目的 进一步提高宫腔粘连的超声诊断准确率。方法 对476例超声诊断的宫腔粘连病例进行回顾性分析。结果 476例经阴道彩超诊断的宫腔粘连患者,超声主要表现:内膜回声连续性中断,内膜厚薄不均。超声结合临床表现,将患者分成轻度粘连、中度粘连和重度粘连。71例重度粘连患者于我院行宫腔镜治疗。经阴道彩超结合临床,对宫腔粘连的诊断准确率达100%。结论 经阴道彩色多普勒超声是诊断宫腔粘连首选的检查手段。经阴道彩超结合临床,对宫腔粘连具有很大的诊断价值,对粘连的分级有助于指导临床制定治疗计划。

Objective To improve the ultrasound diagnostic accuracy rate of Intrauterine Adhesions. Methods Retrospectively analysis of 476 intrauterine adhesions cases were diagnosed by the transvaginal color ultrasound. Results Main imaging characteristics of 476 IUA cases were endometrial echo interruption, uneven thickness, et al. Combining ultrasound with clinical performance, the data was classified into three types: mild IUA, moderate IUA, severe IUA. 71 cases of severe IUA were treated with hysteroscopy surgery. Conclusion Transvaginal ultrasound with clinical data diagnosis for the intrauterine adhesions has higher practical value. The classification is helpful for making the treatment plan.

目的 探讨儿童肾病综合征(NS)的红细胞分布宽度(RDW)与肾功能损害的关系。方法 收集168例NS患者作为观察组,根据eGFR分期分为三组,按照起病时长4月为界限分为两组;选健康儿童100例为对照组。检测各组血常规、肝肾功能等,采用SPSS 21.0软件进行统计分析。结果 ①与对照组相比,NS患儿的RBC[(4.86±0.69)vs(4.32±0.48)],RDW[(13.39±1.69)vs(12.99±1.04)]升高,差异有统计学意义(P<0.05);②RDW在肾功能3期(14.60±1.36)较2期(12.84±0.79)升高,在起病时长≤4月患儿(13.66±1.78)较健康儿童(12.99±1.04)上升,差异有统计学意义(P<0.05);红细胞平均容积(MCV)在起病时长≤4月较对照组下降,起病时间>4月组较起病时长≤4月上升,差异有统计学意义(P<0.05)。结论 儿童NS患者的RBC、RDW较健康儿童升高,RDW在肾功能3期较2期升高。

Objective To investigate the relationship between red cell distribution width(RDW) and renal function damage in children with nephrotic syndrome(NS). Methods 168 NS patients were chosen as the observation group, divided into three groups by eGFR level, while also divided into two groups by onset duration of 4 months. 100 healthy children were included as the control group. The blood routine, biomedical function of liver and kidney were detected. Data were analyzed by SPSS 21.0. Results ① Compared to control group, NS patients have higher levels of RBC[(4.86±0.69) vs (4.32±0.48)] and RDW[(13.39±1.69) vs (12.99±1.04)], P<0.05; ② RDW is higher in the third phase of renal function than the second [(14.60±1.36) vs(12.84±0.79)], and also higher in the onset duration of less than 4 months group than the control group [(13.66±1.78) vs (12.99±1.04)], P<0.05; Mean corpuscular volume is lower in the onset duration group of less than 4 months than the control group, and higher in the onset duration group more than 4 months than the onset duration group of less than 4 months, P<0.05. Conclusion The RBC, RDW are higher in children NS patients than in the healthy children; RDW is higher in the third renal function than the second renal function.

目的 探讨绝经期后女性血清铁蛋白水平与代谢综合征之间的关系。方法 收集218例确诊为MS的绝经期后女性患者为试验组,对照组为经我院检查健康绝经期后的女性300例,分别测FBG、TC、TG、LDL-C、HDL-C、HbA1C、INS、SF;计算体重指数(BMI)以及测量腰围;测血压;用HOMA稳态模型来评价胰岛素抵抗指数(HOMA-IR)。结果 MS组较非MS组的铁蛋白(SF)值高(P<0.01),SF四分位各组之间比较,FBG、TG、HDL-C,BMI,腰围,收缩压、舒张压有差异(P<0.05或P<0.01),四组间年龄、TC、LDL-C无差异。与SF呈正相关的参数有腰围(P<0.01),舒张压(P<0.01),空腹血糖(P<0.01),胰岛素抵抗指数(P<0.01),负相关的参数为HDL-C(P<0.01)。结论 绝经期后女性的SF水平与MS呈显著相关,其中腰围、舒张压、空腹血糖、HDL-C、胰岛素抵抗指数与血清铁蛋白之间存在较大关联性。

Objective To study the relationship of serum ferritin level with metabolic syndrome in postmenopausal women. Methods 218 postmenopausal women with metabolic syndrome and 300 healthy postmenopausal women were included in this investigation, to detect FBG, TC, TG, LDL- C, HDL-C, HbA1C, INS, SF, calculated body mass index (BMI) and to measure waist circumference, blood pressure; Using HOMA steady-state model to evaluate indexes of insulin resistance (HOMA IR). Results Serum ferritin level was significantly higher in MS group than in the non-MS group(P<0.01). Serum ferritin quarterback was compared between each group, there were differences in FBG, TG, HDL-C,BMI, waist circumference,SBP, DBP(P<0.05 or P<0.01). There were no differences in age, TC, LDL-C. Serum ferritin level was significantly positive correlated with waist circumference (P<0.01), DBP(P<0.01), FBG(P<0.01), insulin resistance index (P<0.01), and negative correlation with HDL-C(P<0.01). Conclusion Serum ferritin level is significantly associated with metabolic syndrome in postmenopausal women. Waist circumference, DBP, FBG, HDL -C, insulin resistance index are closely associated with the serum ferritin.

目的 探讨功能训练在Haglund病伴轻度认知障碍患者中的应用效果。方法 成立功能训练培训小组对46例关节镜Haglund病伴轻度认知障碍术患者实施功能训练,干预时间6个月。训练前后对患者Baird-Jackson踝关节评分、自我效能和临床疗效评估进行测评。结果 训练后,患者Baird-Jackson踝关节评分、自我效能优于训练前,临床疗效优良率升高,训练前后比较,差异均有统计学意义(P＜0.01)。结论 功能训练能促进关节镜Haglund病伴轻度认知障碍术患者踝关节功能康复和提高自我效能。

Objective To investigate the effects of application of functional training to Haglund disease patients with mild cognitive impairment. Methods The functional training group was built and gave functional training to 46 patients of Haglund disease with mild cognitive impairment. The period of intervention lasted 6 months. Before and after the training, We assessed patients in terms of scores of Baird-Jackson ankle joint, self-efficacy and clinical efficacy. Results After the training, scores of Baird-Jackson ankle joint and self-efficacy became higher and the excellent rate of clinical efficacy has risen. Compared with those before the training, the difference had statistic significance (P<0.01). Conclusion Functional training has a positive impact on the recovery of ankle joint function of Haglund disease patients with mild cognitive impairment and improve their self-efficacy.

目的 探讨糖尿病自我管理支持对社区2型糖尿病患者生化指标控制的影响。方法 2015年1月1日前已确诊为2型糖尿病患者,随机分为对照组和干预组,对照组303例按照广州市基本公共卫生服务包要求进行定期随访、体检及健康教育,干预组130例进行自我管理支持干预,观察两组生化指标的变化。结果 与对照组比较,自我管理支持组的空腹血糖、总胆固醇、甘油三酯、谷丙转氨酶、尿酸控制效果较好,差异有统计学意义(P<0.05)。结论 自我管理支持对社区2型糖尿病患者生化指标控制的效果良好,值得推广。

Objective To evaluate the control effect of biochemical criterion in patients with type 2 diabetes under diabetes self-management support in community. Methods 130 patients with type 2 diabetes in community from January 2015 to December 2015 accepting the diabetes self-management support were chosen as research group, another 303 diabetic patients without the diabetes self-management support were set as control group, the effect of management was analyzed. Results There was statistically significant difference (P<0.05) in biochemical criterion including blood sugar (BS), total cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT) and uric acid (UA). Conclusion Control effect of biochemical criterion was good in the diabetes self- management support for people with type 2 diabetes, which was worth to be popularized.

目的 探索利伯曼康复治疗对慢性精神分裂症患者社会功能的影响。方法 选取长期住院的慢性精神分裂症患者130例,随机分为研究组65例和对照组65例,研究组实施利伯曼康复治疗,在康复训练前与训练后的第1、3月末分别采用护士用住院病人观察量表(NOSIE)和住院精神病人康复疗效评定量表(IPROS)对患者进行评价。结果 患者通过利伯曼康复治疗后,NOSIE量表总积极分、社会能力、社会兴趣、个人整洁等得分有明显提高;IPROS量表的工疗情况生活能力社交能力讲究卫生能力都有较明显的提高(T、P<0.01)。结论 利伯曼康复治疗对患者的社会功能的改善有积极的意义。

Objective To explore the impacts of Lieberman rehabilitation technique on chronic schizophrenic patient's quality of life. Methods 130 patients diagnosed with chronic schizophrenia with over 5-year long hospitalization were divided into two groups randomly, with 65 samples at either study group or control group. Team to implement a lieberman rehabilitation. NOSIE and IPROS were used by nurse to assess the performance of all samples in one month after the beginning of the study and three months after the beginning study. Results After intervention, the performance of samples in study group indicated that patients had significantly higher score in NOSIE total score, social ability, social interest, individual tidiness. Patient's total negative points including irritability, mental performance, retardation and depression were decreased. IPROS living ability and social ability has improved significantly(P≤0.01). Conclusion Lieberman rehabilitation technique can improve patients'social function.

目的 分析总结异丙酚静脉麻醉复合利多卡因乳腺后间隙局部浸润麻醉在乳腺多发性肿块真空辅助微创旋切术的临床应用体会。方法 通过对我院2012年3月—2015年3月380例乳腺多发性肿物在异丙酚静脉麻醉复合利多卡因乳腺后间隙局部浸润麻醉下行真空辅助微创旋切术的病例,进行回顾性综合分析。结果 手术前、中和手术后血氧饱和度无明显变化;手术中平均动脉压、心率与术前比较,差异有统计学意义(P<0.05);麻醉效果好,术后并发症少。结论 乳腺多发性肿物真空辅助微创旋切术采用异丙酚静脉麻醉复合利多卡因乳腺后间隙局部浸润麻醉,安全可行,患者依从性好、满意度和耐受度较高,临床效果满意。

Objective To investigate the applicative value of Propofol intravenous anesthesia combining with local infiltration anesthesia in vacuum assisted biopsy minimal invasive system for multiple breast lumps excision. Methods Encor minimally invasive surgery was performed under Propofol intravenous anesthesia together with local infiltration anesthesia in 380 cases with multiple breast lumps admitted to our department from March 2012 to March 2015. Anesthesia effect, SpO₂, MAP and HR were analyzed retrospectively. Results All 380 patients achieved good anesthetic effect for completing multiple breast lumps excision. The postoperative complications were less. There was no obvious change of oxyhemoglobin saturation (SpO₂) before, during and after the surgery period (P>0.05). The mean arterial pressure (MAP) and heart rate (HR) had statistical significance compared the surgery period with the pre-operative time (P<0.05). Conclusion Vacuum assisted biopsy minimal invasive system under Propofol intravenous anesthesia combining with local infiltration anesthesia is a safety and feasible method for multiple breast lumps excision. It has more advantages including perfect anesthetic effect, good patient compliance, higher satisfaction and higher tolerance level.

目的 探讨白癜风初诊患者外周血细胞因子水平与临床分型、皮损面积的相关性。方法 收集我院2009年7月—2013年7月4年间收治的初诊白癜风患者78例及健康志愿者37例,用ELISA检测外周血血清IL-6、IL-2, IFN-γ、TNF-α浓度并判断其与白癜风分型、皮损程度的相关性。结果 与对照组相比,白癜风各分型组的IL-6、IL-2水平均升高,其中,散在性的升高幅度最为明显。IL-6及IL-2与皮损面积呈正相关,其相关系数分别为0.664及0.483,P值分别为0.021及0.014。结论 IL-2及IL-6在白癜风的发病过程中起重要作用,且在不同的分型中的表达存在差异,并与皮损面积呈正相关。

Objective To evaluate the correlation of cytokine level of peripheral blood cells, clinical classification and skin lesion in preliminary diagnosis of vitiligo. Methods A total of 78 patients with vitiligo of preliminary diagnosis and 37 health volunteers were collected from July 2009 to July 2013. The peripheral blood were collected for ELISA measurement of IL-6, IL-2, IFN-γand TNF-α, and evaluated whether the cytokines concentration was correlated to clinical classification and skin lesion. Results Compared to control group, IL-6 and IL-2 in all of classification of vitiligo was higher, and the most increase was observed in scattered group. Both IL-6 and IL-2 showed the positive correlation with skin lesion (CI: 0.664 and 0.483, P=0.021 and 0.014). Conclusion IL-2 and IL-6 maybe play a key role in vitiligo etiology, and showed different level in different classification of vitiligo. Besides, they showed a positive correlation with skin lesion.

目的 研究PF诱导化疗联合调强放疗及二维放疗对鼻咽癌近远期疗效影响的回顾性分析。方法 回顾性分析2008年1月—2008年12月中山大学附属肿瘤医院收治的101例鼻咽癌患者治疗情况,按照治疗方案技术分为调强组(n=42)和二维组(n=59)。比较两组患者临床疗效,近期毒副反应及生存情况。结果 放疗结束时调强组患者总缓解率92.86%与二维组77.97%比较差异有统计学意义(P<0.05)。调强组Ⅲ-Ⅳ级胃肠道反应26.19%及黏膜炎14.29%发生率与二维组比较显著较少,差异有统计学意义(P<0.05)。两组患者远期毒副反应及生存率比较无显著差异(P>0.05)。结论 PF诱导化疗联合调强放疗治疗鼻咽癌患者,近远期临床疗效好,毒副反应少。

Objective To study the effects of PF induced chemotherapy combined with intensity modulated radiation therapy and two-dimensional radiotherapy on the short and long term curative effects in nasopharyngeal carcinoma. Methods The treatment condition of 101 cases of patients with nasopharyngeal carcinoma who were treated in the Tumor Hospital Affiliated to San Yat-sen University between January and December 2008 were retrospectively analyzed. According to different treatments, the cases were divided into the intensity modulated group and the two-dimensional group. The clinical curative effects, short-term toxic and side effects and survival status were compared between the two groups. Results At the end of radiotherapy, the total remission rate in the intensity modulated group was 92.86% while in the two-dimensional group was 77.97% (P<0.05). In the intensity modulated group, the incidence rates of grade Ⅲ-Ⅳgastrointestinal tract reactions (26.19%) and mucositis (14.29%) were significantly lower than those in the two-dimensional group (P<0.05). There was no significant difference in long-term side effects and survival rate between the two groups (P>0.05). Conclusion PF induced chemotherapy combined with intensity modulated radiation therapy in the treatment of patients with nasopharyngeal carcinoma has good short and long-term curative effects and few toxic and side effects.

目的 探讨单倍体亲缘异基因造血干细胞移植治疗重型再生障碍性贫血(SAA)的可行性。方法 对1例诊断SAA 4年余,先后经CsA治疗、脐血移植治疗均无效并反复输注红细胞、血小板的12岁男性患者进行单倍体亲缘异基因造血干细胞移植,供者为其胞兄,高分辨HLA基因型5/10相合,预处理方案为BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d。干细胞来源为G-CSF动员的骨髓+外周造血干细胞,共计输注单个核细胞(MNC)4.055×10⁸/kg(受者体重),CD 34 2.331×10⁶/kg。GVHD预防:-1 d采用与受者HLA部分相合的第三方脐带血细胞,术后联合应用环孢素A、短程氨甲碟呤、霉酚酸酯。结果 造血缓慢重建,术后22天(+22 d)ANC>0.5×10⁹/L,术后3月血小板脱离输注。+26天DNA指纹图全部表现为供者基因型。+40天血型转为供者型“O”型。+29 d出现急性移植物抗宿主病aGVHD(胃肠型,Ⅲ度),+31 d、+34 d及+42 d予巴利昔单抗20 mg静滴,+40 d、+44 d、+63 d输注间充质干细胞,患者急性GVHD逐渐控制。期间曾出现肺部感染、口腔黏膜炎及巨细胞病毒血症,经抗感染后可控制。现随访3年,血象正常稳定,Kamofsky评分100分。结论 单倍体亲缘异基因造血干细胞移植治疗SAA,对无相合供者(包括亲缘或非亲缘)且强效免疫抑制治疗失败的患者,可考虑进行,GVHD和感染为主要并发症,需根据患者病情采用相应措施。

Objective To investigate the feasibility of haploid genetic allogeneic hematopoietic stem cell transplantation in the treatment of severe aplastic anemia(SAA) in our hospital. Methods A 12-year-old patient with acquired SAA for 4 years showed no response to CsA and cord blood transplant treatment and was transfusion-dependent. Lacking an HLA-identical sibling donor, the patient was treated with HSCT from his brother 5/10 matched at the generic level. Theconditioning regimen was BU+CTX+ATG:BU 3.2 mg/kg×2 d,CTX 50 mg/kg×4 d,ATG 2.5 mg/kg×4 d. Stem cells were the source of G-CSF mobilization of bone marrow and peripheral blood stem cells, dose of stem cells infused: mononuclear cells (MNC) 4.055×10⁸/kg (body weight of subject), CD34 2.331×10⁶/kg. Prevention of GVHD: -1 d Third-party umbilical cord blood cells which were HLA partially matched were used. Postoperative joint use included cyclosporine A, short-course methotrexate, mycophenolate mofetil. Results Hematopoiesis was slowly rebuilding, 22 d after surgery (+22 d) ANC> 0.5×10⁹/L, after three months departing from transfusion of platelets. +26 d suggesting that the DNA fingerprints showed donor genotypes. +40 d into donor blood type “O” type. + 29 d occurred acute GVHD (GI type, Ⅲ degrees), + 31 d, + 34 d + 42 d infusion of basiliximab 20mg, + 40 d, + 44 d, + 63 d infusion of mesenchymal stem cells. Gradually acute GVHD was controlled in the patient, who had lung infections, oral mucositis and cytomegalovirus viremia, could be controlled with anti-infective. Now followed up for 3 years, hemogram change has been normal and stable. Kamofsky score was 100 points. Conclusion It may be considered to have haploid genetic allogeneic hematopoietic stem cell transplantation for treatment of SAA, for those patients who have non-matched donor (including relatives and non-relatives) and potent immunosuppressive therapy failure. GVHD and infection are major complications. Need to adopt appropriate measures in accordance with the patient's condition.