目的 探讨两种不同机器学习算法在妊娠期糖尿病(gestational diabetes mellitus,GDM)风险预测中的应用。方法 选取2019年7月—2020年8月在广州市妇女儿童医疗中心及广东省计划生育专科医院进行产前检查的孕早期妇女520例,其中妊娠期糖尿病孕妇200例,随机抽取同期正常孕妇320例,收集孕妇的一般资料和孕早期(8～12周)的生化指标、血常规和凝血功能等检测资料。利用这些分析变量建立支持向量机(SVM)和Logistic回归(LR)预测模型。根据模型预测能力和模型实用性,如准确率、精确率、真阳性(TP)率、假阳性(FP)率、召回率、F测度、受试者工作特征曲线(ROC)进行效果评价。结果 两种预测模型的分类准确率总体为86%。SVM模型在真阳性(TP)率、假阳性(FP)率、召回率、F测度、受试者工作特征曲线(ROC)方面优于LR模型。结论 在分类与预测方面,支持向量机算法比Logistic回归模型更具有实用价值。

Objective To explore the application of two different machine learning algorithms in the risk prediction of gestational diabetes mellitus (GDM). Methods A total of 520 pregnant women with gestational diabetes mellitus were selected from Women and Children's Medical Center and Guangdong Family Planning Hospital from July 2019 to August 2020, including 200 cases of gestational diabetes mellitus, and 320 normal pregnant women in the same period. The general information of pregnant women and the detection data of biochemical indexes, blood routine test and coagulation function in early pregnancy (8～12 weeks) were collected. Support vector machine (SVM) and logistic regression (LR) prediction models were established by using these analysis variables. According to the predictive ability and practicability of the model, something like accuracy rate, precision ratio, true positive (TP) rate, false positive (FP) rate, recall rate, F-measure and receiver operating characteristic curve (ROC) were evaluated. Results The classification accuracy of the two models was 86%. SVM model is better than LR model in TPrate, FPrate, recall rate, F measure and ROC. Conclusion Support vector machine is more practical than logistic regression model in classification and prediction.

目的 了解广州市肾综合征出血热住院病例临床表现和流行病学特征,分析患者出现重症的影响因素,为加深疾病认知和识别重症提供科学依据。方法 回顾性选取2014年1月以来在广州市二级及以上医疗机构住院的明确诊断为肾综合征出血热的患者572例作为本研究研究对象,自行设计问卷,收集患者流行病学史、临床表现和实验室检测结果,采用多因素Logistic回归分析识别患者重症HFRS的影响因素。结果 572例患者中男406人,女166人,男女比2.45:1,年龄最小者14岁,最大89岁,平均年龄(41.21±14.16)岁。临床表现以发热、起病急、乏力为主,三者分别占比96.33%、88.29%和82.32%,重症病例93例,重症率16.26%,不同颈红、胸红、腹痛、腹泻、恶心、呕吐、眼睑浮肿、黄疸、少尿或无尿、低血压、休克、白细胞计数减少、尿膜状物情况和鼠类暴露情况的患者重症发生率差异有统计学意义(均 P<0.05),多因素Logistic回归分析结果显示年龄为40～49岁、呕吐、休克、房内有老鼠及食物粮食无防鼠设备是患者发生重症的危险因素,其OR值和95%CI分别为2.712(95%CI:1.039~7.077)、2.99(95%CI:1.462~6.114)、5.822(95%CI:1.891~17.927)和3.292(95%CI:1.479 ~7.327)。结论 临床表现有呕吐和休克症状以及有明确的啮齿类动物暴露史者重症的风险更高,在今后的防治中,应进一步加强健康宣传教育,广泛开展灭鼠活动,临床上对存在高危风险的病例进行早期干预以提高患者的预后效果。

Objective To understand the clinical manifestations and epidemiological characteristics of hospitalized cases of hemorrhagic fever with renal syndrome in Guangzhou, analyze the influencing factors of patients with severe illness, and provide scientific basis for deepening disease recognition and identifying severe illness. Methods A retrospective selection of 572 patients with a clear diagnosis of hemorrhagic fever with renal syndrome who were hospitalized in second-level and higher medical institutions in Guangzhou since January 2014 were selected as the research objects. Questionnaires were designed and the epidemiological history clinical manifestations and laboratory test results of patients were collected. Multivariate logistic regression analysis was used to identify the influencing factors of patients with severe HFRS. Results Among the 572 patients, there were 406 males and 166 females. The male-to-female ratio was 2.45:1. The youngest was 14 years old, the oldest was 89 years old, and the average age was (41.21±14.16)years old. The clinical manifestations were mainly fever, acute onset, and fatigue, which accounted for 96.33%, 88.29% and 82.32%. There were 93 severe cases with a severe rate of 16.26%. Different neck redness, chest redness, abdominal pain, diarrhea, nausea, and nausea, vomiting, eyelid edema, jaundice, oliguria or anuria, hypotension, shock, decreased white blood cell count, urine membranes and rodent exposure, there were statistically significant differences in the incidence of severe illness (all P<0.05). The logistic regression analysis of factors showed that the age of 40-49 years, vomiting, shock, the presence of rats in the room, and food without rodent-proof equipment were risk factors for severe illness. The OR values and 95%CI were 2.712 (95 %CI: 1.039-7.077), 2.99 (95%CI: 1.462-6.114), 5.822 (95%CI: 1.891-17.927) and 3.292 (95%CI: 1.479-7.327). Conclusion Patients with clinical manifestations of vomiting and shock symptoms and a clear history of rodent exposure are at higher risk of severe illness. In the future prevention and treatment, health promotion and education should be further strengthened, rodent control activities should be carried out extensively, and early intervention is taken clinically to improve the patient's healing effect.

目的 探究小分子化合物逆转素(reversine,Rev)对胆管结扎(BDL)诱导的大鼠胆汁淤积性肝损害、纤维化、上皮细胞-间充质转化以及胆管反应的影响。方法 雄性Lewis大鼠随机分成三组,每组各5只。按照如下处理:BDL组大鼠行2周的胆管结扎;BDL+Rev组行胆管结扎同时给予腹腔注射逆转素;对照采用假手术(Sham)。2周后获取血液和肝组织。血指标检测总白蛋白(TP)、总胆红素(TBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、γ谷氨酰转肽酶(GGT)。H&E染色检测肝组织病理。Azan染色检测组织胶原蛋白。免疫组化检测肝组织α平滑肌肌动蛋白(α-SMA)、结蛋白(Desmin)、波形蛋白(Vimentin)、细胞角蛋白(CK7,CK19)、β-连环蛋白(β-Catenin)以及上皮细胞粘附分子(EpCAM)蛋白的表达情况。结果 胆管结扎导致肝脏合成的总白蛋白量下降,总胆红素(TBIL)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、γ谷氨酰转肽酶(GGT)水平明显上升,逆转素处理使下降的总白蛋白上升,使上升的总胆红素(TBIL)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、γ谷氨酰转肽酶(GGT)水平向正常水平回复。逆转素可以缓解胆汁淤积引起的肝纤维化,表现为下调BDL引起的胶原蛋白和α-SMA蛋白沉积。逆转素可以抑制胆汁淤积引起的上皮细胞-间充质转化表现为逆转素明显降低BDL导致的Desmin和Vimentin的表达。逆转素可以抑制胆汁淤积引起的胆管反应表现为明显减少CK7和CK19阳性胆管的表达含量。逆转素抑制胆汁淤积引起的胆管反应与调节β-Catenin和EpCAM的表达有关。结论 逆转素可以缓解胆汁淤积引起的大鼠肝损害,具有一定的保护作用。逆转素可以成为一种潜在治疗药物。

Objective To investigate the effect of reversine (REV) on bile duct ligation (BDL) -induced hepatic damage, fibrosis, epithelial-mesenchymal transformation, and ductular reaction in rats. Methods Male Lewis rats were randomly divided into three groups with 5 rats in each group. Bile duct ligation was performed in the BDL group for two weeks. BDL+ REV group was treated with bile duct ligation and intraperitoneal injection of reversine. The control group was Sham operation (Sham). Blood and liver tissue were obtained after 2 weeks. Blood indexes were determined for total albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and γ-glutamyl transpeptidase. Hepatic histopathology was detected by H&E staining. Azan staining was used to detect tissue collagen deposition. Immunohistochemistry was used to detect the expression of α-SMA, desmin, vimentin, cytokeratin, β-catenin and epithelial cell adhesion molecule (EpCAM) protein. Results Bile duct ligation resulted in the decrease of total albumin synthesis in liver, and the increase of total bilirubin, glutamic-oxalacetic transaminase, alkaline phosphatase and γ-glutamyltranspeptidase. The levels of total bilirubin, aspartate transaminase, alkaline phosphatase and γ-glutamyltranspeptidase returned to the normal level with reversine treatment. Reversine could alleviate cholestasis-induced liver fibrosis by downregulating BDL-induced deposition of collagen and α-SMA protein. Reversine inhibited cholestasis-induced epithelial-mesenchymal transformation by significantly reducing BDL-induced desmin and vimentin expression. Reversine could inhibit cholestasis-induced ductular reaction by significantly reducing the expression of CK7 and CK19 positive biliary cells. Inhibition of cholestasis induced ductular reaction by reversine was associated with regulation of β-catenin and EpCAM expression. Conclusion Reversine can alleviate liver damage caused by cholestasis in rats and have a protective effect. Reversine may be a potential treatment that need further investigation.

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 探讨湿化高流量鼻导管通气(HHFNC)联合枸橼酸咖啡因治疗早产儿呼吸暂停的临床疗效。方法 选取2016年1月—2017年12月我院收治的58例呼吸暂停的早产儿为研究对象,随机分为两组:HHFNC组和对照组,HHFNC组除采用枸橼酸咖啡因治疗方案外,联合HHFNC法进行治疗;对照组采取鼻导管吸氧联合枸橼酸咖啡因治疗。结果 HHFNC组较之对照组治疗早产儿呼吸暂停的总有效率更高,差异有统计学意义(P<0.05);HHFNC组较之对照组总用氧时间、无创辅助通气的时间减少,住院时间缩短,差异有统计学意义(P<0.05)。结论 湿化高流量鼻导管通气(HHFNC)联合枸橼酸咖啡因减少早产儿呼吸暂停的发生,改善早产儿呼吸状况。

目的 对喀什地区和广州地区过敏性疾病儿童血清过敏原特异性IgE进行检测并比较检测结果。方法 选择喀什地区第一人民医院(喀什地区)和广东省妇幼保健院、广州市番禺区中心医院(广州地区)过敏性疾病儿童,血清标本采用国产欧博克试剂盒(酶联免疫法)检测过敏原特异性IgE。结果 两地区过敏性疾病儿童的过敏原IgE总阳性率均随年龄增长逐渐升高。广州地区过敏性疾病儿童对牛奶的IgE阳性率随年龄增长逐渐降低,对屋尘螨/粉尘螨则逐渐升高,组间比较均有统计学意义差异(P均<0.05)。喀什地区过敏性疾病儿童对花生/榛子/开心果、葎草/艾蒿/豚草、猫/狗毛皮屑的血清IgE阳性率明显高于广州地区,而对牛奶、屋尘螨/粉尘螨的血清IgE阳性率明显低于广州地区(P均<0.05)。结论 喀什地区和广州地区过敏性疾病儿童过敏原特异性IgE结果存在显著差异,过敏性疾病需要做好不同地区过敏原的监测。

目的 探讨扩张型心肌病采用诺欣妥治疗的效果及对其心功能的影响。方法 本文将2020年2月—2020年10月收治的扩张型心肌病患者50例作为研究对象,对所有患者按照随机方式进行分组,对照组25例患者以常规抗心衰治疗与依那普利治疗,观察组25例患者在常规抗心衰治疗的基础上给予诺欣妥治疗,统计分析用药后有效率、治疗前后心功能指标、6 min步行距离及炎症因子水平。结果 两组之间炎症因子水平相比,观察组较对照组低;6 min步行距离、用药后有效率相比,观察组较对照组高;心功能指标相比,观察组SV、LVEF较对照组高,LVESD、LVEDD较对照组低,P＜0.05。结论 采用诺欣妥治疗扩张型心肌病效果显著,总有效率较好,可有效改善患者心功能指标,增加6 min步行距离,减轻炎症因子水平,改善患者预后。

目的 探讨D-二聚体在急诊胸痛中心早期鉴别诊断急性主动脉综合征(AAS)的重要性,以及讨论如何结合D-二聚体检测优化现有胸痛中心的急救流程。方法 收集近1年来我院胸痛中心收治的50例以胸痛为主诉的患者资料,其中25例最终确诊AAS的患者作为AAS组,以同一时期诊治的25例进行了急诊经皮冠状动脉介入治疗(PCI)确诊的急性非ST抬高型心肌梗死(NSTEMI)患者作为对照组。所有患者在首诊时检测血D-二聚体,通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),分析D-二聚体对AAS与NSTEMI的鉴别诊断价值,并探讨其优化胸痛中心救治流程的实际意义。结果 AAS组D-二聚体水平明显高于NSTEMI组,差异具有统计学意义(P<0.001),且在D-二聚体为89 500 μg/L时取得最佳截止点。结论 对于胸痛患者早期鉴别诊断,D-二聚体具有重要参考价值。

Objective To explore the importance of D-dimer in early differential diagnosis of acute aortic syndrome (AAS) in the emergency chest pain center. And to discuss how to combine D-dimer detection with optimizing the first aid process of existing chest pain centers. Methods The data of 50 patients who complained of chest pain in the chest pain center of our hospital in the past 1 year was collected, including 25 patients who were finally diagnosed as AAS group. Other 25 patients with acute non-ST elevation myocardial infarction (NSTEMI) diagnosed by emergency percutaneous coronary intervention (PCI) were included as control group. Blood D-dimer was detected in all patients at the first visit. By drawing receiver operating characteristic curve (ROC), the value of D-dimer in differential diagnosis between AAS and NSTEMI was analyzed, and the practical significance of optimizing the treatment process of chest pain center was discussed. Results The level of D-dimer in AAS group was significantly higher than that in NSTEMI group (P<0.001), and the best cutoff point was obtained when D-dimer was 895.00 μg/L. Conclusion D-dimer has reference significance for early differential diagnosis of patients with chest pain.

目的 观察佩戴软弹性咬合板对磨牙症患者牙周组织应力的影响。方法 创建颌骨和牙列的三维有限元模型,对模型右侧上、下颌的每颗牙加载与牙体长轴呈0°、45°、90°的成人最大咬合力,分析使用不同厚度软弹性咬合板(1 mm、2 mm)后,牙槽骨及牙周膜所受应力的大小及分布,设不使用软弹性咬合板组做阴性对照。结果 在各咬合力加载角度下,与对照组相比,1 mm软弹性咬合板对牙周膜应力的缓冲效率平均为16%,对牙槽骨应力的缓冲效率平均为15%。2 mm软弹性咬合板对牙周膜及牙槽骨应力缓冲效率平均为26%及25%。在所有组别中,牙周组织的最大应力均集中于颊、舌侧牙槽嵴顶附近,但使用软弹性咬合板后应力集中范围减少,应力分布更均匀。结论 软弹性咬合板可以作为咬合应力的缓解装置,它有助于消减磨牙症产生的额外应力对牙周组织造成的破坏。

Objective To observe the effect of wearing an elastic soft occlusal splint on the stress of periodontal tissue in patient with bruxism. Methods A three-dimensional finite element model of jaw and dentition was created. Each tooth in the test area was loaded with the maximum adult occlusal force at 0°, 45°, and 90° with respect to the long axis of the tooth. 1 mm and 2 mm elastic soft occlusal splint were used, and the stress of the alveolar bone and periodontal ligament with and without elastic soft occlusal splint were analyzed and compared. Results Compared with the control group, 1 mm splint reduced the periodontal ligament stress of patient by an average of 16% and the alveolar bone stress by an average of 15%. After wearing a 2 mm splint, the patient's periodontal ligament and alveolar bone stress were reduced by 26% and 25% respectively. In all groups, the maximum stress of the periodontal tissue was on the buccal and lingual alveolar ridge crest, but the stress distribution was more uniform after using the soft occlusal splint. Conclusion The soft occlusal splint can be used to relieve occlusal stress and help eliminate the damage to periodontal tissue caused by the extra stress in bruxism.

目的 了解早产儿母亲群体的知识需求和情感特征,为延续性护理提供证据支持。方法 创建早产儿妈妈群,群成员共43人,通过整理并计量分析2018年9月—2019年1月的该微信群群聊记录,对群聊记录进行主题分类,归纳出对话频次最多及参与人数过半的聊天主题,并统计分析不同孕妇情况不同早产儿情况下早产儿母亲的关注内容。结果 早产儿母亲对早产儿照护相关知识需求较大,尤其在早产儿生长发育管理及疾病管理知识方面。此外,不同家庭月均收入水平、不同文化程度、不同分娩孕周、新生儿出生体质量不同、新生儿住院天数不同,其对话主题明显不同,对比有统计学意义(P<0.05)。结论 延续性护理工作中应加强早产儿照护相关知识宣教,根据孕妇和早产儿情况给予更加针对性的指导,同时不能忽视早产儿母亲的心身需求。此外,对群聊记录进行资料分析的方法可靠,建议在未来的研究中应用。

Objective To investigate the knowledge needs and psychological characters of the mothers of premature infants, providing the basis for continuous nursing. Methods WeChat group of mothers of premature infants was established and 43 group members were included. Chatting records of the WeChat group from September 2018 to January 2019 were extracted and classified into relevant topics. The topics with the most conversations or more than half of the participants and the topic related to the psychological experiences of mothers of premature infants were further analyzed. Results Mothers of premature infants had a large knowledge need for the care for premature infants, especially the knowledge about the growth and development management of premature infants and disease management of premature infants. Moreover, some mothers of premature infants had negative psychological feelings. Mothers with different family monthly income, educational levels, pregnancy duration, different weight and hospitalization cycles of their infants, had different chatting topics, which differences were significant (P<0.05). Conclusion In continuous nursing for mothers of premature infants, education on the care for premature infants should be strengthened and comprehensive measures of mental health should be undertaken. Additionally, the method of analyzing chatting records seems reliable and can be applied in future studies.