目的 通过比较术前螺旋CT诊断与X线、超声诊断,并分析螺旋CT的影像学表现,探讨急诊螺旋CT在外伤性肠及肠系膜损伤诊断及定位的价值。方法 回顾性分析经手术证实的65例行急诊平扫的肠或肠系膜损伤的术前CT、X线、B超等影像诊断结果,比较不同影像报告与术后诊断的符合情况,分析外伤性肠及肠系膜损伤的CT诊断的特点。结果 对肠及肠系膜损伤的CT诊断准确率高于X线、B超诊断准确率,差异有统计学意义(P=0.012,P<0.001),螺旋CT对外伤性肠及肠系膜损伤有对应的征象,利于做出定位诊断。结论 螺旋CT对腹部外伤性肠及肠系膜损伤具有良好的诊断及定位的价值。

Objective To investigate the value of spiral CT in enteral and mesenteric injury diagnosing and localizing caused by abdominal traumatic emergency,by the means of analyzing and comparing the preoperative CT report to X-ray and b-ultrasound reports. Methods 65 cases of confirmed enteral or mesenteric injury were recruited to explore their preoperative CT、X-ray and b-ultrasound features.Statistical analysis was conducted to calculate and compare the rate of sensitivity of 3 different test in diagnosing enteral and mesenteric injury. Results The accuracy of CT in diagnosing enteral and mesenteric injury were better than X-ray and b-ultrasound,the differences were statistical significance(P=0.012,P<0.001),and the CT features can help to localize the injury position. Conclusion Spiral CT scans have value in diagnosing enteral and mesenteric injury.

目的 了解佛山市南海区性传播疾病(STD)门诊病人单纯疱疹病毒感染的流行情况。方法 对2013年1月—2014年6月间前往佛山市南海区3个规范化性病门诊就诊的患者进行问卷调查、生殖器疱疹临床诊断和单纯疱疹病毒分类抗体检测、分泌物实时荧光定量聚合酶链反应(FQ-PCR)检测。结果 350例疑似生殖器疱疹患者中,HSV-I的IgM 和IgG的检出率分别是5.4%(19/350)和87.7%　(307/350),HSV-II的IgM 和IgG检出率分别是2.9%(10/350)和42%(147/350),两种血清型中以HSV-I感染为主,且IgG 阳性率高于IgM(HSV-I的χ²=238.1,P＜0.005;HSV-II的χ²=259.08,P＜0.005);HSV-ⅡIgG感染者147例(男115例,女32例),感染率分别为41.2% 和42.7%。男性HSV-ⅡDNA感染率高于女性,二者差异有统计学意义(χ²=3.94,P＜0.05)。结论 本地区性病门诊中HSV抗体检出率高,以HSV-I感染为主;对于疑似生殖器疱疹患者,同时进行HSV抗原及血清HSV-I、HSV-II的 IgM和 IgG抗体联合检测更有助于临床GH诊断;男性患者易于临床诊断。

Objective To investigate the epidemiological characteristics of herpes simplex virus infection in patients attending a sexually transmitted diseases(STD)clinic in Nanhai District of Foshan. Methods The 350 patients attending the three standardized STD clinic in Nanhai District of Foshan from January,2013 to June,2014 were interviewed with an anonymous questionnaire,blood-tested for HSV(IgM、IgG) antibody.And secretion was detected by FQ-PCR for HSV antigen. Results In 350 patients with suspected GH,the positive rate of HSV-I IgM and IgG were 5.4%(19/350)and 87.7%(307/350).The positive rate of HSV-II IgM and IgG were 2.9%(10/350)and 42%(147/350),respectively.HSV-I infection was principal in two serologic types,and the positive rate of IgG was higher than that of IgM (P<0.05).There were 147 patients infected HSV-II IgG(male 115,female 32).The infection rate is 41.2% and 42.7%.The infection rate of HSV-ⅡDNA in men was higher than that in women.There was a significant difference between them(P<0.05). Conclusion There was a high positive detection rate of HSV from sexually transmitted disease clinic in this region.And HSV-1 was principal.For patients with suspected genital herpes,detection of HSV antigen tests combined with HSV-I、HSV-II IgM and IgG serum antibody tests is more helpful in the clinical diagnosis of genital herpe.HSV infected men patients were likely to clinically diagnose.

目的 探讨中青年医护人员血尿酸(UA)水平与心血管危险因素的关系。方法 利用国人缺血性心血管疾病发病危险的评估方法及简易评估工具“心血管危险积分”评价982名中青年医护人员的心血管危险因素,计算其危险评分积分值,用四分位法根据UA值将研究对象分为四组,比较不同分组间的临床资料,分析UA水平与心血管危险因素的关系。结果 UA水平与心血管危险因素存在正相关(P＜0.01);Ⅲ、Ⅳ组心血管危险积分均高于Ⅰ、Ⅱ组,差异有统计学意义(P＜0.01)。结论 UA增高是心血管疾病的一个重要危险因素,重视高尿酸血症的防治,对预防中青年医护人员的心血管疾病的发生具有重要意义。

Objective To study the relationship between serum uric acid levels and risk factor of cardiovascular disease in young and middle-aged medical staff. Methods Using of risk assessment method and simple assessment tools of cardiovascular risk score of Chinese ischemic cardiovascular disease, the study appraised risk factors of cardiovascular disease about 982 young and middle-aged medical staffs, calculated the risk score integral value. The study divided objects of study into four groups with quartile's method according to serum uric acid levels, compared clinical data between different groups, analyzed the correlation between uric acid level and cardiovascular risk factors. Results Serum uric acid level and cardiovascular risk factors had positive correlation(P<0.01); Ⅲ,Ⅳ group's cardiovascular risk score were higher than Ⅰ, Ⅱ group; the difference had statistics significance(P<0.01). Conclusion Hyperuricemia is an important risk factors in cardiovascular disease. Paying attention to hyperuricemia prevention has important significance to prevention of cardiovascular disease in young and middle-aged medical staff.

目的 调查广州市在校大学生AIDS相关知识及对HIV感染者态度现状,为学校更有效地开展大学生AIDS健康教育提供依据。方法 采用目的抽样方法,对广州市某高校 1200名在校大学生进行关于AIDS相关知识、态度的问卷调查。结果 不同年级、生源地,AIDS相关知识差异均有统计学意义(P值均＜0.01);多数学生对HIV感染者持积极态度,但仅5.73%的学生愿意与HIV感染者共餐;2.70%愿意与感染HIV的同学同住一个寝室。网络是大学生获取AIDS相关知识的最主要途径。结论 大学生AIDS相关知识知晓率水平较高,但缺乏系统性和全面性;多数学生对HIV感染者持积极态度,但是一旦与自我卷入较深,即表现出对HIV感染者的回避甚至歧视。高校应加强对大学生AIDS健康教育的系统性、全面性和深刻性,以消除对AIDS的心理恐惧,达到对HIV感染者的零歧视。

Objective To investigate the AIDS related knowledge of the Guangzhou undergraduates and the attitudes on HIV infection status, for the school to provide basis for AIDS health education and to carry out AIDS health education during college students more effectively. Methods 1200 college students in a university in Guangzhou were surveyed by a questionnaire on HIV/AIDS related knowledge and attitudes, using the way of purposive of sampling. Results There was statistical significant difference on the AIDS-related knowledge in the different grades and origin of students (P<0.01). The majority of students has a positive attitude to the HIV-infected, but only 5.73% of them wer willing to share a meal with HIV-infected persons, and 2.70% of them were willing to live with HIV-infected. The network is the most important way to access to HIV/AIDS related knowledge for college students. Conclusion The level awareness during college student on AIDS-related knowledge is high, but lack of systematic and comprehensive. The majority of students had a positive attitude towards the HIV-infetected, however once self-involved, they may avoid even discriminate the HIV-infected individuals. Therefore, the universities should strengthen AIDS health education of college students comprehensively and profoundly, in order to eliminate fear of AIDS, and reached zero discrimination HIV-infected persons in the future.

目的 对86例青春期多囊卵巢综合症(polycystic ovary syndrome,PCOS)患者进行随访,探讨患者长期治疗的依从性。方法 选择2009年11月—2012年6月在我院门诊首次诊断为青春期PCOS患者进行前瞻性队列研究。按随诊方法不同分为常规随访组和可及与连贯病人服务(ACC)组,前瞻随访6个月。分别在初次就诊时、3个月及6个月后对比两组的身体质量指数(Body Mass Index, BMI)、复诊率和遵医嘱服药率。结果 共86名患者入组,其中常规随访组43人,ACC组43人。两组基线资料基本一致。随访3月时,两组的BMI、复诊率和遵医嘱服药率的差异无统计学意义(P>0.05)。随诊6月时,ACC组的复诊率和服药依从性均优于常规随访组分别为(97.7% 比 81.4%,97.7% 比 76.7%,P＜0.05),BMI比常规随访组下降(22.33±7.31 比 24.59±7.8 kg/m²,t<0.05)。结论 可及与连贯的病人服务可以改善青春期PCOS患者BMI及长期随诊的复诊率和服药依从性。

Objective To investigate the compliance of adolescent patients with polycystic ovary syndrome (PCOS) in long-term treatment by access to care and continuity of care(ACC) on 86 cases. Methods A prospective cohort study was taken for 6 months on adolescent patients diagnosed as PCOS for the first time in out-patient department from November 2009 to June 2012. These patients were selected and divided into ACC group and regular follow-up group according to the different modes of follow-up visit. The relevant data including body mass index (BMI), clinic visit rate and rate of medication adherence were compared in the first visit and 3rd, 6th month in the follow-up visit. Results 86 patients were enrolled with 43 in ACC group and 43 in regular follow-up group. The baseline information was similar between the two groups. There were no statistically significant difference between groups in BMI, clinic visit rate and rate of medication adherence after 3 months (P>0.05). However, after 6 months, BMI, clinic visit rate and rate of medication adherence were significantly improved in the ACC group compared to the regular follow-up group (22.33±7.31 vs 24.59±7.8 kg/m², 97.7% vs 81.4%, 97.7% vs 76.7%, P＜0.05, respectively). Conclusion ACC could improve BMI, clinic visit rate and medication adherence of adolescent patients with polycystic ovary syndrome in long-term treatment.

目的 本研究通过检测吸入布地奈德治疗支气管哮喘患儿前、后气道重塑、肺功能及外周血TGF-β浓度的变化,探讨布地奈德在哮喘患儿气道重塑早期干预的作用。方法 将2013年1月—2014年10月在我院确诊为支气管哮喘患儿18例,给予规律吸入布地奈德治疗6个月,分别于治疗前、后检测肺功能、外周血TGF-β浓度以及通过高分辨CT(HRCT)测量支气管管壁厚度(T)并计算管壁面积(WA)、支气管管壁厚度与气管外径之比(WT%)、气道壁横截面面积占气道总截面积的的百分比(WA%)。结果 吸入布地奈德治疗治疗6个月后,哮喘患儿WT%、WA%、肺功能以及TGF-β浓度均明显改善,与治疗前比较差异有统计学意义(P<0.05)。结论 规律吸入布地奈德治疗能减轻支气管哮喘患儿早期气道重塑,改善肺功能,可能通过下调细胞因子TGF-β的表达有关。

Objective We detected the changes of Airway remodeling,lung function and peripheral blood concentrations of TGF-β in asthmatic children before and after inhaled budesonide, and explored the role of budesonide in airway remodeling before early intervention in asthmatic children. Methods 32 cases of children were diagnosed asthma in our hospital,and given treatment of inhaled budesonide for 6 months, and to detect lung function,pheral blood TGF-β concentration as well as measuring the bronchial wall thickness (T) and calculate the wall area (WA), the outer diameter of the trachea and bronchial wall thickness ratio (WT%), the cross-sectional area of the airway wall accounted for airway percentage (WA%) of the total cross-sectional area by high-resolution CT (HRCT) before and after treatment. Results After treatment with inhaled budesonide in six months, the asthma WT%, WA%, lung function, and TGF-β concentrations were significantly improved, the differences compared with that before treatment were statistically significant(P<0.05). Conclusion The treatment of inhaled budesonide can alleviate asthmatic airway remodeling in early, improve lung function,possibly related to down the expression TGF-β.

目的 评估关节松动联合运动疗法对颞下颌关节慢性不可复性盘前移位患者的疗效。方法 采用随机对照方法,将46例慢性不可复性盘前移位患者随机分为联合治疗组(n=24)及对照组(n=22), 对照组仅接受传统治疗(包括超短波、超声波、软组织按摩及健康教育),治疗组在传统治疗的基础上应用关节松动联合运动疗法。在治疗前和治疗后2周采用最大张口度(maximal interincisal opening,MIO)、目测类比法(visual analog scale,VAS)、口腔健康影响程度量表(health impact profile-14,HIP-14)评价疗效。结果 治疗前两组患者一般情况类似。治疗后两组颞下颌关节MIO、VAS、HIP-14得分较治疗前改善(P<0.05),组间比较,治疗组在MIO、VAS、HIP-14评分比对照组改善(P<0.05)。结论 关节松动联合运动疗法治疗颞下颌关节慢性不可复性盘前移位疗效明显,值得推广。

Objective To evaluate the effectiveness of joint mobilization combined with therapeutic exercise in patients with chronic anterior disc displacement without reduction of temporomandibular joints. Methods 46 patients with chronic anterior disc displacement without reduction were randomly divided into two groups. The treatment group of 24 cases received joint mobilization combined with therapeutic exercise and conventional therapy (ultrashort-wave diathermy, ultrasound therapy, soft tissue massage, health education), 22 cases in the control group received conventional treatment.The treatment was administered for 2 weeks. The baseline and endpoint outcome assessment measures were maximal interincisal opening (MIO),visual analogue scale(VAS)score and oral health impact profile (HIP-14). Results After the treatment, significant improvements were observed in the two groups of all the outcome measurements (P<0.05).Maximal interincisal opening, visual analogue scale and oral health impact profile were improved significantly in the treatment group than in the control group (P<0.05). Conclusion Joint mobilization combined with therapeutic exercise can improve the symptoms of chronic anterior disc displacement without reduction.

目的 通过比较利伐沙班、依若肝素和非抗凝治疗对全膝关节表面置换术后的疗效,分析全膝关节置换术后抗凝治疗的必要性、有效性及安全性。方法 选取2010年1月—2013年8月我科收治的全膝关节表面置换术的患者154例,按治疗方式分成利伐沙班组(A组)、依若肝素钠组(B组)及非抗凝组(C组)。观察各组术后静脉血栓栓塞发生率;术前及用药后凝血功能指标的变化;术后总失血量、显性失血量、隐性失血量;伤口情况;膝关节功能HSS评分。结果 A组与B组术后无静脉栓塞症发生,C组出现静脉栓塞症3例;A、B、C三组术前与术后凝血功能指标差异均无统计学意义(P>0.05);B组术后显性失血量高于A组(P<0.05);三组患者术前及术后各回访时间点膝关节功能HSS评分差异无统计学意义(P>0.05)。结论 抗凝药物预防全膝关节置换术后静脉血栓栓塞症的效果确切,利伐沙班与依若肝素疗效相当;抗凝治疗不会增加术后失血量及伤口并发症的发生率,且对术后膝关节中期功能恢复无影响。全膝关节表面置换术后使用抗凝治疗效果良好,安全性可。

Objective To compare the influence of anticoagulant therapy on the curative effect after total knee arthroplasty and evaluate the necessity, effectiveness and safety of anticoagulant therapy. Methods 154 patients after total knee arthroplastyfrom January 2010 to August 2013 in our department were divided into the rivaroxaban group (group A), the enoxaparin group (B group) and non anticoagulation group (group C) according to the treatments. It was observed that the postoperative venous thromboembolism incidence; changes of blood coagulation indexes before and after the operation; the total blood loss、dominant blood loss and hidden hemorrhage; the wound; the HSS score of knee function. Results None of postoperative venous thromboembolism occurred in group A and B, three cases of venous thromboembolism in group C;The differences of between preoperative and postoperative coagulation indexes in three groups had no statistical significance (P>0.05); Dominant blood loss in group B was significantly higher than that of group A (P<0.05); No statistical significance in the HSS scores of knee function of three group (P>0.05). Conclusion The effect of anticoagulant drugs on the prevention of venous thromboembolism after total knee arthroplasty is effective, same efficacy in the treatment with rivaroxaban or enoxaparin; anticoagulant therapy does not significantly increase the postoperative blood loss and the incidence of wound complications, does not influence the recovery of postoperative mid-term knee function. The use of anticoagulation therapy after total knee arthroplasty has good effect and be safety.

目的 探讨颈动脉残端压(SP)联合电生理监测在颈动脉内膜切除术(CEA)中的应用价值。方法 回顾性分析19例CEA患者临床资料,通过监测SP、体感诱发电位(SEP)和运动诱发电位(MEP),以确定术中是否放置转流管;比较术前和术后6月美国国立卫生院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分变化情况。结果 10例患者SP≥50mmHg,SEP和MEP监测无异常,术中未放置转流管;5例患者SP<50 mmHg,SEP波幅下降>50％,MEP监测正常,予以放置转流管;3例患者SP≥50 mmHg,SEP波幅下降>50％,MEP监测正常,予以放置转流管;1例患者SP>50 mmHg,SEP监测正常,MEP波幅下降>50％,未放置转流管。所有患者手术均获得成功,无手术死亡率。患者术后6月NIHSS评分和术前无统计学差异(P>0.05),但术后6月mRS评分较术前下降(P<0.05)。结论 通过术中SP、SEP和MEP联合监测,有助于避免CEA术后缺血性脑卒中的发生,提高CEA手术的安全性。

Objective To investigate the value of stamp pressure(SP), somatosensory and motor evoked potentials(SEP,MEP) monitoring in carotid endarterectomy. Methods 19 patients with carotid endarterectomy were retrospectively analyzed.SP, SEP and MEP were monitored during the operation.National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to evaluate the neurological function before and 6 months after surgery. Results Intraluminal shunting was not performed in 10 patients with normal SP, SEP and MEP.However, intraluminal shunting technique was used in 5 patients (SP<50 mmHg and SEP fluctuation decreased by 50％) and 3 patients (SP≥50 mmHg and SEP fluctuation decreased by 50％).1 patient showed the fluctuation of MEP decreased by 50％, while SP and SEP was normal, no shunting was performed.All patients were successfully operated, and no mortality occurred.The mRS score, not the NIHSS score, revealed statistically difference between preoperation and 6 months after surgery (P<0.05). Conclusion The combination of SP, SEP and MEP monitoring maybe useful for preventing ischemic stroke after carotid endarterectomy, increasing the safety of surgery.