目的 探究硼替佐米、地塞米松联合环磷酰胺治疗骨髓瘤的疗效及对患者不良反应发生的影响。方法 研究对象为我院2016年1月—2020年12月收治的60例骨髓瘤患者,将其随机分为研究1组(n=20)、研究2组(n=20)与对照组(n=20)。对照组给予硼替佐米联合沙利度胺及地塞米松化疗,研究1组给予硼替佐米联合环磷酰胺及地塞米松化疗,研究2组给予硼替佐米联合来那度胺及地塞米松化疗。对比三组治疗效果、免疫功能变化情况、相关血清因子水平以及骨代谢因子水平变化情况。结果 对照组治疗有效率85.0%比研究1组95.0%、研究2组90.0%低(P＜0.05);三组治疗前的免疫对比无较大差异(P＞0.05),对照组经治疗后的免疫功能比研究组差(P＜0.05);三组治疗前的相关血清因子水平比较无较大差异(P＞0.05),对照组经治疗后的相关血清因子水平比研究1组、研究2组高(P＜0.05);对照组经治疗后的骨代谢因子水平变化比研究1组、研究2组差(P＜0.05)。结论 硼替佐米、地塞米松联合环磷酰胺治疗骨髓瘤效果理想,药物不良反应发生率下降,患者生活质量得到改善,可在临床推广应用。

Objective To investigate the clinical efficacy of bortezomib,dexamethasone combined with cyclophosphamide in the treatment of myeloma and the effect on the occurrence of adverse reactions in patients. Methods The subjects were 60 myeloma patients admitted to our hospital from January 2016 to December 2020, and they were randomly divided into study group 1 (n=20), study group 2 (n=20) and control group (n=20). The control group received bortezomib combined with thalidomide and dexamethasone chemotherapy, the study group 1 received bortezomib combined with cyclophosphamide and dexamethasone chemotherapy, and the study group 2 received bortezomib combined with lenalidomide and dexamethasone chemotherapy. The therapeutic efficacy, the changes of immune function,serum factors and bone metabolism factors were compared among the three groups. Results The effective rate of control group was 85.0%, which was lower than those of study group 1 and study group 2 (P＜0.05). There was no significant difference of immune function among the three groups before treatment (P＞0.05), which of the control group after treatment was worse than that of the study groups (P＜0.05). There were no significant differences in the levels of related serum factors among the three groups before treatment (P＞0.05),which in the control group after treatment was higher than those in the study group 1 and study group 2 (P＜0.05). After treatment, the changes of bone metabolic factors in control group were worse than those in study group 1 and study group 2 (P＜0.05). Conclusion Bortezomib, dexamethasone combined with cyclophosphamide in the treatment of myeloma had ideal effect, and the incidence of adverse drug reaction was reduced, the quality of life of patients was improved, which can be popularized in clinical application.

目的 探讨甲状腺Bethesda Ⅲ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法 收集356例Bethesda Ⅲ结节患者,对其诊断原因, ROM及亚分类进行总结分析。结果 在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),Bethesda Ⅲ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。Bethesda Ⅲ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P＜0.05)。结论 Bethesda Ⅲ类的诊断具有一定的主观性和经验性,而对Bethesda Ⅲ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。

Objective To investigate the diagnostic causes of Bethesda Ⅲ (AUS/FLUS) thyroid nodules and the value of subcategories in predicting risk of malignancy (ROM) of thyroid nodules. Methods The data of 356 cases of Bethesda Ⅲ nodules were collected, and the causes, ROM and subcategories were summarized. Results In 97 resected specimens, 72 were diagnosed as papillary thyroid carcinoma (PTC), and the ROM of Bethesda Ⅲ was 74.2%. The main factors affecting the diagnosis of PTC were small lesions, few puncture cells, atypical nuclear features and lack of papillary structure. Secondary factors included significant interstitial fibrosis or calcification, unqualified smear, improper fixation, poor staining and lack of cytological diagnosis experience. According to the subcategories of Bethesda Ⅲ, 132 cases were included in low-risk group, nodules of 12 cases in the group were resected, which ROM was 8.3%; 122 cases were included in high-risk group, nodules of 70 cases were resected, which ROM was 92.9%; 102 cases were included in middle-risk group, nodules of 15 cases were resected, which ROM was 40.0%. The differences between high-risk group and low/medium-risk group were statistically significant (P＜0.05). Conclusion The diagnosis of Bethesda Ⅲ is subjective and empirical in some degree, and the risk related subcategories of Bethesda Ⅲ nodules is helpful to achieve better ROM stratification and improve the clinical management of the disease.

目的 研究妊娠早期低血压对子宫动脉血流的影响。方法 前瞻性连续收集2020年9月—2021年3月在广州市妇女儿童医疗中心行产前检查的早孕期正常单胎妊娠孕妇,分为两组:低血压组(43人)及正常血压组(73人),分别监测两组孕妇的双侧子宫动脉血流搏动指数 (pulse index,PI)及收缩期峰值 (peak systolic velocity,PSV),并比较两组间PI及PSV是否有统计学差异。结果 双侧子宫动脉血流PI与平均动脉压呈线性正相关关系(P＜0.05)。低血压组双侧子宫动脉PI低于正常血压组,差异有统计学意义(P＜0.05),低血压组右侧子宫动脉PSV低于正常血压组,差异有统计学意义(P＜0.05),左侧子宫动脉PSV两组间无差异(P＞0.05)。结论 低血压孕妇子宫动脉血流动力学参数异常降低,临床应重视妊娠期低血压孕妇子宫动脉血流动力学异常者的围产期管理。

Objective To study the relationship between early pregnancy hypotension and uterine artery blood flow. Methods We prospectively and consecutively selected pregnant women with normal singleton pregnancy in early pregnancy for this study from September 2020 to March 2021 in Guangzhou Women and Children's Medical Center. According to the blood pressure, they were divided into hypotension group (n=43) and normal blood pressure group (n=73). We monitored the pulse index (PI) and peak systolic velocity (PSV) of bilateral uterine artery blood flow, then compared the PI and PSV between the two groups. Results There was a positive linear correlation between PI and mean arterial pressure (P＜0.05). The PI of bilateral uterine arteries in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of right uterine artery in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of left uterine artery in hypotension group was not different from that in normal blood pressure group (P＞0.05). Conclusion Uterine artery hemodynamic parameters of hypotensive pregnant women decreased abnormally, so attention should be paid to the perinatal management of pregnant women with abnormal uterine artery hemodynamics.

目的 探讨大黄穴位贴联合直肠指力刺激在脑卒中后便秘患者的应用效果。方法 本研究选择2019年1月—2019年12月间我院收治的脑卒中后便秘患者90例,随机分成A组(大黄穴位贴组),B组(直肠指力刺激组),C组(大黄穴位贴联合直肠指力刺激组)三组,每组30例。记录三组患者便秘治疗有效率,采用Wexner便秘评分系统评估三组患者治疗前后的便秘程度并进行自身前后对比。结果 三组干预前后Wexner评分采用自身配对非参数秩和检验,差异有统计学意义(P＜0.05)。三组干预前后差值采用Kruskal-Wallis H检验结果差异有统计学意义(H=26.211,P＜0.05),经过两两对比,差异有统计学意义(P＜0.05)。值得注意的是,干预后C组Wexner评分下降。干预后C组患者的有效率高于其他两组,有效率结果为C组(90%)＞B组(80%)＞A组(53.5%),差异有统计学意义(P＜0.05)。结论 相较于单一应用大黄穴位贴或直肠指力刺激,大黄穴位贴联合直肠指力刺激治疗效果更好,可有效降低便秘发生率,提高病人生活质量。

Objective To explore the effect of rhubarb acupoint application combined with rectal finger force stimulation in patients with constipation after stroke. Methods In this study, 90 patients with post-stroke constipation admitted to our hospital from January 2019 to December 2019 were randomly divided into group A (rhubarb acupoint application group), group B (rectal finger force stimulation group) and group C (rhubarb acupoint application combined with rectal finger force stimulation group), 30 cases in each group. The effective rates of constipation treatment in the three groups were recorded, and the Wexner constipation scoring system was used to evaluate the degree of constipation before and after treatment among three groups. Results The Wexner scores of the three groups before and after treatment were analyzed by self-paired non-parametric rank sum test, and the differences were statistically significant (all P<0.05). The difference among the three groups before and after treatment using Kruskal-Wallis H test was statistically significant (H=26.211, P<0.05), and after pairwise comparison, the differences were statistically significant (P<0.05). It was worth noting that the Wexner score of group C dropped significantly after treatment. The effective rate of treatment in group C was significantly higher that those in the other two groups. The result showed effective rate of group C (90%)＞ group B (80%)＞group A (53.5%), the difference was statistically significant (P<0.05). Conclusion Compared with the single treatment of rhubarb acupoint application or rectal finger force stimulation, the combined treatment had better efficacy, which reduced incidence of constipation and improved the quality of life of patients.

目的 对3例儿童Rotor综合征的临床特点及SLCO1B1和SLCO1B3基因突变分析,提高儿科医生对Rotor综合征的认识。方法 收集广州市妇女儿童医疗中心2018年—2019年确诊的3例Rotor综合征患儿的临床资料,对患儿及其家系成员肝脏常见遗传代谢性疾病二代测序筛查并家系验证结果进行分析。结果 患儿主要临床表现为反复或持续巩膜和(或)皮肤轻度黄染,实验室检查提示高直接胆红素血症。二代测序发现3例患儿均为SLCO1B1基因c.1738C＞T纯合突变和SLCO1B3基因5号内含子区域大片段插入纯合突变。SLCO1B1基因和SLCO1B3基因2处纯合突变均进行了家系验证。文献报道的SLCO1B1基因c.1738C＞T突变是无义突变,可以造成蛋白功能缺失;SLCO1B3基因的大片段插入突变虽暂未有文献收录或报道,但大片段的插入突变可引起移码突变而造成编码蛋白功能丧失。结论 由于基因检测技术的不断进步,Rotor综合征不断被儿科医生所认识。SLCO1B1和SLCO1B3双基因纯合或复合杂合突变是3例Rotor综合征患儿的分子遗传基础。

Objective To better understand Rotor syndrome(RS)in children,the clinical features and SLCO1B1 and SLC01B3 gene mutations were analyzed. Methods The clinical data of the 3 pediatric cases diagnosed in Guangzhou Women and Children's Medical Center between 2018 and 2019 was collected. Genomic DNA was extracted from the children and their family members, and subjected for second-generation sequencing to screen the known genes for liver genetic metabolic diseases. Then the detected mutations were confirmed by Sanger sequencing analysis. Results The main clinical manifestations were recurrent or persistent mild yellowish sclera and/or skin. Laboratory examinations showed hyperbilirubinemia with direct bilirubin elevating. Second generation sequencing showed that all 3 children were c.1738c＞Thomozygous mutations of SLCO1B1 gene and homozygous mutations of large fragment insertion in SLCO1B3 gene intron 5. Two homozygous mutations in SLCO1B1 gene and SLCO1B3 gene were verified in families.SLCO1B1 gene c.1738C＞T mutation,a nonsense mutation reported in references,could lead to protein function loss.A large insertion mutation of SLCO1B3 gene could cause frame-shift mutation which might lead to protein function loss even though it was neither reported in the references nor recorded in SNP database. Conclusion Due to the progress in the clinical application of gene detection technology, RS has been recognized gradually by pediatricians. Homozygous mutations or compound heterozygous mutations simultaneously occurred in SLCO1B1 and SLCO1B3 gene were the molecular genetics base in these cases of RS.

目的 探讨“分-全带教”在提高门诊实习生处方审核能力的应用效果。方法 对2016届实习生进行“分-全带教”,在实习初期、后期组织实习生对100张门诊处方进行处方审核,登记审核结果。结果 实施“分-全带教”后,处方成功审核例数实习初期的163例(27.17%)提高到后期的487例(81.17%)。结论 应用“分-全带教”模式,有利于门诊实习生掌握处方审核技巧,在提高实习生处方审核能力中有良好应用前景。

Objective To make a discussion of the application result of point-all teaching model in improvement of prescription review ability of interns at outpatient service process. Methods To implement point-all teaching model on interns enrolled in 2016. To ask them to review 100 outpatient prescription at the beginning and ending of the internship respectively and record the results of their review. Results After the implementation of point-all teaching model, the correct review of the prescription has been improved from 163 (27.17%) at the beginning to 487 (81.17%) at the ending. Conclusion The point-all teaching model is conducive for interns at outpatient department to master the technique for review, so it is promising in the improving the prescription review ability of interns.

目的 研究乳腺癌根治术中保留乳头乳晕对术后疗效、上肢功能及外观满意度的影响。方法 选取我院2013年3月—2018年5月40例早期乳腺癌的患者为研究对象,按照数字表随机分组的方案分为观察组和对照组各20例。观察组患者采用保留乳头乳晕的乳腺癌根治术治疗;对照组患者采用传统的根治性手术。比较两组手术时间、术中出血量、术后引流量、术后下床时间、住院时间。比较两组患者术后上肢功能情况,采用上肢功能评定量表(disabilities of arm,shoulder and hand scale,DASH)评估。比较两组术后乳房外观满意度及两组患者术后并发症发生率。结果 观察组手术时间、术中出血量、术后引流量及平均住院时间均低于对照组,差异有统计学意义(P＜0.05)。观察组与对照组患者术后患侧上肢水肿及活动受限发生率相当,差异无统计学意义(P＞0.05)。观察组皮瓣缺血发生率为10.0%低于对照组40.0%,差异有统计学意义(P＜0.05)。观察组术后乳房外观优良率为90.0%,高于对照组优良率60.0%,差异有统计学意义(P＜0.05)。观察组患者术后并发症发生率15.0%低于对照组35.0%,差异有统计学意义(P＜0.05)。结论 保留乳头、乳晕的乳腺癌根治术具有手术效果好、与传统根治术相比,对上肢功能损伤较小、美容效果更好,患者满意度较高等优点,值得临床应用和推广。

目的 探讨三维超声技术对胃癌检出及TNM分期的诊断价值。方法 取2015年2月—2017年9月河南省南阳市中心医院收治的89例胃癌患者作为研究对象,并对其进行术前二维超声(2D-US)、三维超声(3D-US)检查,观察患者体内肿瘤病灶形态、长径及病变浸润程度,同时根据2010年国际抗癌联盟(UICC)制定的TNM分期标准预测胃癌分期,并将预测分期结果与术后病理分期结果进行比较。结果 89例胃癌患者中,胃体癌22例,胃窦癌28例,贲门胃底癌17例,全胃癌22例;其中,黏液腺癌16例,低分化腺癌26例,中高分化腺癌35例,未分化癌12例;TNM分期:T1期18例,T2期25例,T3期31例,T4期15例。3D-US胃癌检出准确率(95.51%)高于2D-US(80.90%),差异有统计学意义(P＜0.05);3D-US检出胃癌T1期准确率(94.12%)高于2D-US(53.33%)(P＜0.05);3D-US检出胃癌T2期准确率(95.83%)高于2D-US(70.00%)(P＜0.05);3D-US检出胃癌T3期准确率(100.00%)高于2D-US(81.48%)(P＜0.05);3D-US检出胃癌T4期准确率(100.00%)高于2D-US(60.00%)(P＜0.05)。结论 3D-US图像清晰、直观、立体感强,可充分显示2D-US不能显示的肿瘤立体结构,从而提高胃癌检出准确率和术前TNM分期预测准确率,临床推广应用价值较高。

目的 探讨甲状旁腺全切除加前臂自身移植术(tPTX+AT)对并发继发性甲状旁腺功能亢进(SHPT)的尿毒症患者心脏功能的影响。方法 将50例接受tPTX+AT治疗的尿毒症并发SHPT患者作为手术组,并配对选择50例同期未接受手术治疗的尿毒症并发SHPT患者作为非手术组。对所有患者进行12个月的随访,分析两组随访过程中心室结构、心脏功能及甲状旁腺功能相关指标的变化情况。结果 在随访过程中,手术组LVD、IVSS、LVPWT、NT-proBNP、iPTH、Ga及P均呈现降低趋势,LVEF呈现升高趋势(P<0.05);非手术组LVEF、iPTH及Ga呈现升高趋势,LVD、IVSS、LVPWT、NT-proBNP及P呈现降低趋势(P<0.05)。在随访6个月及随访12个月时,手术组LVD、IVSS、LVPWT、NT-proBNP、iPTH、Ga及P低于非手术组,LVEF高于非手术组(P<0.05)。结论 tPTX+AT可有效的改善尿毒症并发SHPT患者的心室结构及心脏功能,并可在一定程度上改善患者的甲状旁腺功能。

目的 探讨精神分裂症患者亚甲基四氢叶酸还原酶 (MTHFR)基因多态性、血浆HCY水平与心血管疾病发生风险的相关性。方法 收集住院精神分裂症患者164例,记录一般资料和测定患者MTHFR C677T基因多态性、血浆同型半胱氨酸(HCY)水平、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、Framingham心血管疾病发生风险评分(FRS)等指标。其中10年心血管疾病发生风险用 Framingham心血管疾病风险评分表来计算。结果 1.CC、CT、TT基因型血浆HCY水平呈增高趋势,差异有统计学意义(P<0.001);CC基因型和CT基因型血浆HCY水平与FRS评分呈正相关关系(r_s=0.27,P=0.016;r_s=0.42,P=0.002);TT基因型血浆HCY水平与FRS评分之间无相关性(r_s=0.05,P=0.784)。2.低、中、高风险组的血浆HCY水平差异无统计学意义;低风险组和中风险组血浆HCY水平与FRS评分呈正相关关系(r_s=0.29,P=0.000;r_s=0.55,P=0.006);高风险组血浆HCY水平与FRS评分无相关性(r_s=-0.16,P=0.66)。结论 精神分裂症病人血浆HCY水平与FRS评分具有相关性,MTHFR C677T基因多态性、血浆HCY水平是对精神分裂症病人心血管疾病风险评估的合理补充之一。