目的 探讨继发性肺结核合并肺部真菌感染的临床特点及相关高危因素。方法 收集广州市胸科医院2017年7月—2019年10月收治的继发性肺结核患者资料,病程均大于3个月,分为真菌感染组106例和非真菌感染组100例进行回顾性分析。结果 单因素分析结果显示,合并肺部其他疾病、非初治、咯血、空洞、应用广谱抗生素>l周、侵袭性操作存在统计学差异(P<0.05)。Logistic多因素分析结果显示,广谱抗生素使用>l周、侵袭性操作为真菌感染的独立危险因素(P<0.05)。结论 对于应用广谱抗生素、进行侵袭性操作的肺结核患者应警惕真菌感染风险,及早预防及诊治。

Objective To investigate the clinical characteristics and related high risk factors of secondary pulmonary tuberculosis complicated with pulmonary fungal infection. Methods Data of patients with secondary tuberculosis admitted to Guangzhou Chest Hospital from July 2017 to October 2019 were collected. All patients with a course of disease longer than 3 months were divided into the fungal infection group (n =106) and the non-fungal infection group (n =100) for retrospective analysis. Results Univariate analysis results showed that there were statistical differences in combined other pulmonary diseases, non-initial treatment, hemoptysis, cavity, application of broad-spectrum antibiotic > for 1 week, and invasive operation (P<0.05). Logistic multivariate analysis showed that >1 week of broad-spectrum antibiotics and invasive procedures were independent risk factors for fungal infection (P<0.05). Conclusion Patients with tuberculosis who are treated with broad-spectrum antibiotics and invasive procedures should be alert to the risk of fungal infection, early prevention and treatment should be undertaken.

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.

目的 观察低出生体重早产儿应用抗生素后肠道菌群的动态变化。方法 选取2018年6月—2019年7月在广州市第一人民医院住院的10名低出生体重早产儿,在出生时、出生后1~2周、出生后2~3周、出生后3~4周、出生后4~5周、出生后5~6周时分别收集粪便样本,通过16s高通量测序检测患儿粪便菌群变化并统计分析。结果 应用抗生素后的低出生体重早产儿肠道菌群α多样性(Shannon指数、Simpson指数、ACE指数和PD_whole_tree指数)下降(P均<0.05),肠道菌群结构在门、科、属水平均发生改变,其中Alistipes、Bacteroides、Lactobacillus、unidentified_Lachnospiraceae、unidentified_Ruminococcaceae、Alloprevotella、unidentified_Cyanobacteria、Bacillus、Stenotrophomonas和Acinetobacter菌属相对丰度减少(P均<0.05)。结论 低出生体重早产儿应用抗生素后肠道菌群多样性下降,肠道菌群结构发生改变,并在抗生素停用后仍持续,针对性补充益生菌或益生元可能有助于肠道菌群恢复稳态。

Objective To observe the dynamic changes of gut microbiota in premature infants with low birth weight after antibiotics therapy. Methods 10 low birth weight premature infants hospitalized in Guangzhou First People's Hospital from June 2018 to July 2019 were included. Fecal samples were collected at birth, 1~2 weeks after birth, 2~3 weeks after birth, 3~4 weeks after birth, 4~5 weeks after birth and 5~6 weeks after birth, respectively. The changes of fecal microbiota were detected and analyzed by 16s high-throughput sequencing. Results The α-diversity of gut microbiota (Shannon index, Simpson index, ACE index and PD_whole_tree index) in low birth weight preterm infants treated with antibiotics decreased (P<0.05). The structure of gut microbiota changed at phylum, family and genus levels, among which Alistipes, Bacteroides, Lactobacillus, unidentified_Lachnospiraceae, unidentified_Ruminococcaceae, Alloprevotella, unidentified_Cyanobacteria, Bacillus, Stenotrophomonas and Acinetobacter decreased (P<0.05). Conclusion The diversity of gut microbiota in low birth weight preterm infants decreased and the structure of gut microbiota changed after antibiotic therapy. Targeted supplementation of probiotics or prebiotics may contribute to the recovery of gut microbial homeostasis.

目的 比较唑来膦酸对 PVP(椎体成形术)治疗OVCF(骨质疏松椎体压缩性骨折)术后再发骨折的影响。方法 收集2016年12月—2018年6月在我院骨科接受PVP治疗患者共70例,其中40人在术后接受了唑来膦酸治疗(观察组),30人在术后接受了安慰剂治疗(对照组),两组患者均给予维生素D和钙剂基础治疗。记录术后6个月、1年、2年腰椎骨密度;术后2年内伤椎及邻近椎体再发骨折情况。结果 观察组伤椎再发骨折率(1/40,2.5%)低于对照组(2/30,6.67%)(P＜0.05);观察组邻椎再发骨折率(2/40,5%)低于对照组(7/30,23.33%)(P＜0.05)。结论 唑来膦酸能较好地预防PVP术后再发骨折。

Objective To compare the effect of zoledronic acid on the treatment of osteoporotic vertebral compression fracture after percutaneous vertebroplasty PVP. Methods From December 2017 to June 2019, a total of 70 patients who received PVP in the hospital medical plastic surgery clinic, 40 patients were collected received zoledronic acid (group A) and 30 patients received placebo (group B) after operation. Both groups received basic treatment of vitamin D and calcium. The bone mineral densits (BMD) of lumbar vertebrae were recorded at 6 months, 1 year and 2 years after operation, and the recurrent fractures of injured vertebrae and adjacent vertebrae were recorded at 2 years after operation. Results The rate of recurrent fracture of vertebrae in group A (1/40, 2.5%) was lower than that in group B (2/30, 6.67%); the rate of recurrent fracture of adjacent vertebrae in group A (2/40, 5%) was grcartly lower than that in group B (7/30, 23.33%). Conclusion Zoledronic acid can prevent recurrent fracture after PVP.

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 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.

目的 探讨延续性健康指导联合预见性干预对慢性脑卒中患者脑功能影响。方法 选取2019年6月—2020年6月我院收治的慢性脑卒中患者118例,使用随机数字表法将其分为两组,对照组进行预见性干预,研究组进行延续性健康指导联合预见性干预。比较两组效果、神经运动功能、不良反应。结果 研究组效果大于对照组(P＜0.05);研究组神经运动功能大于对照组(P＜0.05);研究组不良反应少于对照组(P＜0.05)。结论 慢性脑卒中护理中,延续性健康指导联合预见性干预效果较好,值得应用。

Objective To investigate the effects of continuous health guidance and combined predictive intervention on cerebral function in patients with chronic stroke. Methods A total of 118 patients with chronic stroke admitted to our hospital from June 2019 to June 2020 were selected and divided into two groups using the random number table method. The control group received predictive intervention, and the study group received continuous health guidance combined predictive intervention. The effects, neuromotor functions and adverse reactions of the two groups were compared. Results The effect of the study group was greater than that of the control group (P<0.05). The neuromotor function of the study group was higher than that of the control group (P<0.05). The adverse reactions in the study group were less than those in the control group (P<0.05). Conclusion In the nursing of chronic stroke, the effect of continuous health guidance combined with predictive intervention is good, and it is worth applying.

目的 探讨联合镇静胃肠镜检查在安全性、可行性的效果以及优势方面的临床应用,为优化诊疗流程、方便患者提供科学依据。方法 纳入我院2017年6月—2018年3月行镇静胃肠镜检查的140例患者为研究对象,采用便利抽样法随机分为两组,观察组70例患者行联合镇静胃肠镜检查,对照组70例患者行胃肠镜分次检查。记录并对比分析两组患者的预约时间、检查时长、不适反应、疼痛程度、满意度、检查费用。结果 观察组在预约时间和检查时长、检查后心率变化,患者满意度和检查费用方面,与对照组相比有统计学差异(P＜0.05),而在血压、血氧、镇静及遗忘程度、疼痛程度及不适反应方面无统计学差异(P＞0.05)。结论 联合镇静胃肠镜检查在临床应用方面安全可行,具有便宜、时间少、患者配合度好、符合患者意愿、而且满意度高的优势,值得推广。

Objective To explore the scientific evidence in optimization of diagnosis and treatment process for patients' convenience, we evaluated the clinical effect of gastrointestinal endoscopy with sedation on the safety, feasibility and advantage. Methods We enrolled 140 patients who came to our hospital for gastrointestinal endoscopy from June 2017 to March 2018. We used the convenience sampling method that the patients were randomly divided into two groups: observation group of 70 patients with combined endoscopy, and the control group of 70 patients with seperate endoscopy. We recorded and compared the two groups of patients of appointment time, inspection time, pain degree, patient satisfaction, and cost. Results The two groups were different in the appointment time, inspection time, heart rate changes after endoscopy, patient satisfaction and the costs (P<0.05), while no significant difference was found in blood pressure, blood oxygen degree, sedation, pain degree and discomfort reaction(P>0.05). Conclusion Combined sedative gastrointestinal endoscopy is safe and feasible in clinical application, with the advantages of low cost, less time, good patient cooperation, in line with the wishes of patients, and high satisfaction, which is worthy of popularization.

目的 探讨多参数磁共振成像-经直肠超声(mpMRI-TRUS)认知融合技术引导前列腺穿刺活检的临床应用价值。方法 选取2018 年1月—2020年12月就诊于本院且为前列腺癌疑似患者作为研究对象,分为mpMRI-TRUS组与TRUS组。mpMRI-TRUS组所有病例穿刺活检前均行mpMRI检查,根据MRI结果确定靶向病灶,行mpMRI-TRUS认知融合靶向活检和系统10针活检。TRUS组患者只行系统13针活检,比较两组间前列腺癌的检出率,同时比较mpMRI-TRUS组中靶向活检和系统活检在前列腺癌检出率方面的差异,并对穿刺病理结果进行观察和分析。结果 mpMRI-TRUS组穿刺活检阳性率为43.59%,TRUS组穿刺活检阳性率为33.07%,两组前列腺癌检出率差异无统计学意义。mpMRI-TRUS组中靶向穿刺的单针阳性率、靶向穿刺组织前列腺癌组织占比高于系统穿刺;mpMRI-TRUS组中靶向穿刺阳性率为38.46%,系统穿刺阳性率为42.30%,两者差异无统计学意义。结论 mpMRI-TRUS认知融合技术在前列腺穿刺活检能够以较少的穿刺针数检出前列腺癌,靶向穿刺能提供更多前列腺癌组织,降低前列腺癌穿刺活检的漏诊率。

Objective To explore the clinical application value of multi-parameter magnetic resonance imaging-transrectal ultrasound (mpMRI-TRUS) cognitive fusion technology to guide targeted prostate biopsy. Methods The research objects were patients suspected of prostate cancer from January 2018 to December 2020 and the patients were divided into mpMRI-TRUS group and TRUS group. All cases in the mpMRI-TRUS group underwent mpMRI examination before needle biopsy. The targeted lesions were determined according to the MRI results.And mpMRI-TRUS cognitive fusion targeted biopsy and system 10-needle biopsy were performed. Patients in the TRUS group only underwent a systematic 13-needle biopsy. The detection rate of prostate cancer between the two groups was compared. At the same time, the difference in the detection rate of targeted biopsy and systematic biopsy in the mpMRI-TRUS group was also compared. The pathological results of puncture were observed and analyzed. Results The positive rate of needle biopsy in the mpMRI-TRUS group was 43.59%, and the TRUS group was 33.07%. There was no significant difference in the detection rate of prostate cancer between the two groups. In the mpMRI-TRUS group, the single-needle positive rate and the proportion of prostate cancer tissue were higher than that of system puncture. The positive rate of targeted puncture in the mpMRI-TRUS group was 38.46%, and the system puncture was 42.30%. The difference between the two groups is not statistically significant. Conclusion The mpMRI-TRUS cognitive fusion technology can detect prostate cancer with fewer needles in prostate biopsy. Targeted biopsy puncture can provide more prostate cancer tumor tissues and reduce the missed diagnosis rate of prostate cancer biopsy.