落实率”为主题,进行现状调查,设定目标,进行要因分析,制定并实施措施,比较品管圈活动前后护士落实便秘预防措施情况。结果 实施品管圈活动后,神经外科卧床患者便秘预防措施落实率从活动前的41.59%上升至活动后85.6%,差异有统计学意义(P＜0.05)。结论 品管圈活动可以有效提高神经外科卧床患者便秘预防措施落实率,降低便秘的发生率,减轻患者痛苦,改善患者生活质量。

目的 探讨入院准备中心制度在我院乳腺外科住院预约统筹管理的实践情况。方法 2017年1月—12月广州市第一人民医院入院准备中心对乳腺外科30张床位实施病床集中预约管理,依据患者病情进行预约,合理安排患者入院。结果 2017年1至12月我院乳腺外科共预约入院1225人/次,成功办理预入院1096人/次,约占乳腺外科总入院人数的77.85%。预入院进行手术患者415人/次,其中3日内手术患者为285人/次,预入院三日内手术率为68.67%。结论 预入院制度对乳腺外科病床进行集中预约管理能有效保证床位充分使用,为患者提供方便、有效的医疗服务,值得基层医院推广。

目的 探讨6野切线射野方式调强放疗(6F-IMRT)用于左侧乳腺癌根治术后放疗的临床价值。方法 纳入我院70例左侧乳腺癌根治术患者为研究对象,进行模拟CT增强扫描,三维重建后勾画大体靶区,分别对每个患者靶区设计4F-IMRT、5F-IMRT、6F-IMRT三种治疗计划,规定计划靶区(PTV)达到95%的处方剂量前提下,分析三种治疗计划PTV所受照射的平均剂量、最大剂量、最小剂量,95%、100%等剂量线包绕的靶区体积(V₉₅、V₁₀₀),适形度指数(CI)及剂量不均匀指数(HI),并比较三种计划下心脏、双肺、右乳受照射剂量。结果 各治疗计划靶区最大剂量、最小剂量、平均剂量比较无统计学意义(P＞0.05)。6F-IMRT的V₉₅、V₁₀₀均高于4F-IMRT、5F-IMRT,差异有统计意义(P＜0.05)。4F-IMRT、5F-IMRT、6F-IMRT的CI呈递增趋势,HI呈递减趋势,各组间比较差异有统计学意义(P＜0.05)。三种放疗计划中心脏的平均剂量、V₃₀,双肺的平均剂量、V₂₀、右乳平均剂量比较无显著差异(P＞0.05)。三种放疗计划中,4F-IMRT右乳V₁₀显著低于5F-IMRT、6F-IMRT,差异有统计学意义(P＜0.05),但均在最大耐受剂量范围内。结论 与4F-IMRT、5F-IMRT相比,6F-IMRT用于左侧乳腺癌根治术后放疗有明显剂量学优势,可提高靶区照射剂量,靶区适形程度及剂量均匀性均较好,而且并不会增加周围正常器官照射剂量。

目的 以临床病例为研究对象,探讨年龄与性别对鼻咽癌自我病情延误的影响,寻找鼻咽癌科普宣教的重点靶标人群。方法 收集2015年4月—2015年12月广州医科大学附属肿瘤医院放疗科鼻咽癌病区收治的经活检病理确诊初治鼻咽癌患者62例(年龄28～77岁,中位年龄49岁),记录患者主诉症征出现至病理确诊鼻咽癌其相关症状的持续时间,采用t检验和Pearson相关分析探讨性别及年龄对鼻咽癌确诊前相关症征持续时间的影响。结果 62例患者确诊前均自我发现鼻咽癌相关症征,其中43例(69.4%)发现鼻咽原发灶相关症状,35例(56.5%)发现颈部淋巴肿大症状。Pearson相关分析显示,鼻咽癌确诊前颈部淋巴结肿大持续时间与年龄呈正相关(P＜0.05);t检验结果显示,男性患者鼻咽癌确诊前症状持续时间大于女性患者(P＜0.05)。结论 年龄较大和男性人群鼻咽癌自我病情延误较为严重,应该作为包括临床症状在内的鼻咽癌科普宣教的重点人群。