目的 探究磁敏感加权成像(SWI)对帕金森病(PD)与血管性帕金森综合征(VPS)的鉴别诊断价值。方法 回顾性分析我院2013年1月—2016年12月收治的30例PD患者(PD组)和30例VPS患者(VPS)组SWI分析结果,比较两组患者的脑椎体外系各核团的相位值差异,同时将两组患者的测量值与来我院行常规体检的正常者作为对照组进行测量比较。结果 PD组患者的黑质致密带(SNc)、苍白球(GP)、壳核(PUT)相位值较VPS组、对照组更低,组间数据对比有差异(P<0.05);而对照组的SNc、GP、PUT的相位值与VPS组相比无差异(P>0.05);三组对象的红核(RN)、尾状核(CN)测量值无差异(P>0.05);采用Hoehn&Yahr对PD患者和VPS进行分级后发现,各级PD患者SNc相位值之间差异均有统计学意义(P＜0.05),VPS组Ⅰ~Ⅱ级、III级与IV级患者相比,SNc、PUT、尾状核(CN)有统计学差异(P<0.05),而RN相位值无差异(P>0.05)。结论 采用磁敏感加权成像对PD患者和VPS患者的椎体外系各核团的相位值进行测量,能对两者的鉴别起到较大的参考价值。

Objective To explore the value of magnetic susceptibility weighted imaging (SWI) in the differential diagnosis of Parkinson's disease (PD) and vascularized Parkinson's syndrome (VPS). Methods The results of SWI analysis of 30 patients with PD (PD) and 30 patients with VPS (VPS) from January 2013 to December 2016 were retrospectively analyzed. The results were compared between the two groups. Of the phase value of the difference between the two groups of patients with the measured values and routine examination of our hospital as a control group for comparison. Results The phase values of the substantia nigra (SNc), globus pallidus (GP) and crustal nucleus (PUT) were significantly lower in the PD group than in the VPS group and the control group (P <0.05).There was no significant difference in the GP and PUT values between the control group and the VPS group (P> 0.05).There was no significant difference in the red nuclei (RN) between the three groups (P> 0.05).There was significant difference in SNc phase values between PD patients at all levels (P <0.05). Compared with patients with grade IV, grade I and II were higher than those of patients with grade IV (P <0.05), and the difference was statistically significant (P <0.05) between PD patients and VPS. (P <0.05), but there was no significant difference (P> 0.05) between the PUT and the caudate nucleus (CN). Conclusion The phase value of the nucleus of the vertebral body in PD patients and VPS patients was measured by magnetic susceptibility weighted imaging, which could be used as a reference for the identification of the two.

目的 探讨不同分化程度前列腺癌患者的直肠超声图像特征,为前列腺癌分化程度的诊断提供依据。方法 纳入我院收治的前列腺癌患者120例,均接受直肠超声检查,根据Gleason评分评估分化程度分成低分化组(n=41)、中分化组(n=39)与高分化组(n=40)。分析不同分化程度患者的结节大小、血流分级、回声、边界是否清晰以及包膜完整性,并对血流频谱进行观察。结果 低分化组的结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、边界欠清晰、包膜欠完整、高回声占比高于高分化组,且低分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于中分化组,中分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于低分化组,差异有统计学意义(P<0.05)。结论 不同分化程度前列腺癌患者的直肠超声表现存在差异,随着分化程度越低,肿瘤边界清晰度、包膜完整性越差,血流越丰富。

目的 探讨无创呼吸机辅助常规药物治疗重症哮喘的疗效及对肺功能的影响。方法 选取我院于2014年2月—2017年6月间收治的60例重症哮喘患者作为研究对象,按照随机数字法分为对照组和研究组,对照组30例予以常规药物治疗,研究组30例予以无创呼吸机辅助常规药物治疗。比较两组患者临床疗效、肺功能指标、气血指标、心率、哮喘症状评分以及药物使用情况。结果 研究组临床有效率(96.66%)高于对照组(76.66%)(P＜0.05)。2组患者干预前肺功能指标、气血指标及心率比较无差异(P＞0.05),干预后两组心率、PaCO₂均较干预前降低,PaO₂、FEV1、FEV1/FVC均较干预前升高(P＜0.05),研究组较对照组改善明显(P＜0.05)。两组患者干预前哮喘症状评分比较无差异(P＞0.05),干预后两组哮喘症状评分均较干预前降低,且研究组较对照组降低明显(P＜0.05)。研究组使用茶碱类药物、糖皮质类激素、受体激动剂药物比例均低于对照组(P＜0.05)。结论 无创呼吸机辅助常规药物治疗重症哮喘可显著改善患者血气指标及肺功能,疗效确切。

目的 研究参附注射液在小儿川崎病治疗中的应用价值。方法 将2015年1月—2016年12月期间在我院接受治疗的川崎病患儿120例作为研究对象,并按照随机数表法将其随机分为两组,对照组和观察组,每组60例。对照组采取丙种球蛋白注射、口服阿司匹林、激素等常规治疗措施,观察组在对照组的基础上实施参附注射液治疗。对比2组患儿的退热时间、住院时间、C反应蛋白变化情况、红细胞沉降率,观察2组治疗期间的不良反应发生情况。结果 治疗后,观察组患儿的C-反应蛋白水平、红细胞沉降率与白细胞水平均小于对照组,血小板与血红蛋白水平高于对照组,退烧时间与治疗时间均小于对照组,差异有统计学意义(P＜0.05);2组的不良反应发生率相比较,差异无统计学意义(P＞0.05)。结论 参附注射液可以有效降低川崎病患儿机体内的C-反应蛋白水平、红细胞沉降率,改善血常规指标,加快康复进程,且具有一定的安全性。

目的 对我院43例经临床诊断及随访证实的足底筋膜炎患者MRI诊断资料进行回顾性研究,总结其MRI特征。方法 选取2016年8月—2017年8月因足底疼痛就诊的43例患者为本次研究对象,对患者进行彩超及MRI诊断,对比诊断患侧及健侧足底筋膜厚度及评测者间相关系数。结果 经临床及随访证实足底筋膜炎患者43例。MRI诊断结果:43例患者中最常见表现为足底筋膜周围软组织水肿,32例患者表现为跟骨骨髓水肿,17例患者观察到足底筋膜内肌腱信号改变。彩超及MRI诊断患侧、健侧足底筋膜厚度均有差异,MRI诊断优于对照组,组间差异有统计学意义(P＜0.05);彩超及MRI评测者间相关系数有差异,MRI诊断优于对照组,组间差异有统计学意义(P＜0.05)。结论 足底筋膜炎采用MRI诊断可观察到足底筋膜厚度及信号改变,对跟骨骨髓水肿、筋膜周围软组织肿胀改变程度有良好诊断表现,临床可作为足底筋膜炎诊断的首选方法。

Objective The MRI diagnostic data of 43 patients with plantar fasciitis confirmed by clinical diagnosis and follow-up were retrospectively studied. Methods Selection in August 2016 to August 2017 because of a foot pain clinic of 43 patients as the research object, to colour to exceed and MRI in the diagnosis of patients with diagnosed with lateral contrast and health parapodum bottom thickness of the membrane and the correlation coefficient between the reviewers. Results 43 cases of plantar fasciitis were confirmed by clinical and follow-up. Of MRI diagnosis results: 43 cases of plantar fascia around the most common soft tissue edema, 32 patients were characterized by calcaneal bone marrow edema, 17 patients were observed in the plantar fascia tendon signal change. There were significant differences in the diagnosis and treatment of the lateral and healthy side of the MRI diagnosis, and the MRI diagnosis was significantly better than the control group, and the difference between the groups was statistically significant (P< 0.05). There was significant difference in correlation coefficient between color ultrasound and MRI. MRI diagnosis was significantly better than the control group, and the difference between groups was statistically significant (P< 0.05). Conclusion Plantar fasciitis plantar fascia was observed by MRI in the diagnosis of thickness and signal change, soft tissue around the heel bone marrow edema, fascia swelling degree of change has a good diagnosis performance, clinical can be used as the preferred methods for the diagnosis of plantar fasciitis.

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.

目的 探讨品管圈活动提高出院产妇母乳喂养调查问卷在随访系统回复率中的效果。方法 成立“品管圈组织”,确立“提高出院产妇母乳喂养调查问卷在随访系统的回复率”为主题,对活动前2月~14月回复率低进行原因分析,拟定实施对策,比较实施前后问卷的回复率。结果 出院产妇母乳喂养调查问卷在随访系统的回复率由29.9%提高到了71.7%,差异有统计学意义(P<0.001)。结论 通过品管圈活动可提高出院产妇母乳喂养调查问卷在随访系统的回复率。

Objective To explore the application and effect of the quality control circle(QCC) on the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system. Methods We set up a quality control circle, identified the project of improving the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system, analyzed the reasons of the low response rate from February to April. Then, we established and implemented improvement measures and compared the result before and after implementation. Results The response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system was raised from 29.9% to 71.7% (P<0.001). Conclusion With application of QCC program, the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system is improved.

目的 探讨重症胸外伤患者在行胸腔镜手术探查同期行肋骨骨折内固定术的有效性和临床意义。方法 选取我院2008年—2017年收治的68例具有胸腔镜手术探查指征的重症胸外伤患者,其中36例同期行肋骨骨折内固定术,32例单纯行胸腔镜探查术。比较2组患者的VAS评分、镇痛药物用量、卧床时间、住院天数等。结果 2组患者术后VAS评分、镇痛药物用量、卧床时间、住院天数等有统计学差异。结论 胸腔镜手术探查同期行肋骨骨折内固术治疗重症胸外伤可降低术后并发症的发生,加速患者的康复,值得推广。

Objective To investigate the clinical significance and effectiveness of thoracic endoscopic surgery for patients with severe thoracic trauma. Methods 68 cases of severe thoracic trauma with thoracoscopic operation, of which 36 cases underwent internal fixation of rib fracture and 32 cases were performed by thoracoscope. The VAS score, analgesic dosage, bed time and hospitalization days were compared between the two groups. Results There were significant differences in VAS score, analgesic dosage, bed time and hospitalization days after operation in the two groups. Conclusion The treatment of severe thoracic trauma by thoracoscopic surgery and internal fixation of rib fracture may reduce postoperative complications and accelerate the recovery of patients, which is worth popularizing.

目的 探讨CD117在肺基底样细胞鳞状细胞癌(BSCC)与小细胞肺癌(SCLC)中的鉴别诊断作用。方法 免疫组织化学检测CD117在肺BSCC与SCLC中的表达情况,并进行统计学分析,同时文献复习CD117在这两种肿瘤中的表达情况。结果 CD117在SCLC中特异性高表达(阳性率为78%),并且具有高的敏感度、特异度、阳性预测值及阴性预测值(分别为100%、78.2%、68.7%、100%),与文献报道一致(阳性率37%～100%);而在BSCC中未见有CD117的表达,文献未见有CD117在BSCC中表达情况报道。结论 CD117有可能成为鉴别诊断BSCC与SCLC的重要指标之一。但由于本报道例数有限,还需要更大型的研究进一步证明CD117在鉴别诊断二者中的敏感度及特异度。

Objective To investigate the role of CD117 in differentiating basaloid squamous cell carcinoma (BSCC) from small cell carcinoma (SCLC) in lung. Methods Immunohistochemistry staining of CD117 and statistic data were analyzed in BSCC and SCLC, and relevant literature were reviewed. Results CD117 was specifically expressed in high level ( positive rate 78%) in SCLC with high sensitivity, specificity, positive predictive value and negative predictive value (respectively 100%、78.2%、68.7%、100%), which was highly consistent with literature reports (positive rate 37%-100%). CD117 was not detected in BSCC in our report and it was the same as in literatures. Conclusion Although our results showed that it was possible that the expression of CD117 would play an important role in differentiating BSCC from SCLC, due to limited cases in number, more studies are needed to elucidated the sensitivity and specificity.