目的 评价综合营养干预措施与传统的单纯药物治疗对花都区老年原发性骨质疏松 (OP)患者生命质量的影响。方法 采用随机法将符合标准的OP患者随机分配到干预组(A组)和对照组(B组)接受相应的干预处理。干预组给予综合营养干预措施,而对照组只给予单纯的抗骨质疏松药物。结果 干预组人群干预前后生命质量的8个维度中的6个维度得分与干预前比较,差别有统计学意义(P<0.05)。 对照组人群生命质量的8个维度中只有2个维度与干预前比较,得分间差别有统计学意义(P<0.05)。结论 综合营养干预措施可以提高老年OP患者的生命质量。

目的 探讨原发性肾上腺淋巴瘤的临床表现及诊疗方法。方法 总结我院收治的1例原发性肾上腺淋巴瘤患者的临床表现及诊疗方法,并回顾性分析国内外文献资料。结果 患者在全身麻醉下行右侧肾上腺肿瘤根治术+右叶肝部分切除术+膈肌修补术,取病理活检结果为(右肾上腺区、肝)弥漫性大B细胞淋巴瘤,术后使用R-CHOP方案规律化疗8次,随访1年患者已完全缓解,未见复发征象。结论 原发性肾上腺淋巴瘤是临床少见的恶性程度高的肿瘤,主要以弥漫大B细胞淋巴瘤多见,早期无明显特异性,且缺乏典型临床表现,临床上易误诊,一旦确诊,应及早手术并化疗以减缓疾病进展及减轻患者痛苦。

目的 探讨白癜风初诊患者外周血细胞因子水平与临床分型、皮损面积的相关性。方法 收集我院2009年7月—2013年7月4年间收治的初诊白癜风患者78例及健康志愿者37例,用ELISA检测外周血血清IL-6、IL-2, IFN-γ、TNF-α浓度并判断其与白癜风分型、皮损程度的相关性。结果 与对照组相比,白癜风各分型组的IL-6、IL-2水平均升高,其中,散在性的升高幅度最为明显。IL-6及IL-2与皮损面积呈正相关,其相关系数分别为0.664及0.483,P值分别为0.021及0.014。结论 IL-2及IL-6在白癜风的发病过程中起重要作用,且在不同的分型中的表达存在差异,并与皮损面积呈正相关。

Objective To evaluate the correlation of cytokine level of peripheral blood cells, clinical classification and skin lesion in preliminary diagnosis of vitiligo. Methods A total of 78 patients with vitiligo of preliminary diagnosis and 37 health volunteers were collected from July 2009 to July 2013. The peripheral blood were collected for ELISA measurement of IL-6, IL-2, IFN-γand TNF-α, and evaluated whether the cytokines concentration was correlated to clinical classification and skin lesion. Results Compared to control group, IL-6 and IL-2 in all of classification of vitiligo was higher, and the most increase was observed in scattered group. Both IL-6 and IL-2 showed the positive correlation with skin lesion (CI: 0.664 and 0.483, P=0.021 and 0.014). Conclusion IL-2 and IL-6 maybe play a key role in vitiligo etiology, and showed different level in different classification of vitiligo. Besides, they showed a positive correlation with skin lesion.

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 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 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   分析原发性肾病综合征（PNS）患儿在糖皮质激素（激素）治疗后淋巴细胞亚群及免疫因子的水平变化，以探讨PNS耐药机制。方法   选取PNS患儿共71例，正常对照组108例，收集PNS患者在激素治疗前、后及正常对照组儿童的淋巴细胞亚群［CD4⁺ 、CD8⁺ 、CD4⁺ /CD8⁺ 、CD19⁺ 和自然杀伤（NK）细胞］及免疫因子水平，并分析激素治疗后激素敏感患儿和激素耐药患儿相关指标的差异。结果  PNS患儿淋巴细胞亚群及免疫因子水平异常，激素治疗后PNS患儿总免疫球蛋白E（IgE）水平［767.50（270.25，1 937.50）IU/mL vs 311.00（62.70，757.00）IU/mL］（P=0.008）下降，而CD4⁺ T细胞比例［（33.88±7.42）% vs（38.25±7.16）%］（P=0.004）升高，激素治疗敏感患儿NK细胞比例高于激素治疗耐药患儿［（8.39±4.60）% vs（4.72±1.99）%］（P=0.034），IgE水平低于耐药患儿［311.00（62.70，633.00）IU/mL vs783.00（88.05，1 290.00）IU/mL］（P＜0.001）。结论  PNS患儿淋巴细胞亚群分布及免疫球蛋白水平异常，激素治疗可影响患儿CD4⁺ T细胞比例及IgE水平，并且NK细胞比例和IgE水平与患儿激素耐药相关。

       Objective  To evaluate the changes of lymphocyte subsets and immune factors levels in children with primary nephrotic syndrome（PNS），and explore the pathogenesis of PNS．Methods  A total of 71 patients with PNS and 108 normal control cases were selected．Flow cytometry was used to detect the concentration of lymphocyte subsets（CD4⁺ ，CD8⁺ ，CD4⁺ /CD8⁺ ，CD19⁺  and natural killer［NK］ cells）and immune factors before and after treatment．The difference of  related factors between steroid-sensitive and steroid-resistant children after therapy were analyzed．Results  Lymphocyte subsets and immune molecule levels were abnormal in children with NPS．The level of IgE（767.50［270.25，1 937.50］IU/mL vs 311.00［62.70，757.00］IU/mL，P=0.008）was significantly decreased after therapy（P＜0.05），while CD4⁺  T cells（［33.88±7.42］% vs［38.25±7.16］%，P=0.004）were significantly increased．The level of NK cells in steroid-sensitive children was significantly higher than that in steroid-resistant children（［8.39±4.60］% vs［4.72±1.99］%，P=0.034），while the level of  IgE was significantly lower than that of steroid -resistant children（311.00［62.70，633.00］IU/mL vs 783.00［88.05，1 290.00］IU/mL，P＜0.001）．Conclusions  The distribution of lymphocyte subsets and the level of immune factors in PNS children were abnormal．Steroid therapy could affect the levels of CD4⁺  T cells and IgE，and the levels of NK cells and IgE were related to steroid-resistance in PNS children．

       目的   探讨CT、MRI影像学表现对原发性肝细胞癌（HCC）微血管侵犯（MVI）的诊断价值。方法   选取2018年1月—2024年7月江门市第二人民医院（江门市中心医院蓬江分院）和江门市中心医院120例（共158个病灶）HCC患者，均行上腹部CT、MRI平扫+增强及弥散加权成像（DWI）检查；以术后病理结果为金标准。比较CT、MRI平扫+增强及DWI对HCC MVI诊断效能；分析HCC MVI诊断中CT、MRI平扫+增强及DWI检查与术后病理确诊结果之间的一致性；比较HCC MVI与无HCC MVI患者影像学表现及表观扩散系数（ADC）值。结果    DWI检查对HCC MVI的诊断效能（灵敏度、特异度、准确度、阳性预测值、阴性预测值）均显著性高于CT、MRI平扫+增强（P＜0.05）；CT、MRI、DWI对原发性肝细胞癌患者微血管侵犯的诊断效能比较，差异均无统计学意义（P＞0.05）。在HCC MVI诊断效能中，CT、MRI影像学表现与术后病理确诊结果之间为中度一致性；DWI与术后病理确诊结果之间为高度一致性。HCC MVI患者的强化方式在非边缘动脉期强化、强化包膜、晕状强化、结中结、门脉分支癌栓占比均显著性高于无HCC MVI患者（P＜0.05）。在不同b值（400、800、1 000、1 500 s/mm² ）下，HCC MVI患者的ADC值均显著性高于无HCC MVI患者（P＜0.05）。结论    CT、MRI平扫+增强及DWI对HCC MVI均具有较好的诊断效能，而MRI诊断结果与病理诊断一致性更佳，尤其DWI图中ADC值可更加精准地判断HCC的患者是否发生微血管侵犯，有助于指导临床医生建立“个体化”精准诊疗策略。

       Objective  To explore the diagnostic value of CT and MRI imaging manifestations for microvascular invasion（MVI）in primary hepatocellular carcinoma（HCC）．Methods  A total of 120 patients（158 lesions in total）with HCC in the Second People’s Hospital of Jiangmen（Pengjiang Branch of Jiangmen Central Hospital）and Jiangmen Central Hospital were selected from January 2018 to July 2024，all underwent CT and MRI plain + enhanced and diffusion-weighted imaging（DWI）of the upper abdomen；postoperative pathology results was used as the diagnostic gold standard．The diagnostic efficacy of CT，MRI plain + enhanced and DWI for HCC MVI was compared．The concordance among CT，MRI plain + enhanced and DWI examinations with postoperative pathological diagnostic findings in the diagnosis of HCC MVI．Imaging manifestations and apparent diffusion coefficient（ADC）values in patients with and without HCC MVI were compared．Results  Diagnostic effectiveness of DWI examination for HCC MVI（sensitivity，specificity，accuracy，positive predictive value，negative predictive value）were all significantly higher than those of CT and MRI plain + enhanced（P＜0.05）；none of the differences were statistically significant（P＞0.05）in the comparison of diagnostic effectiveness of CT，MRI，and DWI for the diagnosis of MVI in patients with primary HCC．In HCC MVI diagnostic effectiveness，moderate concordance was found among CT，MRI imaging phenotypes and postoperative pathology results；high concordance was found between DWI and postoperative pathology results．In HCC MVI patients，the proportion of non-marginal arterial reinforcement，enhanced envelope，halo reinforcement，nodal in nodal and portal branch cancer thrombi was significantly higher than that in patients without HCC MVI（P＜0.05）．At different b-values（400，800，1 000，1 500 s/mm² ），ADC values were all significantly higher in patients with HCC MVI than in patients without HCC MVI（P＜0.05）．Conclusions  CT，MRI plain + enhanced and DWI have good diagnostic effectiveness for HCC MVI，while MRI diagnostic results are in better concordance with pathologic diagnosis．In particular，ADC values in DWI maps can more accurately determine whether MVI occurs in patients with HCC，which helps to guide clinicians to establish“individualized”and precise diagnosis and treatment strategies．

       目的   探讨非肌层浸润性膀胱癌患者初次经尿道膀胱肿瘤电切术的复发情况及危险因素。方法   以93例非肌层浸润性膀胱癌患者进行研究，2018年1月至2022年1月西藏自治区人民政府驻成都办事处医院泌尿外科医院收治采取经尿道膀胱肿瘤电切术，术后随访24个月，复发22例，未复发71例，比较复发与未复发基础情况、不同肿瘤直径、不同肿瘤分期、分级、数量、是否带蒂、灌注化疗方式等特征患者的复发情况，对具有统计学意义的因素，采取非条件Logistic多因素回归分析，明确术后复发的危险因素。结果   肿瘤分期T1期者的复发率为32.08%，高于Ta期者15.50%，肿瘤分级为高级别者的复发率为53.33%，高于低级别者17.95%，肿瘤多发者的复发率为35.71%，高于单发者的13.73%，肿瘤不带蒂者的复发率为38.71%，高于肿瘤带蒂者的16.13%，常规灌注化疗患者的复发率为29.85%，高于术后即刻+灌注化疗患者的7.69%，比较差异均有统计学意义（χ ² 分别为6.648、4.836、6.872、6.166、5.834、5.902，P分别为0.010、0.027、0.008、0.013、0.015、0.024）。肿瘤分期T1期、肿瘤分级为高级别、肿瘤多发、常规灌注化疗为非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发的危险因素（P＜0.05）。结论   非肌层浸润性膀胱癌患者初次采取经尿道膀胱肿瘤电切术容易因为临床分期为T1期、肿瘤分级为高级别、肿瘤多发及常规灌注等出现复发，应采取针对性干预措施，改进灌注化疗方式，降低复发率。

       Objective  To investigate the  relapse and  risk factors of non-muscular invasive bladder cancer after primary transurethral resection．Methods  A total of 93 patients with non-muscular invasive bladder cancer were selected for study．They were received by the hospital from January 2018 to January 2022 and underwent transurethral resection．After 24 months of follow-up，22 patients recurred，and 71 patients did not recur．The recurrence of patients with different tumor diameter，tumor stage，grade，numbers，pedicel or not，and infusion chemotherapy methods were compared．For the statistically significant factors，unconditional logistic regression analysis was used to determine the independent risk factors for recurrence．Results  The recurrence rate in T1 stage of tumor was 32.08% higher than that in Ta stage，which was 15.50%．The recurrence rate in high stage was 53.33% higher than that in low stage，which was 17.95%．The recurrence rate in multiple tumor patients was 35.71% higher than that in single tumor patients，which was 13.73%．The no-pedicle tumor recurrence rate was 38.71% higher than that with pedicle，which was 16.13%．The recurrence rate in patients receiving conventional infusion chemotherapy was 29.85% higher than that in patients receiving immediate postoperative infusion chemotherapy，which was 7.69%．The differences were statistically significant（χ ² =6.648、4.836、6.872、6.166、5.834、5.902，P=0.010、0.027、0.008、0.013、0.015、0.024）．The independent  risk factors of recurrence after primary transurethral resection were tumor stage T1，high grade tumors，multiple tumors，routine perfusion chemotherapy as non-muscular invasive bladder cancer（P＜0.05）．Conclusions  The  patients with  non-muscular invasive bladder cancer taking transurethral resection for the first time are prone to recurrence because of the clinical stage of T1，tumor grade of high grade，multiple tumors and routine perfusion．Targeted intervention measures  should be taken to improve the perfusion chemotherapy method to reduce the recurrence rate．

    目的   研究羽毛球颠球运动对低年级小学生近视的改善效果，为制定儿童青少年近视干预方案提供依据。方法   采用方便抽样方法，抽取广州市1个城区1所小学三年级4个班共182名学生作为研究对象。基线调查完成后，以班为单位，采用随机数字表法将4个班分为干预组（2个班，91例）和对照组（2个班，91例），干预组安排羽毛球颠球项目体育活动，对照组按原教学计划安排非球类常规体育活动。比较两组干预前后筛查性近视率、视力不良率和近视进展程度。结果  干预前两组的年龄、性别、筛查性近视率、视力不良率及近视分级比较，差异均无统计学意义（P＞0.05）。两组干预后的等效球镜度数（SE）比较，差异无统计学意义（P＞0.05）；对照组干预后的裸眼远视力（UDVA）低于干预组，△UDVA、△SE均高于干预组，差异均有统计学意义（P＜0.05）。对照组新发筛查性近视率29.13%、累积筛查性近视率49.45%、累积视力不良率68.13%及近视进展程度，均高于干预组新发筛查性近视率7.69%、累积筛查性近视率34.07%、累积视力不良率52.74%及近视进展程度，差异均有统计学意义（P＜0.05）。结论   羽毛球颠球运动能降低低年级小学生视力不良进展速度，减少近视的发生率及近视程度，学校可结合引起近视的因素进行灵活应用，以预防近视的发生发展。

      Objective  To study the impact of badminton juggling on the myopia of lower-grade primary school students and to provide a basis for developing myopia intervention strategies for children and adolescents．Methods  By using the convenience sampling method，182 third-grade students from four classes in a primary school in a district of Guangzhou were selected as subjects．After completing the baseline survey，the four classes were divided into an intervention group（2 classes，91 students）and a control group（2 classes，91 students）using a random number table．The intervention group was arranged to participate in badminton juggling sports activities，while the control group followed the original teaching plan without ball games．The study compared the screening rate of myopia，the rate of poor vision，and the degree of myopia progression before and after the study in both groups．Results  On baseline，there were no statistically significant differences between the two groups in terms of age，gender，rate of screening myopia，poor vision，and myopia grading（P＞0.05）．After 12 months，there was no statistically significant difference in the spherical equivalent（SE） comparison between the two groups（P＞0.05）．However，the uncorrected distance visual acuity（UDVA） of the control group after 12 months was significantly lower than that of the intervention group，and both △UDVA and △SE were significantly higher than those of the intervention group，with all differences being statistically significant（P＜0.05）．Incidence of screening myopia in the control group （29.13%），the cumulative rate of screening myopia（49.45%），the cumulative rate of poor vision （68.13%），and the degree of myopia progression was significantly higher than those in the intervention group，which had incidence of screening myopia at 7.69%，the cumulative rate of screening myopia at 34.07%，cumulative rate of poor vision at 52.74%．All these differences were statistically significant（P＜0.05）．Conclusions  Badminton juggling can slow down vision deterioration，reduce the incidence and severity of myopia in lower grade primary school students．Schools can flexibly apply these findings in conjunction with factors that contribute to myopia to prevent its occurrence and development．