目的 探讨导致口服华法林患者国际标准化比值异常增高(INR>4.5)的原因。方法 选择148例做过心瓣膜置换术,出院后口服华法林抗凝,复查时国际标准化比值(INR>4.5)异常增高的患者。通过对其用药量以及服用其它药物(包括西药和中药)、营养品、食物等情况进行调查,分析导致口服华法林患者INR异常增高的有关因素,同时对PT检测过程中检验前、检验中的质量控制进行调查,排除检测过程中的影响因素,最后综合分析导致心瓣膜置换术后口服华法林患者INR异常增高的原因。结果 导致口服华法林患者INR异常增高的原因主要是药量过多,占全部调查的47.29%,其中医嘱剂量过多的为39.18%,遗忘重复服药或不理解医嘱的比例为8.10%;其次是受药物相互影响的比例为43.25%,其中受西药影响的比例为33.11%,受中药物影响的占10.14%;药物外影响的因素比例为9.47%,其中受饮食影响的比例为4.06%;受物理治疗影响的比例为5.41%。结论 导致口服华法林患者INR异常增高最主要的原因是用药量过多以及受其他药物的相互影响,同时受饮食及物理治疗的影响。

Objective To investigate the cause of abnormality increase of international normalized ratio (INR) (INR>4.5) in the patients who oral application Warfarin. Methods 148 patients were taken who had cardiac valve replacement operation and oral application warfarin post-discharge as subjects. Their INR abnormality increased when taking reexamination. Through the research of the drugs, the dose (including both Chinese crude drug and western medicine), the nourishments and the foods that the patients took, we find out factors that resulted in INR abnormality increase, while to investigate the quality control of laboratory department and analyze the process before and after PT test, to find out factors that affect the test. Finally, to analyze the causes of INR abnormality increase in patients took warfarin after cardiac valve replacement operation. Results The main reason for the abnormal increase in INR in patients with oral warfarin was the excessive dose, accounting for 47.29% of all surveys, of which 39.18% were excessively prescribed, and the proportion of patients who forgot to repeat or did not understand the doctor's order was 8.10%; The proportion of drug interaction was 43.25%, of which 33.11% were affected by western medicine, 10.14% were affected by Chinese medicine, 9.47% were affected by external medicine, and 4.06% were affected by diet; The proportion of treatment effects was 5.41%. Conclusion The main reason for the abnormal increase in INR in patients with oral warfarin is the excessive use of drugs and the interaction of other drugs, as well as the effects of diet and physical therapy.

目的 探讨胸苷激酶1活性检测在胸腔积液鉴别诊断中的敏感度及特异度。方法 回顾性分析诊断明确的肺炎旁胸腔积液、结核性胸腔积液、癌性胸腔积液患者的临床资料,收集并检测三组患者胸腔积液标本中胸苷激酶1活性并进行比较。结果 三组胸腔积液胸苷激酶1含量分别为: 肺炎旁胸腔积液组: (1.18±0.73)pmol/L、结核组活性(1.31±0.64)pmol/L、癌性组(2.07±1.47)pmol/L。统计分析显示癌性组胸苷激酶1含量高于肺炎旁胸腔积液组及结核组,差异有统计学意义,而肺炎旁组与结核组胸苷激酶1含量无统计学差异。在诊断价值分析方面,当胸苷激酶1≥1.28 pmol/L时支持癌性胸腔积液诊断,但是当胸苷激酶1＜1.28 pmol/L时,无法鉴别肺炎旁和结核性胸腔积液。因此,胸苷激酶1对于癌性胸腔积液的诊断价值较好,对肺炎旁胸腔积液和结核性胸腔积液鉴别诊断效能差。临床可考虑与其他指标,如降钙素原、腺苷脱氨酶等指标联合诊断。结论 胸腔积液胸苷激酶1含量在癌性胸腔积液与非癌性胸腔积液的鉴别诊断中有较好诊断价值。

Objective To investigate the of thymidine kinase 1in differential diagnosis of pleural effusion. Methods A retrospective analysis of thymidine kinase1 activity in the parapneumonic pleural effusion and tuberculous pleural effusion and malignant pleural effusion were conducted. Results The thymidine kinase 1 of this three groups are respectively: parapneumonic group (1.18±0.73pmol/L), tuberculosis group (1.31±0.64pmol/L), and cancer group (2.07±1.47pmol/L). It was shown that the activity of thymidine kinase 1 in cancer group was higher than that of inflammation group and tuberculosis group, the difference was statistical significance, but there was no significant difference between parapneumonic group and tuberculosis group. It supported the diagnosis of malignant pleural effusion when thymidine kinase 1 was greater than or equal to 1.28pmol/L, but when the thymidine kinase 1 was less than 1.28pmol/L, it was impossible to distinguish parapneumonic pleural effusion and tuberculous pleural effusion. Therefore, the diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion is well, but the diagnosis efficiency of thymidine kinase 1 in parapneumonic pleural effusion and tuberculous pleural effusion is not well. Conclusion The diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion and non-malignant pleural effusion is well.

目的 探讨磁共振磁敏感加权成像(SWI)对脑膜、脑转移瘤的诊断价值。方法 随机选取2016年3月—2018年3月我院收治的经临床、病理确诊的50例脑膜、脑转移瘤患者为研究对象,所有患者除常规行T1WI、T2WI扫描及T1WI增强扫描检查外,额外进行SWI检查。观察不同来源脑转移瘤转移部位、肿瘤实质信号在不同成像序列上的特征及对瘤内血管情况和出血状况的判断。结果 脑转移瘤的发生部位多为顶叶(29.75%)和枕叶(20.66%),就血供区域而言,多发生于中动脉(45.45%)和颈内动脉供血区域(38.02%)。不同MRI成像序列中肿瘤信号特征比较,显示均有差异(P<0.001)。其中,肺癌脑转移瘤T1WI呈低信号(62.96%),胃癌T2WI呈现高信号(68.75%),SWI成像序列上多显示为混杂信号。SWI序列成像显示瘤内出血55例(45.45%),显示引流血管16条,瘤内出血及肿瘤血管检出率均明显高于T1WI平扫检查,差异有统计学意义(P<0.05)。结论 不同来源的脑转移瘤MR的表现不同,为逆向推测脑转移瘤来源提供依据,同时SWI是对常规序列的重要补充,尤其是在脑瘤出血和血管检出上有重要作用,值得临床推广使用。

Objective To investigate the diagnostic value of susceptibility-weighted imaging(SWI) in meningiomas and brain metastases. Methods 50 cases of clinically and pathologically confirmed patients with meningioma and brain metastasis admitted to our hospital from March 2016 to March 2018 were randomly selected as the study subjects. All patients received routine T1WI, T2WI scan and T1WI enhanced scan, and additional SWI examination was performed. We observed the characteristics of metastatic sites and tumor parenchymal signals in different imaging sequences of brain metastatic tumors from different sources and to judge the status of intramedullary blood vessels and bleeding. Results The majority of brain metastatic tumors occurred in the parietal lobe (29.75%) and occipital lobe (20.66%). In terms of the blood supply region, the majority occurred in the middle artery (45.45%) and the blood supply region of the lower artery (38.02%). Comparison of tumor signal characteristics in different MRI imaging sequences showed differences, P<0.001. Among them, T1WI of brain metastatic tumor of lung cancer presented significantly low signal (62.96%), T2WI of gastric cancer presented high signal (68.75%), and SWI imaging sequence mostly showed mixed signal.SWI sequence imaging were showed in 55 cases (45.45%) of intracranial hemorrhage and 16 drainage vessels. The detection rate of intracranial hemorrhage and tumor blood vessels was higher than that of T1WI plain scan, with statistically difference (P<0.05). Conclusion MR manifestations of brain metastatic tumors from different sources are different, providing a basis for reverse speculation of the source of brain metastatic tumors. At the same time, SWI is an important supplement to routine sequences, especially in the hemorrhage of brain tumors and the detection of blood vessels, which is worthy of clinical promotion and use.

目的 本研究以ICSI后未成熟卵母细胞为研究对象,分析比较卵母细胞不同发育阶段冷冻对其后续效果的影响,评估ICSI后未成熟卵母细胞的利用价值。方法 未成熟卵母细胞直接成熟培养(新鲜组)与玻璃化冷冻后成熟培养(冷冻组)的成熟率,并利用孤雌激活的方法比较卵母细胞的发育潜力。结果 发现新鲜组与冷冻组体外培养卵母细胞成熟率、受精率、卵裂率、优质胚胎率和囊胚率均无差异(P>0.05)。但两组的GV期卵母细胞成熟率低于MI期(P<0.05),且冷冻组的GV期卵母细胞受精率低于MI期(P<0.05)。不过裸卵体外成熟培养效果欠佳,特别是对GV期卵母细胞,体外成熟培养后的卵母细胞发育潜力低下,无囊胚形成。结论 ICSI后未成熟卵母细胞的冷冻对卵母细胞的发育潜力没有明显影响,但体外成熟培养的卵母细胞发育潜力低下,有待进一步提高体外成熟培养技术。

Objective In this study, the immature oocytes after ICSI were used to analyze the effects of freezing on the subsequent development of oocytes at different developmental stages, and to evaluate the utilization value of immature oocytes after ICSI(intracytoplasmic sperm injection). Methods The immature oocytes was directly cultured (fresh group) and matured after vitrification (frozen group), and the development potential of the oocytes was compared by parthenogenetic activation. Results There was no significant difference in the oocyte maturation rate, fertilization rate, embryo cleavage rate, high quality embryo rate and blastocyst rate between the fresh and frozen groups (P>0.05). However, the maturation rate of GV oocytes in the two groups was lower than MI oocytes (P<0.05), and the fertilization rate of GV oocytes in the frozen group was lower than MI oocytes (P<0.05). However, the in vitro maturation of naked oocytes was not effective, especially for GV oocytes, the oocyte development potential after in vitro maturation was low, there was no blastocyst formation. Conclusion The freezing of immature oocytes after ICSI has no significant effect on the development potential, but the development potential of naked oocytes matured in vitro was low, and the in vitro maturation culture technology of naked oocyte needs to be further improved.

目的 探讨中药竹罐结合体感音乐疗法在筋伤腰痛患者中的应用效果。方法 将128例患者按入院顺序分为实验组(68例)和对照组(60例),对照组采用中药竹罐疗法,实验组采用中药竹罐结合体感音乐疗法,4周后对两组患者的疗效、VAS 评分及满意度进行测评。结果 治疗后实验组患者疗效优于对照组(P＜0.01);治疗后实验组、对照组VAS 评分较治疗前降低,但实验组VAS 评分下降更明显(P＜0.01);治疗后实验组、对照组对治疗效果满意度较治疗前提高,而实验组对治疗效果满意度更高(P＜0.01)。结论 筋伤腰痛患者采取中药竹罐结合体感音乐疗法能起到缓解肌肉痉挛,身心放松,活血化瘀,温筋祛寒的作用。

Objective To explore the application effect of traditional Chinese medicine bamboo jar combined with somatosensory music in patients with tendon injury and low back pain. Methods 128 patients were divided into experimental group (68 cases) and control group (60 cases) according to the order of admission. The control group was treated with traditional Chinese medicine bamboo pot therapy. The experimental group was treated with traditional Chinese medicine bamboo pot combined with somatosensory music therapy. After 4 weeks, the curative effect, VAS score and satisfaction of the two groups were evaluated. Results After treatment, the curative effect of the experimental group was better than that of the control group (P<0.01); the VAS score of the experimental group and the control group was lower than that before treatment, but the VAS score of the experimental group was lower (P<0.01); the satisfaction of the experimental group and the control group was higher than that before treatment, while the satisfaction of the experimental group was more satisfactory (P<0.01). Conclusion The traditional Chinese medicine bamboo pot combined with somatosensory music therapy may alleviate muscle spasm, relax body and mind, promote blood circulation and remove blood stasis, warm tendons and dispel cold.

目的 应用FRAX^®工具评估广州社区中老年人发生骨质疏松性骨折的风险。方法 回顾性研究1 140例广州社区中老年人的临床资料,应用FRAX^®工具计算未来10年发生主要骨质疏松性骨折及髋部骨折的风险,分析不同危险因素与骨折风险的关系。结果 广州社区中老年人群10年内发生主要骨质疏松性骨折概率为(4.2±3.6)%,髋部骨折概率为(1.3±2.4)%。主要骨质疏松性骨折风险及髋部骨折风险、OSTA值均随着年龄增长而增加。多因素回归分析结果显示: 年龄、性别、既往骨折、继发性骨质疏松、股骨颈T值、跌倒对主要部位骨折及髋部骨折风险具有独立性预测意义。结论 FRAX^®工具可用于评估广州社区中老年人骨质疏松性骨折风险,建议在社区中老年人健康体检时应用FRAX^®工具进行骨折风险评估。

Objective To predict the osteoporotic fracture risk in senile people in Guangzhou communities by FRAX,the fracture risk assessment tool published by WHO. Methods Clinical data of 1140 cases were collected for the retrospective analysis. The FRAX tool was uesed to calculate the 10-year probability of a major osteoporotic and hip fracture.The relationship between different risk factors and the fracture risk predicted by FRAX was analyzed. Results The 10-year probability of major osteoporotic fractures was (4.2±3.6)%, and the 10-year probability of hip fractures was (1.3±2.4)%.The 10-year probability of the major osteoporotic and hip fracture increased with age.Multivariate regression analysis showed that age,gender,previous fracture,secondary osteoporosis,T-score of femoral neck BMD and fall were independent predictors of the 10-year probability of major osteoporotic fracture and hip fracture. Conclusion The FRAX tool may be effectively applied to assess the fracture risk of senile population in Guangzhou communities.We recommedated that FRAX-tool should be included in routine health check-up.

目的 探讨钙调磷酸酶结合蛋白1(calcineurin binding protein 1, Cabin1)在肾小管上皮细胞(renal tubular epithelial cells,RTECs)线粒体损伤中的作用机制。方法 采用siRNA干预体外培养RTECs,敲低Cabin1的表达,继而以电镜观察其对RTECs线粒体形态的影响。结果 在对照组和阴性对照组中Cabin1蛋白在RTECs中有高表达,采用siRNA干预RTECs后,Cabin1蛋白的表达量较对照组和阴性对照组降低50%以上(P＜0.05)。对照组与阴性对照组中,线粒体形态规则,呈圆形或椭圆形,线粒体膜完整,线粒体嵴清晰可见。敲低组中,线粒体肿胀,呈长条形或不规则形,线粒体膜、线粒体嵴结构模糊甚至消失。结论 敲低Cabin1引起RTECs的线粒体形态学异常,提示Cabin1是维持RTECs线粒体正常功能的重要分子。

Objective To investigate the role of calcineurin binding protein 1 (Cabin1) in renal tubular epithelial cells (RTECs) mitochondrial dysfunction. Methods Knocked down Cabin1 in RTECs with siRNA, Western bolt was applied to detect the level of Cabin1 protein. The morphology of mitochondria in RTECs were observed under microscopy. Results In control and negative control groups, Cabin1 protein was obviously expressed in RTECs. After knocked down by siRNA, Cabin1 protein expression was decreased (P＜0.05). In Cabin1 knocked down group, mitochondria changed from large and ellipsoid shape to the small, long and irregulars. Morover, mitochondria were swollen and cristae were remarkably dissolved. Conclusion Knocked down Cabin1 induced RTECs mitochondrial dysfunction, which indicates Cabin1 is a crucial factor regulating mitochondrial function.

目的 探讨Meis1在人子宫内膜细胞中的表达及其受雌、孕激素调控的规律。方法 通过免疫细胞化学和western blot的方法检测雌、孕激素对体外培养的在子宫内膜基质细胞(ESC)及Ishikawa细胞中Meis1的表达及调控。结果 Meis1在ESC和Ishikawa细胞均有表达,且均表达于细胞核中;在ESC中,E2、P4和 E2＋P4三组中Meis1平均蛋白表达水平均高于对照组(P<0.05)。Meis1在E2、P4和 E2＋P4组之间的表达水平亦差异有统计学意义(P<0.05),表达强度E2＋P4组>P4组>E2组;在Ishikawa细胞中,E2、P4和 E2＋P4使Meis1表达增强,表达强度P4组>E2＋P4组>E2组,但与对照组比较无差异(P>0.05),E2、P4和 E2＋P4各组间亦无差异(P>0.05)。结论 转录因子Meis1在ESC和Ishikawa细胞中受到雌、孕激素的调控,可能在子宫内膜容受性分子网络的构建中发挥着重要的作用。

Objective To investegate the expression and regulation discipline of Meis1 in human ESC and Ishikawa cells in vitro by estrogen and progesterone stimuli. Methods Immunocytochemistry and western blot were used to detect the expression and regulation discipline of Meis1 in human normal endometrial cells. Results Meis1 expressed both in endometrial stromal cells (ESC) and in ishikawa cells, and both situ in nucleus. In ESC, the expression of Meis1 was up-regulated by E₂/P₄ and E₂＋P₄, and the up-regulated effect may be superposition by E₂＋P₄, the differences between the groups were statistically difference(P<0.05). In Ishikawa cells, western blot showed that the expression of Meis1 was up-regulated by E₂/P₄ and E₂＋P₄. The differences weren't statistically significant when compared with the control group or between themselves(P>0.05). Conclusion The expression of transcription factor Meis1 is regularly regulated by estrogen and progesterone, which may be a key role during the formation of endometrial receptivity molecular network.

目的 了解长沙市雨花区环卫工人的健康状况,为有针对性地制定健康教育措施提供依据。方法 为环卫工人进行体格检查,对其体检资料进行统计分析。结果 1 672名受检环卫工人中仅有57人所检项目完全正常,异常检出率达96.60%,其中男性职工的总体检出率要高于女性职工(P<0.05);男性职工慢性咽炎、高血压、血脂异常、高尿酸血症、肾囊肿的检出率较女性职工高(P<0.05);而女性职工肾结石、甲状腺结节、痔疮的检出率要高于男性职工(P<0.05)。体检结果尚具有一定的年龄段分布规律,膝关节退变、超重和肥胖、慢性咽炎、脂肪肝、高尿酸血症、甲状腺结节等检出率差异有统计学意义(P<0.05);其中膝关节退变、高血压、前列腺增生等检出率随着年龄的增长而增加。结论 环卫工人的卫生保健意识薄弱,进一步促进改善他们的工作条件,并对其进行健康教育非常必要。

Objective To understand the health status of sanitation workers in Yuhua District of Changsha city, and to provide evidence for the establishment of health education measures. Methods The sanitation workers were examined by medical examination and their physical examination data were statistically analyzed. Results In the 1 672 subjects of sanitation workers there were only 57 people seized items completely nor -mal. Abnormal rate was 96.60%. The total examination rate of male workers was higher than that of female workers (P<0.05); morbidity of male workers in chronic pharyngitis, hypertension, dyslipidemia, hyperuricemia and renal cysts were higher than female workers (P<0.05); morbidity of the female workers in kidney stones, thyroid nodules, hemorrhoids, was higher than that of the male workers (P<0.05). The examination results had age distribution. There was statistically significant in knee joint degeneration, overweight and obesity, chronic pharyngitis, hyperuricemia, fatty liver, thyroid nodule (P<0.05); the knee joint degeneration, hyperten -sion, prostatic hyperplasia detection rate increased with age. Conclusion The sanitation workers' awareness of health care is weak. It is necessary to further improve their working conditions and to carry out health education for them.

目的 分析比较经皮微创椎弓根钉内固定和传统开放式手术治疗脊椎骨折的优劣差异。方法 本研究选择我院2015年2月—2016年6月收治的脊椎骨折患者72例,按照治疗方法的不同将全部患者分成对照组(36例)和实验组(36例),两组患者分别给予传统开放式手术治疗和经皮微创椎弓根钉内固定治疗,对两组患者的临床疗效进行观察分析。结果 在手术时间、手术出血量、切口长度以及住院时间方面,实验组患者均优于对照组(P＜0.05);实验组患者术后的血清肌酸激酶活性低于对照组患者(P＜0.05);治疗后两组患者椎体前缘高度、Cobb's角均优于治疗前(P＜0.05),但是组间比较差异无统计学意义(P＞0.05)。术后两组患者均没有发生椎间隙感染、神经损伤、切口感染等并发症。结论 在对脊椎骨折患者进行治疗时,经皮微创椎弓根钉内固定治疗和传统开放式手术治疗的临床疗效比较类似,但是和传统开放式手术相比较,经皮微创椎弓根钉内固定治疗对患者的损伤更加轻微,术后恢复时间更短。