目的 探讨超声评分法在体表高分化脂肪肉瘤(WDLPS)和良性脂肪瘤(LP)鉴别诊断中的价值,为两者的鉴别诊断和治疗方式选择提供依据。方法 回顾性分析经病理证实的 14 例(共15个肿块)体表WDLPS和 37 例(共40个肿块)LP临床资料及超声声像图特征,比较2组患者的发病年龄、性别、发病部位、肿块长径、短/长径比、肿块形态、边界、有无包膜、内部回声、回声分布、位置及血流分级等指标。筛选出有统计学差异指标,绘制ROC曲线,计算评分系统的诊断效能。结果 WDLPS和 LP患者在年龄、肿块长径、短/长径比值、有无包膜、位置以及血流分级6个指标有统计学差异(P＜0.05),对以上6个指标赋予0或1分建立病灶评分系统,总分0～6分。计算不同分值对WDLPS的诊断效能,以总分≥3分时诊断效能最高,灵敏度86.7%,特异度77.5%,正确率80%,阳性预测值59.1%,阴性预测值93.9%。结论 基于超声图像特征的评分方法在总分≥3分时,对术前鉴别WDLPS和LP具有较好的诊断效能,能够为临床治疗方案选择提供重要参考依据,值得推广应用。

Objective To evaluate the value of ultrasonography scoring system in differential diagnosis of well-differentiated liposarcomas (WDLPS) and benign lipoma (LP), and to provide evidence for the differential diagnosis and treatment choice. Methods Fourteen WDLPS cases (total of 15 masses) and 37 LP cases (total of 40 masses) were diagnosed by surgical histopathology, which clinical data and the ultrasound images were analyzed retrospectively. The parameters including age, gender, region, mass length, length/width ratio, shape, margin, envelope echoes, echogenicity, texture, location, blood flow were compared between the groups above. A scoring system was established by analyzing the parameters with statistical differences, and the ROC curve was plotted to calculate the best cut-off value and evaluate the diagnostic efficiency of the scoring system. Results There were statistically significant differences between two groups in the following six parameters: age, mass length, length/width ratio, envelope echoes, location, blood flow(P＜0.05). The scoring system was established by assigning 0 or 1 point to each factor, and the total score was 0～6 points. The highest diagnostic efficiency of WDLPS was observed at the cut-off value ≥ 3. The sensitivity, specificity, accuracy, the positive predictive value and the negative predictive value was 86.7%, 77.5%, 80%, 59.1%, 93.9% respectively. Conclusions The ultrasonography-based scoring system has a better diagnostic efficacy in differentiating WDLPS and LP, which can provide an important reference basis for the selection of clinical treatment, and is worthy of promotion and application.

目的 建立HPLC法测定人血浆中亚胺培南浓度,并基于稳定性试验结果建立临床标本采样流程。方法 以0.01 mol·L^-1乙酸铵缓冲液(pH 6.8)-乙腈(95∶5,V∶V)为流动相,用Agilent Zorbax SB-AQ(4.6 mm×250 mm,5 μm)色谱柱,进样量30 μL,柱温30 ℃,流速1.0 mL·L^-1,紫外检测波长298 nm,分别考察了在不同温度,加入稳定剂等条件下亚胺培南的稳定性。结果 亚胺培南在3.30～105.60 μg·mL^-1线性关系良好(R²=0.999 1),定量下限为0.41 μg·mL^-1,批内回收率在97.83%～103.54%,批间回收率在99.43%～104.24%,日内、日间RSD＜15.0%;在稳定性血浆中,亚胺培南在低温、室温条件下可分别稳定72 h和18 h,在非稳定性血浆中,分别为24 h和6 h。结论 本方法简便、快速、准确,可用于监测亚胺培南浓度,且基于稳定性试验建立临床标本采样流程,能确保血药浓度监测结果准确性。

Objective To determine the concentration of imipenem in human plasma by HPLC method, and establish the sampling process of clinical specimens based on stability investigation result. Methods The mobile phase was consisted of 0.01 mol·L^-1 ammonium acetate buffer(pH 6.8)-acetonitrile(95∶5, V∶V), and using Agilent Zorbax SB-AQ column(4.6 mm×250 mm,5 μm)to investigat the stability of imipenem under different temperature and with or without stabilizer. The injection volume was 30 μL, the colum temperature was 30℃, the flow rate was 1.0 mL·L^-1 and the detection wavelength was 298 nm. Results Imipenem had a good correlation coefficient(R²=0.999 1)at concentration of 3.30-105.60 μg·mL^-1. The lower limit of quantification was 0.41 μg·mL^-1, the intra-batch and inter-batch recovery rate were 97.83%-103.54% and 99.43%-104.24%, the intra-day and inter-day RSD were less than 15.0%. In stabilized plasma, imipenem could maintain stable at low temperature for 72 h and room temperature for 18 h, in non-stabilized plasma for 24 h and 6 h respectively. Conclusions This method was simple, rapid and accurate, which was suitable for the imipenem therapeutic drug monitoring, and establishing the sampling process of clinical specimen based on stability test could ensure the accuracy of plasma concentration monitoring.

目的 使用分层应变技术评价以mFOLFOX6化疗的结直肠癌患者左心室功能的变化。方法 收集30例病理确诊为结直肠癌患者,各位患者均采用mFOLFOX6(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗方案,以自身对照做研究,分别于化疗前、化疗中期、化疗后期行心脏超声检查,获取常规参数,并采集左心室心尖四腔、三腔、两腔切面、短轴二尖瓣、乳头肌、心尖切面的三维动态图像,获取左心室的心肌心内膜下、中层、心外膜下心肌的纵向应变(GLSendo、GLSmid、GLSepi)及左心室心肌心内膜下、中层、心外膜下圆周应变(GCSendo、GCSmid、GCSepi)的数值,计算△GLS(△GLS=GLSendo-GLSepi),△GCS(△GCS=GCSendo-GCSepi),并比较这些数值的绝对值在化疗前后的变化。结果 无论化疗前还是化疗后,各层心肌均有跨壁梯度的存在。与化疗前相比:化疗后各层心肌应变参数的绝对值均降低,GLSendo和GCSendo、ΔGLS下降更为显著(P<0.05),其中,GLSendo的ROC曲线下面积为0.766,P<0.001,选25.3%为诊断界点,灵敏度为83.3%,特异度为70%;ΔGLS的ROC曲线下面积为0.749,P<0.001,选4.1%为诊断界点,灵敏度为76.7%,特异度为73.3%。结论 心肌分层应变技术有助于早期发现mFOLFOX6致结直肠癌患者左心室各层心肌功能的变化,GLSendo、ΔGLS是该技术中较为敏感的指标。

Objective To evaluate the changes of left ventricular function in patients with colorectal cancer treated with mFOLFOX6 using layer-specific strain analysis. Methods The data of 30 patients with pathologically diagnosed with colorectal cancer were collected. All patients were treated with mFOLFOX6 (5-fluorouracil+oxaliplatin+calcium leucovorin) chemotherapy. The self-control study was carried out before, during, and after chemotherapy, and cardiac ultrasound was performed to obtain conventional parameters, and three-dimensional dynamic images of the left ventricular apex four-chamber, three-chamber, two-chamber section, short-axis mitral valve, papillary muscle, and apical sectionare were acquired. The longitudinal strain of the three layer of myocardium (GLSendo、GLSmid、GLSepi) and the circumferential strain of myocardium (GCSendo、GCSmid、GCSepi) were collected, and △GLS (△GLS=GLSendo-GLSepi), △GCS (△GCS=GCSendo-GCSepi) were calculated, and the absolute values of these indexes before and after chemotherapy were compared. Results No matter before or after chemotherapy, there was a transmural gradient in each layer of myocardium. Compared with those before chemotherapy, the absolute values of myocardial strain parameters of each layer were reduced after chemotherapy, and GLSendo and GCSendo and ΔGLS decreased more significantly (P<0.05),while the area under the ROC curve of GLSendo was 0.766, P<0.001.Selecting 25.3% as the diagnostic boundary, the sensitivity was 83.3%, and the specificity was 70%.The area under the ROC curve of ΔGLS was 0.749, P<0.001. Selecting 4.1% as the diagnostic boundary, the sensitivity was 76.7%, and the specificity was 73.3%. Conclusions The myocardial layer-specific strain analysis is helpful for early detection of changes in the myocardial function of the left ventricle, which caused by mFOLFOX6 in patients with colorectal cancer. GLSendo and ΔGLS are sensitive indicators in this technique.

目的 了解精神科护士的临床决策意识与其情绪智力水平的相关性。方法 采用护理临床决策量表(CDMNS),情绪智力量表(WLEIS)对来自广州市3家医院的230名精神科护士进行问卷调查,并对结果进行相关性分析。结果 精神科护士临床决策意识得分为(133.25±14.68)分,情绪智力得分为(74.15±11.77)分,精神科护士临床决策意识总分与情绪智力能力总分呈显著正相关(r=0.413,P＜0.05)。结论 精神科护士临床决策意识、情绪智力为中等水平,提高情绪智力水平有助于提高精神科护士的临床决策能力。

Objective To understand the correlation between the clinical decision-making awareness of psychiatric nurses and their emotional intelligence. Methods Using the clinical decision-making in nursing scale (CDMNS) and Wong & Law emotional intelligence scale (WLEIS), a questionnaire survey was conducted among 230 psychiatric nurses in 3 hospitals in Guangzhou, and correlation analysis was performed on the results. Results The clinical decision consciousness score of psychiatric nurses was (133.25±14.68), and the emotional intelligence score was (74.15±11.77). The total score of clinical decision consciousness of psychiatric nurses was significantly positively correlated with the total emotional intelligence ability score (r=0.413, P<0.05). Conclusions The clinical decision-making awareness and emotional intelligence of psychiatric nurses were at a medium level. Increasing the level of emotional intelligence can help improving the clinical decision-making ability of psychiatric nurses.

目的 了解高职医学生职业决策困难现状及其主要影响因素,提出改善对策。方法 采用分层整群抽样方法,选取广州市某职业院校740名全日制医学生进行问卷调查。结果 被调查高职医学生职业决策困难总平均分值为(3.55±0.647),其中职业规划探索维度均分最低为(3.42±0.797),其它维度均分从低到高分别是职业目标探索(3.49±0.766)、职业信息探索(3.58±0.678)和职业自我探索(3.69±0.659);单因素方差分析结果显示,不同专业、所在专业是否为第一志愿、不同家庭所在地的高职医学生职业决策困难分值均存在差异(P<0.05);多元逐步回归分析结果显示,家庭所在地、学校职业规划指导课程、兼职或见习的经历、学校活动(就业指导讲座、职业规划大赛等)、对所学专业的就业前景很乐观、学校提供了充足的就业信息、曾参加过创新创业大赛,是医学生职业决策困难的预测因素(P<0.05)。结论 高职医学生职业决策困难程度处于中等水平,学校可通过开展有针对性的职业指导,建立系统的职业决策困难测评与干预体系,搭建实践、就业服务平台等方法改善高职医学生职业决策困难状况,为学生提供强有力的支持与保障;政府可加大政策导向,引导高职医学生面向基层就业。

Objective To understand the current situation and main influencing factors of career decision-making difficulties of higher vocational medical students, and put forward improvement countermeasures. Methods The method of stratified cluster sampling was adopted, with 740 full-time medical students from a vocational college in Guangzhou being investigated. Results The average score of career decision-making difficulty of medical students surveyed in higher vocational colleges was (3.55±0.647), in which the average score of the career planning exploration was the lowest (3.42±0.797), and the average scores of other dimensions from low to high were career goal exploration (3.49±0.766), career information exploration (3.58±0.678) and career self-exploration (3.69±0.659). The results of one-way analysis of variance (ANOVA) showed that there were significant differences in the scores of career decision-making difficulties of medical students in higher vocational colleges among different majors, the major being the first choice or not, and different living places (P<0.05). The results of multiple stepwise regression analysis showed that family location, school guidance courses for career planning, part-time or trainee experience, school activities (employment guidance lectures, career planning competitions, etc.), being optimistic about the employment prospects of their majors, schools providing sufficient employment information, and having participated in innovation and entrepreneurship competitions were predictors of difficulties in career decision-making for medical students (P<0.05). Conclusions The difficulty of career decision-making of medical students in higher vocational colleges was in the middle level. Schools can establish a systematic evaluation and intervention system aiming at career decision-making difficulties by carrying out targeted career guidance, and build practice and employment service platform to improve the career decision-making difficulties of medical students in higher vocational colleges, and to provide strong support and security for students. The government can enhance policy guidance for medical students in higher vocational colleges to apply for primary hospital.

目的 观察龙氏正骨手法配合浮针临床上治疗颈源性头痛的疗效。方法 将本院80例颈源性头痛患者按1:1随机分为观察组和对照组,观察组采用龙氏正骨手法配合浮针治疗,对照组采用龙氏正骨手法治疗,于1疗程后比较2组临床疗效、疼痛视觉模拟评分(VAS)和颈椎活动度评分(ROM)情况。结果 治疗后两组VAS较治疗前均有改善(P<0.05),观察组较对照组明显(P<0.05)。2组ROM较治疗前均有改善(P<0.05),组间差异无统计学意义(P>0.05)。治疗组的愈显率高于对照组(P<0.05)。结论 龙氏正骨手法配合浮针治疗颈源性头痛能更好地减轻疼痛程度,方便高效。

Objective To observe the clinical effect of Long's bone-setting manipulation combined with floating acupuncture therapy on cervicogenic headache. Methods A total of 80 patients with cervicogenic headache in our hospital were randomly divided into observation group and control group evenly. The observation group was treated with Long's bone-setting manipulation combined with floating acupuncture therapy, and the control group was treated with Long's bone-setting manipulation only. After one course of treatment, the clinical efficacy,pain visual analogue score (VAS) and cervical joint range of motion (ROM) in the two groups were compared. Results After treatment, the VAS of the two groups was improved compared with that before treatment (P<0.05), and the VAS of the observation group was significantly higher than that of the control group (P<0.05). ROM in the two groups was improved compared with that before treatment (P<0.05), and there was no significant difference between the two groups (P>0.05). The effective rate of the treatment group was higher than that of the control group (P<0.05). Conclusions Long's bone-setting manipulation combined with floating acupuncture therapy in the treatment of cervicogenic headache can better reduce the degree of pain, which is convenient and efficient.

目的 研究羌活胜湿汤对风湿外感头痛患者的疗效。方法 选择2018年1月—2020年12月我院收治的62例风湿外感头痛患者,随机分为2组。对照组服用5 mg的氟桂利嗪胶囊,每晚1次;观察组联用羌活胜湿汤。比较2组风湿外感头痛患者的有效率,治疗前后的睡眠质量评分和视觉模拟评分法(VAS)评分。结果 观察组风湿外感头痛患者的有效率(96.77%)高于对照组(80.64%) (P<0.05);治疗前,2组风湿外感头痛患者的VAS评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的VAS评分降低(P<0.05),且观察组风湿外感头痛患者的VAS评分更低(P<0.05);治疗前,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分降低(P<0.05),且观察组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分低于对照组(P<0.05)。结论 羌活胜湿汤对风湿外感头痛患者有显著的疗效,与其能明显减轻疼痛程度和改善睡眠质量有关。

Objective To investigate the effect of Qianghuo Shengshi decoction on patients with wind-damp headache. Methods A total of 62 cases of patients with wind-damp headache who were treated in our hospital from January 2018 to December 2020 were selected and divided into two groups randomly. The control group took 5 mg of flunarizine capsules once a night; the observation group took Qianghuo Shengshi decoction additionally. The effective rate, sleep quality score and visual analogue scale(VAS) score before and after treatment were compared between the two groups of patients. Results The effective rate of the observation group (96.77%) was significantly higher than that of the control group (80.64%, P<0.05). Before treatment, the VAS scores of the two groups of patients with exogenous wind-damp headache were not significantly different (P>0.05). After treatment, the VAS scores of the two groups were significantly reduced (P<0.05), and the score drop of the observation group was significant (P<0.05). Before treatment, there were no significant differences in night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition score between the two groups (P>0.05), after treatment, the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in both groups were significantly decreased (P<0.05), and the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in the observation group were significantly lower than those in the control group (P<0.05). Conclusions Qianghuo Shengshi decoction had a significant effect on patients with wind-damp headache, and its was related to its ability of significant pain reduction and sleep quality improvement.

目的 观察首诊-复诊-住院-产后管理的模块化护理干预对妊娠期糖尿病(GDM)围产期患者的影响。方法 回顾性收集我院2020年1月—2021年1月GDM患者91例,按照患者意愿及不同护理方案分组。常规护理组45例予以常规护理,模块化管理组46例在常规护理基础上予以首诊-复诊-住院-产后管理的模块化护理。比较2组患者首诊时、分娩后血糖控制水平、围产期患者并发症发生情况、围产期新生儿并发症发生情况、护理工作满意度。结果 分娩前模块化管理组空腹血糖、餐后2 h血糖低于常规护理组(P＜0.05);模块化管理组围产期患者并发症发生率8.70%(4/46)低于常规护理组24.44%(11/45)(P＜0.05);模块化管理组围产期新生儿并发症发生率6.52%(3/46)低于常规护理组22.22%(10/45)(P＜0.05);模块化管理组护理工作满意度93.48%(43/46)高于常规护理组77.78%(35/45)(P＜0.05)。结论 首诊-复诊-住院-产后管理的模块化护理干预可改善GDM患者的血糖水平,降低围产期患者及新生儿并发症发生率,同时能提升患者护理工作满意度。

Objective To observe the effect of modularized nursing intervention on perinatal patients with gestational diabetes mellitus (GDM), including first visit, subsequent visit, hospitalization and postpartum management. Methods Ninety-one patients with GDM in our hospital from January 2020 to January 2021 were retrospectively grouped according to patients' wishes and different nursing plans, and their data were collected. Forty-five patients in the routine nursing group received routine nursing, and 46 patients in the modular management group received modularized nursing in addition to the routine nursing, including first visit, subsequent visit, hospitalization and postpartum management. The blood glucose level at the first visit and after delivery, the incidence of complications in perinatal patients, the incidence of complications in perinatal neonates, and the satisfaction of nursing work were compared between two groups. Results Before delivery, FPG and 2hPG levels in modularized management group were lower than those in routine nursing group (P<0.05). The incidence of perinatal complications in modularized management group was 8.70% (4/46), lower than that in routine nursing group (24.44%, 11/45, P<0.05). The incidence of neonatal complications in the modularized management group was 6.52% (3/46), lower than that in the routine nursing group (22.22%, 10/45, P<0.05). The nursing job satisfaction rate of modular management group was 93.48% (43/46), higher than that of routine nursing group (77.78%, 35/45, P<0.05). Conclusions Modularized nursing intervention of first visit, subsequent visit, hospitalization and postpartum management could improve the blood glucose level of patients with GDM, reduce the incidence of complications in perinatal patients and neonates, and improve patients' satisfaction with nursing work.

目的 探究血清C反应蛋白与白蛋白比值(CRP/ALB)、中性粒细胞与淋巴细胞比值(NLR)、血糖不稳定指数(GLI)水平对重症肺炎患者预后的预测价值。方法 将我院2020年1月—2021年5月收治的126例重症肺炎患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(93例)和死亡组(33例)。对比2组患者的一般资料,采用多因素Logistic分析重症肺炎患者高危因素,应用ROC曲线评估血清CRP/ALB、NLR、GLI水平对重症肺炎患者预后的预测价值。结果 2组患者一般资料对比,NEU、CRP、APACHEⅡ、CRP/ALB、NLR、GLI水平差异有统计学意义(P<0.05);多因素Logistic回归分析显示APACHEⅡ评分、血清CRP/ALB、NLR、GLI水平是重症肺炎患者死亡的危险因素;ROC曲线分析结果显示,CRP/ALB、NLR、GLI曲线下面积分别为0.837,0.826,0.837。结论 CRP/ALB、NLR、GLI水平对重症肺炎患者预后均具有较高的预测价值,其中以CRP/ALB的预测价值最佳。

Objective To explore the prognostic predictive value of serum CRP/ALB, NLR and GLI in patients with severe pneumonia. Methods A total of 126 patients with severe pneumonia treated in our hospital from January 2020 to May 2021 were divided into survival group (93 cases) and death group (33 cases) according to the prognosis of 28 days of hospitalization. The general data of the two groups were compared, the high-risk factors of patients with severe pneumonia were analyzed by multivariate logistic, and the predictive value of serum CRP/ALB, NLR and GLI levels on the prognosis of patients with severe pneumonia was evaluated by ROC curve. Results There were significant differences in the levels of NEU, CRP, APACHE Ⅱ, CRP/ALB, NLR and GLI between the two groups (P<0.05); multivariate logistic regression analysis showed that APACHE Ⅱ score, serum CRP/ALB, NLR and GLI were the risk factors of death in patients with severe pneumonia; ROC curve analysis showed that the areas under CRP/ALB, NLR and GLI curves were 0.837, 0.826 and 0.837 respectively. Conclusions The levels of CRP/ALB, NLR and GLI had high predictive value in the prognosis of patients with severe pneumonia, among which CRP/ALB had the best predictive value.

目的 探讨艾灸联合五禽戏治疗颈型颈椎病的疗效。方法 选择我院2019年3月—2020年11月收治的116例颈型颈椎病患者作为研究对象,随机分为实验组和对照组,各58例。其中对照组患者给予艾灸常规治疗,观察组患者在上述治疗的基础上外加五禽戏康复治疗。比较2组患者治疗前后的颈部症状积分、颈椎活动度(ROM)评分、McGill疼痛问卷(MPQ)、Northwick Park颈部疼痛量表(NPQ)评分,观察2组疗效、不良反应及预后情况。结果 实验组治疗有效率高于对照组,预后复发率低于对照组(P<0.05)。与治疗前相比,2组患者治疗后的NPQ评分、MPQ 评分、颈部症状积分、ROM评分均降低,且实验组降低更明显(P<0.05)。结论 颈部症状积分、颈椎活动度及NPQ评分可以较好地对五禽戏联合艾灸治疗颈型颈椎病的疗效进行反映评价,具有一定的临床应用价值。

Objective To explore the efficacy of moxibustion combined with Wuqinxi in treating cervical spondylosis. Methods The 116 patients with cervical spondylosis admitted to our hospital from March 2019 to November 2020 were selected as the research objects, and they were divided into experimental group and control group by random number method, with 58 cases in each group. The patients in the control group were given conventional moxibustion treatment, and the patients in the observation group were treated with Wuqinxi rehabilitation therapy on the basis of moxibustion. The scores of neck symptom, cervical spine range of motion (ROM), McGill pain questionnaire (MPQ), Northwick Park neck pain questionnaire(NPQ) scores before and after treatment were compared between the two groups, and the differences in clinical efficacy and prognosis of the two groups were observed. Results The effective rate of treatment in the experimental group was significantly higher than that of the control group, and the recurrence rate was significantly lower than that of the control group (P<0.05). Compared with that before treatment, NPQ score, MPQ score, neck symptom score, ROM score were significantly reduced in both groups after treatment, and the reduction of these indicators was more significant in the experimental group, with statistically significant differences (P<0.05). Conclusions The neck symptom score, cervical ROM and NPQ score could better reveal and evaluate the efficacy of Wuqinxi combined with moxibustion in the treatment of cervical spondylosis, and had certain clinical application value.