目的 探讨血必净注射液对ANP大鼠肠道菌群及肠黏膜屏障功能的影响。方法 40只SD大鼠随机分为空白组、假手术组、ANP组和血必净治疗组(每组10只),空白组不作任何处理,假手术组翻动十二指肠后关腹,ANP组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射建模,治疗组在建模后经鼠尾静脉注射血必净注射液(3 mL/kg)。24 h后处死大鼠并采样,ELISA法测血AMS、CRP、LPS、TNF-α、IL-6、IL-1β、DAO和D-乳酸等指标,粪菌样本行16SrRNA高通量测序分析,实时定量PCR法检测5种细菌数量,病理检测胰腺和回肠组织,比较各组大鼠的指标。结果 ①ANP组大鼠血AMS升高,CRP、LPS、TNF-α、IL-6、IL-1β、DAO、D-乳酸水平以及胰腺、小肠病理评分均高于空白组和假手术组(P<0.001);②治疗组AMS低于ANP组,血必净可降低上述各种血清指标水平和胰腺、小肠病理评分(P<0.001);③肠道菌群微生态分析显示,血必净可改善ANP大鼠粪菌的丰富度和多样性,缩小与空白组、假手术菌种种类的差异,增加厚壁菌门菌量;治疗组乳酸杆菌、双歧杆菌和普拉梭菌的菌量高于ANP组,肠球菌和大肠埃希的菌量低于ANP组(P<0.001)。结论 血必净可增加ANP大鼠肠道菌群的丰富度和多样性,增加有益菌的含量,减少内毒素和促炎因子释放,改善肠黏膜屏障功能。

Objective To investigate the effect of Xuebijing injection on intestinal flora and intestinal mucosal barrier function in ANP rats. Methods 40 SD rats were randomly divided into blank group, sham operation group, ANP group and Xuebijing treatment group (10 in each group). The sham operation group closed the abdomen after turning the duodenum. The ANP model was established by retrograde injection of 4.5% sodium taurocholate solution into the biliopancreatic duct. Xuebijing injection (3mL/kg) was injected into the tail vein of the rats in the treatment group. 24 hours later, the rats were sacrificed and sampled. AMS, CRP, LPS, TNF-, il-6, il-1, DAO and d-lactic acid were measured by ELISA. The fecal bacteria samples were analyzed by 16SrRNA sequencing technique. Real-time quantitative PCR was used to detect the populations of 5 bacteria in fecal sample. The pathology of pancreas and ileum were examined, and the indexes of rats in each group were compared. Results ①In ANP group, AMS was increased, levels of CRP, LPS, TNF-, il-6, il-1, DAO, d-lactic acid, pancreatic and intestinal pathology scores were higher than those in the blank group and the sham group (P<0.001).②In treatment group,AMS was lower than ANP group, and Xuebijing could reduce the levels of the above factors and scores of pancreatic and intestinal pathology (P<0.001).③ The microecological results of intestinal flora showed that Xuebijing treatment could improve the richness and diversity of fecal bacteria, reduce the difference between Xuebijing group and blank group and sham operation group, and increase the quantity of firmicutes. The amount of Lactobacillus, Bifidobacteria and Clostridium prasei in the Xuebijing group was higher than that in ANP group, while the amount of enterococci and Escherichia coli was lower than that in the ANP group (P<0.001). Conclusion Xuebijing can increase the richness and diversity of intestinal flora, increase the content of beneficial bacteria, reduce the release of endotoxin and pro-inflammatory factors, and improve the intestinal mucosal barrier function in ANP rats.

目的 探讨具有不同载脂蛋白E4等位基因(Apolipoprotein E4 alleles,APOE4)阿尔茨海默病患者的神经心理学量表差异。方法 纳入2014年1月—2017年12月广州市第一人民医院收治阿尔茨海默病患者28人,分别予简易精神状态检查量表、阿尔茨海默病评定量表-认知部分、临床医师通过面谈对变化的印象、日常生活活动能力量表、神经精神问卷,并检测量表间相关关系。之后随访18个月,观察量表评测的各功能变化及互相间相关性。检测不同载脂蛋白E4等位基因等阿尔茨海默病相关基因分布及与量表间相关关系。结果 认知评定量表间、认知评定量表与整体评价量表间、以及认知评定量表与日常活动能力评定量表间具有相关性。精神与行为症状量表分数与其他评定量表无明显相关性。随访中各量表分数变化间均无相关性。各基因组间功能变化无显著性差异,载脂蛋白E4等位基因变异主要影响患者的认知功能。等位基因分布与患病年龄,日常活动能力及精神与行为症状无相关性。结论 阿尔茨海默病量表评测的各认知领域间相关性不同,功能变化间无相关关系。载脂蛋白E4等位基因变异主要影响患者的认知功能。

Objective The present study aimed to elucidate the performance of multiple psychological tests among different Apolipoprotein E4 alleles (APOE4) in people with Alzheimer's disease (AD). Methods 28 patients were enrolled from January 2014 to December 2017 in Guangzhou First People'S Hospital. All patients were tested by using Mini-mental State Examination (MMSE), Alzheimer's disease Assessment Scale (ADAS-cog), Clinician's Interview-Based Impression of Change (CIBIC-Plus), Activities of Daily Living (ADL) and the NeuroPsychiatric Inventory (NPI). After 18 months follow-up visit, the change of the tests points were recorded. AD pathogenic genes, including Apolipoprotein E4 allele's variations, were detected in all patients. Then the correlations of APOE4 alleles and multiple psychological tests were analyzed. Results The correlations were confirmed between MMSE and ADAS-cog, MMSE and CIBIC-plus, MMSE and ADL, ADAS-cog and CIBIC-plus, ADAS-cog and ADL. NPI showed no correlation with the others. No correlation was found between changes of multiple psychological tests after 18 months follow-up. APOE4 alleles' variation affected cognitive function mainly. The effects of APOE4 on ADL and NPI showed no statistical significance in AD patients. No correlation was found among patients groups with different APOE4 alleles in all psychological tests and age of onset. Conclusion The correlations were existed among multiple cognitive domains while levels were different. The changes between psychological tests showed no correlations. APOE4 alleles' variation affected cognitive function mainly.

目的 分析2019新型冠状病毒(COVID-19)肺炎的肺部影像表现,提高对该病的影像学诊断认识。方法 回顾性分析2020年1月20日—2020年2月20日在我院就诊并最终经临床确诊的COVID-19肺炎患者的影像学及临床资料,所有患者均在入院后三天内行胸部X线检查或高分辨率CT平扫,分别记录每位患者两种影像检查方式的影像学表现,包括病灶累及的肺叶、磨玻璃影(GGO)、实变影、铺路石征、纤维索条及小叶间隔增厚等征象。结果 共22例确诊为COVID-19肺炎,其中男:女为1:1,年龄范围20~82岁;平均年龄为(52.9±16.2)岁。21例行胸部X线检查,其中有3例患者同时行肺部CT平扫检查;1例患者仅行胸部CT平扫检查。21例X线检查中16例(76%)胸片表现为斑片状、絮状致密影,余5例(24%)检查双肺未见异常征象。4例CT扫描患者中均可以见到病灶(100%),其中有3例(75%)累及5个肺叶,1例(25%)仅累及1个肺叶;均表现为胸膜下磨玻璃影、斑片状实变影、铺路石征、小叶间隔增厚、小血管增粗及支气管气象;其中1例(25%)出现淋巴结肿大;2例(50%)出现纤维索条影。结论 影像学检查对COVID-19的诊断和病情评估具有重要价值,其中X线检查对于部分病灶显示欠佳, 胸部CT平扫对于病变的检查较为准确,可作为COVID-19首选的影像学检查方法,为临床上早期诊断及治疗提供依据。

Objective To analyzed the pulmonary imaging manifestations of 2019 novel coronavirus (COVID-19) pneumonia, in order to improve the imaging diagnosis of the disease. Methods Retrospective analysis of the imaging and clinical data of 22 patients infected with the 2019 Novel Coronavirus (COVID-19) were reviewed, which all the patients took the X-ray or CT scan, and to record the images in the two types of inspection for each patient, including the involvement of the consolidation of the lung, ground-glass opacification, consolidation, paving stone chippings, fiber cable and interlobular septal thickening and so on. Results A total of 22 patients were diagnosed with COVID-19, and the ratio of male to female was 1:1, age range is 20~82, mean age is (52.9±16.2.21) patients received chest X-ray examination, including 3 patients received the non-contrast CT examination at the same time; 1 patient received chest CT plain examination only. 16 (76%) among the 21 patients with X-ray showed patchy and flocculent dense shadows, while the remaining 5 patients (24%) showed no abnormal signs in both lungs. 4 patients with CT scan can find the lesions. Among the 4 patients with detect CT scan, 3 patients (75%) involved 5 pulmonary lobes, and 1 patient (25%) only involved 1 pulmonary lobe. All of them showed subpleural ground-glass opacification, consolidation, paving stone chippings, fiber cable and interlobular septal thickening, including lymph node enlargement occurred in 1 case (25%), fiber strip shadows were observed in 2 cases (50%). Conclusion The imaging examination is of great value for the diagnosis and disease evaluation of COVID-19, among which X-ray examination is not good for some lesions, and CT plain scan is relatively accurate for the examination of lesions, which can be used as the preferred imaging method of COVID-19, providing further theoretical basis for early clinical diagnosis and treatment.

目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

目的 评价经椎间孔镜术和显微镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及优缺点,并探讨该术式的有效性、安全性,以期找到更优的手术治疗腰椎间盘突出症方法及临床应用价值。方法 通过回顾性分析我院2019年1月—2019年12月经椎间孔镜下髓核摘除术及显微镜下椎板开窗减压髓核摘除术患者,总随访251例,其中椎间孔组229例,显微镜组22例。采集数据包括病例数、性别、年龄、手术时间、出血量及切口感染情况,术前、术后的JOA评分、VAS评分、ODI功能指数、改良MacNab标准,并对数据进行统计学分析。结果 椎间孔组手术采用局麻下进行,显微镜组采用全麻下进行,其中椎间孔镜组有2例患者因术中腰部剧痛不能配合完成,余患者手术完成顺利。椎间孔镜组平均病程5个月,手术时间(96±10)min,术中出血量(25.8±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为14.23±3.08、6.08±1.64、30.18±7.92,术后JOA评分、VAS评分、ODI功能指数分别是22.65±1.58、1.77±0.5、19.67±3.89,改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%。显微镜组平均病程8个月,手术时间(45±10)min,术中出血量(62±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为15.13±2.06、6.85±1.27、29.42±7.47,术后JOA评分、VAS评分、ODI功能指数分别是23.25±1.31、1.98±0.53、20.12±4.03。椎间孔镜组改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%;显微镜组改良MacNab标准为优17例,良2例,可3例,差0例,总优良率86.4%;两组患者性别、年龄与术前JOA评分、VAS评分、ODI功能指数相关性无统计学意义;9例椎间孔镜术后患者因效果差择期行显微镜下开窗手术治疗。结论 经皮椎间孔镜手术及显微镜下开窗减压髓核摘除手术治疗腰椎间盘突出症疗效均可靠,能有效改善患者下肢放射痛等临床症状,提高患者的生活质量及减轻功能障碍,但椎间孔镜组更具有微创、出血量少、术后恢复快等优势。

目的 系统评价手术与保守治疗无骨折脱位型颈脊髓损伤的疗效。方法 应用计算机检索 PubMed、Cochrane Library、EMbase、OVID、CNKI、维普及万方数据库,纳入关于手术及保守治疗无骨折脱位型颈脊髓损伤疗效比较的随机或非随机对照试验。由2名研究人员独立对文献进行筛选、提取和纳入文献评价,采用 Rev-Man 5.3软件对两种治疗的JOA评分、ASIA运动评分、神经功能恢复率、ASIA分级改善进行Meta分析。结果 ①共纳入13 篇研究,共598例患者,手术和保守治疗组分别371例和227例;②Meta分析显示,与保守治疗相比,手术治疗后的JOA评分更高[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01];神经功能恢复率更高[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01];ASIA分级改善更明显[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006];在ASIA运动评分方面,两者无差异[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]。结论 对于无骨折脱位型颈脊髓损伤的患者,手术治疗更有利于患者神经功能的改善。

Objective To systematically assess the clinical efficacy of surgical treatment versus conservative treatment for CSCIWFD from previously clinical investigations. Methods A systematic search of all the studies published was conducted on the PubMed, Cochrane Library, EMbase, OVID, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between surgical treatment and conservative treatment for CSCIWFD were identified. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the quality of included studies. Meta-analyses were performed to assess variables including Japanese Orthopaedic Association scores(JOA), Neurological function recovery rate, ASIA impairment scale grade, ASIA motor scores. Results ①A total of 13 articles were included, involving 598 patients, of which 371 and 227 patients received sugical or conservative treatment. ②The results of the meta-analysis indicated that, compared with conservative group, surgical group has higher JOA scores[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01], better Neurological function recovery rate[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01], better ASIA impairment scale grade improvement[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006], and there were no significant differences in the ASIA motor scores[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]. Conclusion These result suggests that surgical treatment can improve the neurological function more effectively for patients with cervical spinal cord injury without fracture and dislocation.

目的 探讨广州市第一人民医院2008—2019年所有就诊的肿瘤患者的具体情况,研究各类肿瘤的发病趋势和危害程度,为制定预防措施和工作重点提供依据。方法 根据广州市恶性肿瘤病例登记报告系统数据,对2008—2019年在广州市第一人民医院就诊的23 778例肿瘤病例从基本情况、肿瘤部位和随访情况等几方面进行回顾性统计分析。结果 2008—2019年位列前三位的肿瘤分别是结直肠癌、肺癌和肝癌,甲状腺癌占比呈明显上升趋势。30岁以下年龄组肿瘤种类以白血病为主,30～60岁年龄组肿瘤种类以结直肠癌为主,60岁以上年龄组肿瘤种类以肺癌为主。甲状腺癌的预后最好,胰腺癌的预后最差。纯手术组疗效最佳。结论 在广州地区合理优化资源进行重点肿瘤的筛查,才可以有限降低罹患肿瘤的风险,提高肿瘤患者生命质量。

Objective The aims of study were to explore the situation of all patients with cancer in Guangzhou First People's Hospital from 2008 to 2019, to find the incidence trends and hazards of different types of tumors, and to provide evidence for developing preventive measures. Methods According to the data of the Guangzhou tumor case report system, a retrospective statistical analysis was performed on the basic situation, tumor location and follow-up of 23 778 tumor cases in Guangzhou First People's Hospital from 2008 to 2019. Results The top three tumors in 2008—2019 were colorectal cancer, lung cancer and liver cancer. The tumor types under 30 years old were leukemia, the tumor types in the 30-60 age group were colorectal cancer, and the tumor types above 60 years old were mainly lung cancer. The prognosis for patients with thyroid cancer was the best, and the prognosis for patients with pancreatic cancer was the worst. The effect of the operation group was the best. Conclusion Rational optimization of resources for screening key tumors could reduce tumor incidence and improve the quality of life of cancer cases in Guangzhou area.

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 本研究通过调查中国华南地区一间大型医疗机构(综合医院)中护士日间过度嗜睡的发生率及相关影响因素。方法 纳入了1 102名在职护士要求他们在一段规定的时间内完成一份自我报告问卷,其中包括人口学资料采集、生活习惯(BMI、小睡习惯、打鼾等)、失眠、抑郁、焦虑、MEQ分型、倒班、工作兴趣等与工作及睡眠相关的特征。了解EDS在被试人群中的发生率及其影响因素。结果 共有1 048名护士有效的完成了问卷(应答率为95.1%)。其中169名(16.1%)护士存在日间过度嗜睡(EDS)。抑郁症状(校正后的OR值= 2.24,95%的可信区间 1.51～3.31)、焦虑症状(1.65; 1.02～2.67)、失眠(2.29; 1.56～3.36)、倒班工作(1.98; 1.03～3.83)和对工作的低兴趣(1.74; 1.01～2.99)是EDS发生的独立危险因素。结论 日间过度嗜睡(EDS)在华南地区的综合医疗机构中的青年护士群体中普遍存在。EDS的发生可能与抑郁症状、焦虑症状、失眠、倒班工作和对工作的低兴趣存在相关。

Objective To investigate the prevalence and correlates of excessive daytime sleepiness EDS in a population of hospital nurses in South China. Methods A total of 1 102 nurses working in a large medical center were invited to participate in this cross-sectional study (females 96.9%,mean age 29.6 years). They all completed a self-reported questionnaire consisting of items on demographic variables,lifestyle factors,insomnia,anxiety,depression,and both work-related and sleep related characteristics. Results A total of 1 048 nurses gave a valid response (response rate 95.1%). Among them,169 (16.1%) reported EDS as defined as an Epworth Sleepiness Scale≥14. Depression (adjusted odds ratio=2.24,95% confidence interval 1.51～3.31),anxiety (1.65; 1.02 ～2.67),insomnia (2.29; 1.56～3.36),rotating shift work (1.98; 1.03～3.83) and low interest in work (1.74; 1.01～2.99) were all independent risk factors of the occurrence of EDS. Conclusion EDS were common among this relatively young and healthy nurse population in south China. There were clear associations with EDS and depression,anxiety,insomnia,rotating shift work and low work-related interest.

目的 观察实施微信式延续护理干预对真菌性外耳道炎患者心理状态及治疗效果的影响。方法 选取我院2018 年12月—2019年12 月期间门诊治疗的110例真菌性外耳道炎患者为观察对象,将所选患者随机分为常规组和干预组,常规组55例,采取常规护理;干预组55例,在常规护理的基础上实施微信式延续护理干预。观察两组患者的心理状态及治疗依从性、治疗效果的变化。结果 干预组患者心理状态的改善、治疗依从性、治疗效果均优于常规组,差异有统计学意义(P＜0.05)。结论 在给予真菌性外耳道炎患者实施护理干预的过程中,加入微信式延续护理干预,患者的心理状态得到改善、治疗依从率增加及患者治疗的总有效率提高。因此微信式延续护理干预值得在临床护理中进一步推广。

Objective To observe WeChat continuous nursing intervention on mental state and therapeutic efficacy of fungal external auditory meatus. Methods 110 cases of fungal external auditory meatus treated in our hospital from December 2018 to December 2019 were selected as the observation objects,The selected patients were randomly divided into the conventional group and the intervention group,There were 55 cases in the conventional group,taking regular care; there were 55 cases in the intervention group,on the basis of routine nursing,WeChat continuous nursing intervention was implemented. The psychological status and treatment compliance of the two groups were observed,also changes in treatment outcomes. Results The improvement of psychological state,treatment compliance and treatment effect in the intervention group were better than that in the conventional group.The difference was statistically significant(P＜0.05). Conclusion In the course of nursing intervention for patients with fungal external auditory meatus,WeChat continuous nursing intervention was added.The psychological state of the patients has been improved,the rate of treatment compliance is increased and the total effective rate of treatment is increased greatly.Therefore,WeChat continuous nursing intervention is worthy of further promotion in clinical nursing.