目的 探讨大脑中动脉(MCA)粥样硬化斑块与脑梗死类型的相关性。方法 收集2018年1月—2020年12月的大脑中动脉粥样硬化患者178例,根据患者的临床表现、病史及诊断将患者分为脑梗死组(77例,按梗死部位分为深穿支梗死组、皮质梗死组和分水岭梗死组)和非脑梗死组(101例)。2组患者使用高分辨率核磁共振成像法(HRMRI)检查患者的双侧MCA粥样硬化斑块的特征,包括形态、信号强度及分布位置,从而统计分析粥样斑块特征与脑梗死类型之间的关系。结果 178例患者中77例为脑梗死患者。脑梗死组患者的强化率为55/77(71.4%),无脑梗死组患者的强化率为53/101(52.5%),相比差异有统计学意义(χ²=2.575,P=0.027)。其中脑梗死组中深穿支梗死组强化率为17/23(73.9%,χ²=8.707,P=0.021),皮质梗死组的强化率为13/19(68.4%,χ²=6.244,P=0.017),分水岭梗死组的强化率为25/35(71.4%,χ²=4.963,P=0.028),较非强化相比差异均有统计学意义。结论 大脑中动脉粥样硬化斑块的特征与脑梗死类型关系密切,斑块特征可反映斑块的稳定性,HRMRI对斑块稳定性的判断可预测脑梗死的发生及梗死位置。

Objective To explore the correlation between middle cerebral artery (MCA) atherosclerotic plaque and cerebral infarction patterns. Methods From January 2018 to December 2020, 178 patients with MCA atherosclerosis were divided into cerebral infarction group (77 cases, divided into deep perforating branch infarction group, cortical infarction group and watershed infarction group according to the infarct location) and non-cerebral infarction group (101 cases) according to their clinical manifestations, medical history and diagnosis.Two groups of patients underwent high-resolution magnetic resonance imaging (HRMRI) to examine the characteristics of bilateral MCA atherosclerotic plaques, including morphology, signal intensity and distribution location, to statistically analyze the relationship between the characteristics of atherosclerotic plaque and the patterns of cerebral infarction. Results Of 178 patients, 77 patients with cerebral infarction.The enhancement rate of the cerebral infarction group was 55/77 (71.4%), and that of the non-cerebral infarction group was 53/101 (52.5%), and difference between the two group had statistical significance(χ²=2.575, P=0.027). In the cerebral infarction group, the enhancement rate of the deep perforating branch infarction group was 17/23 (73.9%,χ²=8.707, P=0.021), that of the cortical infarction group was 13/19 (68.4%,χ²=6.244, P=0.017), and that of the watershed infarction group was 25/35 (71.4%,χ²=4.963, P=0.028), and the difference was statistically significant compared with the non-enhanced group. Conclusion The characteristics of MCA atherosclerotic plaque were closely related to the patterns of cerebral infarction,and the characteristics of plaque can reflect the stability of plaque.The judgment of plaque stability by HRMRI may predict the occurrence and paterrn of cerebral infarction.

目的 分析阴道灌洗液中炎性因子表达水平与高危型人乳头瘤病毒(HPV)持续感染的相关性。方法 选择本院2019年3月—2021年3月接诊的80例高危型HPV持续感染患者作为试验组,以病理组织检查结果分组,将19例宫颈癌患者作为试验组1、将30例宫颈上皮不典型增生(CIN)I级患者作为试验组2,将31例CIN II、III级患者作为试验组3,选取同期门诊体检的30例健康女性作为对照组,均进行TGF-β、IFN-γ、IL-17、IL-6表达水平检测,比较4组TGF-β、IFN-γ、IL-17、IL-6水平、高危型HPV负荷量,Pearson分析TGF-β、IFN-γ、IL-17、IL-6水平与高危型HPV负荷量的相关性。结果 阴道灌洗液炎症因子水平、高危型HPV负荷量4组相比较,差异均有统计学意义(P<0.05)。TGF-β、IL-17、IL-6水平与高危型HPV负荷量呈正相关性,与IFN-γ水平呈负相关性,P＜0.05。结论 高危型HPV持续感染患者机体阴道灌洗液中炎性因子水平与高危型HPV负荷量存在一定的相关性,高危型HPV负荷量与IFN-γ水平呈负相关性,与TGF-β、IL-17、IL-6水平呈正相关性,通过检测阴道灌洗液中炎性因子水平,可评估HPV感染程度。

Objective To analyze the correlation between the expressions of inflammatory factors in vaginal lavage fluid and persistent infection of high-risk human papillomavirus(HR-HPV). Methods A total of 80 patients with HR-HPV persistent infection in our hospital from March 2019 to March 2021 were selected as the experimental group. According to the pathological examination results, 19 patients with cervical cancer were selected as the experimental group 1, 30 patients with CIN grade I were selected as the experimental group 2, and 31 patients with CIN grade II and III were selected as the experimental group 3. Thirty healthy women in the same period were selected as the control group. HR-HPV load, TGF- β, IFN-γ, IL-17 and IL-6 levels were detected and were compared among the four groups. Pearson analysis of correlation between TGF- β, IFN-γ, IL-17, IL-6 levels and HR-HPV load was carried out. Results There were significant differences in the levels of inflammatory factors in vaginal lavage fluid and HR-HPV load among the four groups (P<0.05). TGF- β、IL-17 and IL-6 levels were positively correlated with HR-HPV load and negatively correlated with IFN-γ (P<0.05). Conclusions There is a certain correlation between inflammatory factors in vaginal lavage fluid and HR-HPV load in patients with HR-HPV persistent infection. HR-HPV load is negatively correlated with IFN-γ, and positively correlated with TGF-β, IL-17 and IL-6. The degree of HPV infection could be evaluated by detecting the inflammatory factors in vaginal lavage fluid.

目的 探讨负性调节细胞CD4⁺CD25⁺T及其相关细胞因子在慢性阻塞性肺病(COPD)患者外周血中的表达与合并细菌感染的相关性。方法 纳入2018年1月—2019年12月间收治的66例COPD患者作为研究对象,其中急性加重期COPD患者(AECOPD)36例、稳定期患者30例,并纳入同期体检健康者30例作为对照组。对所有纳入的研究对象外周血标本中的CD4⁺CD25⁺T调节性T细胞及其相关细胞因子[白介素-4(IL-4)、白介素-10(IL-10)、干扰素-γ(IFN-γ)]表达水平进行检测,分析相关指标水平与COPD是否合并细菌感染的关系,及预测细菌感染的效能。结果 AECOPD和稳定期COPD患者CD4⁺、CD4⁺CD25⁺、IFN-γ/IL-4水平均低于对照组(P<0.05),IL-4、IL-10水均高于对照组(P<0.05);AECOPD患者IFN-γ水平高于对照组(P<0.05);AECOPD患者CD4⁺、CD4⁺CD25⁺水平低于稳定期COPD患者(P<0.05),IL-4、IL-10、IFN-γ均高于稳定期COPD患者(P<0.05);CD4⁺、CD4⁺CD25⁺水平与IL4、IFN-γ均呈负相关关系(P<0.05),CD4⁺水平与IL-10呈负相关关系(P<0.05);COPD合并感染者CD4⁺水平低于未合并感染者(P<0.05),IL-4、IFN-γ水平均高于未合并感染者(P<0.05);COPD合并革兰氏阴性菌感染者CD4⁺CD25⁺水平低于未合并感染者(P<0.05),IL-10水平均高于未合并感染者(P<0.05);CD4⁺、IL-4、IL-10、IFN-γ均是预测COPD患者合并细菌感染的有效指标(P<0.05),其中IL-4和IFN-γ效能较高。结论 CD4⁺、CD4⁺CD25⁺Treg细胞及其相关细胞因子参与COPD发生发展和患者细菌感染,监测其水平变化有利于为临床诊治提供信息。

Objective To investigate the correlation between the expressions of negative regulatory cell CD4⁺CD25⁺T and its related cytokines in peripheral blood and bacterial infection of patients with chronic obstructive pulmonary disease (COPD). Methods Sixty-six COPD patients admitted between January 2018 and December 2019 were included as the research subjects, including 36 patients with acute exacerbation of COPD (AECOPD) and 30 patients with stable COPD. Another 30 healthy people undergoing physical examination during the same period were included in control group. The expression levels of CD4⁺CD25⁺ regulatory T cell and its related cytokines [interleukin-4 (IL-4), interleukin-10 (IL-10), interferon-γ (IFN-γ)] in the peripheral blood samples were detected among the included subjects. The relationship between levels of related indicators and presence or absence of bacterial infection in COPD and the efficacy of predicting infection were analyzed. Results The levels of CD4⁺, CD4⁺CD25⁺ and IFN-γ/IL-4 in patients with AECOPD and patients with stable COPD were lower than those in control group (P<0.05), while the levels of IL-4 and IL-10 were higher than those in control group (P<0.05). The IFN-γ level of AECOPD patients was higher than that of control group (P<0.05). The levels of CD4⁺ and CD4⁺CD25⁺of AECOPD patients were lower than those of stable COPD patients (P<0.05), while the levels of IL-4, IL-10 and IFN-γ were all higher than those of stable COPD patients (P<0.05). The levels of CD4⁺ and CD4⁺CD25⁺were negatively correlated with IL-4 and IFN-γ (P<0.05), and the CD4⁺level was negatively correlated with IL-10 (P<0.05). The CD4⁺ level in COPD patients with infection was lower than that in patients without infection (P<0.05), while the levels of IL-4 and IFN-γ were higher than those in patients without infection (P<0.05). The CD4⁺CD25⁺level of COPD patients with Gram-negative bacteria infection was lower than that of patients without infection (P<0.05), while the IL-10 level was higher than that of patients without infection (P<0.05). CD4⁺, IL-4, IL-10 and IFN-γ were effective indicators in predicting bacterial infection in COPD patients (P<0.05), and IL-4 and IFN-γ had higher efficacy. Conclusions CD4⁺, CD4⁺CD25⁺ T cell and related cytokines are involved in the occurrence and development of COPD and bacterial infection in patients. Monitoring changes of those levels is helpful to provide information for clinical diagnosis and treatment.

目的 了解精神科护士的临床决策意识与其情绪智力水平的相关性。方法 采用护理临床决策量表(CDMNS),情绪智力量表(WLEIS)对来自广州市3家医院的230名精神科护士进行问卷调查,并对结果进行相关性分析。结果 精神科护士临床决策意识得分为(133.25±14.68)分,情绪智力得分为(74.15±11.77)分,精神科护士临床决策意识总分与情绪智力能力总分呈显著正相关(r=0.413,P＜0.05)。结论 精神科护士临床决策意识、情绪智力为中等水平,提高情绪智力水平有助于提高精神科护士的临床决策能力。

Objective To understand the correlation between the clinical decision-making awareness of psychiatric nurses and their emotional intelligence. Methods Using the clinical decision-making in nursing scale (CDMNS) and Wong & Law emotional intelligence scale (WLEIS), a questionnaire survey was conducted among 230 psychiatric nurses in 3 hospitals in Guangzhou, and correlation analysis was performed on the results. Results The clinical decision consciousness score of psychiatric nurses was (133.25±14.68), and the emotional intelligence score was (74.15±11.77). The total score of clinical decision consciousness of psychiatric nurses was significantly positively correlated with the total emotional intelligence ability score (r=0.413, P<0.05). Conclusions The clinical decision-making awareness and emotional intelligence of psychiatric nurses were at a medium level. Increasing the level of emotional intelligence can help improving the clinical decision-making ability of psychiatric nurses.

目的 探究冠心病患者血清同型半胱氨酸(HCY)、血红素加氧酶-1(HO-1)水平与冠状动脉Gensini积分的相关性,并对其进行分析与探讨。方法 随机选取2020年3月—2021年7月于我院心内科行冠脉造影确诊的冠心病患者108例作为观察组和同期于我院行冠脉造影排除冠心病的健康人群33例作为对照组。根据冠心病患者的Gensini积分将其分为低分组(n=42)、中分组(n=35)和高分组(n=31)。对比观察组与对照组2组研究对象血清HCY、HO-1水平差异,冠心病患者的血清HCY、HO-1水平与Gensini积分的相关性通过Pearson相关分析法分析。结果 观察组血清HCY水平高于对照组(P＜0.05);观察组血清HO-1水平低于对照组血清HO-1水平(P＜0.05)。高分组血清HCY水平高于中分组和低分组(P＜0.05);高分组血清HO-1水平低于中分组和低分组(P＜0.05)。血清HCY水平与Gensini积分呈正相关(P＜0.05),血清HO-1水平与Gensini积分呈负相关(P＜0.05)。结论 血清HCY、HO-1水平与冠心病患者Gensini积分密切相关。

Objective To investigate the correlation between serum homocysteine (HCY), heme oxygenase-1 (HO-1) levels and coronary Gensini score in patients with coronary artery disease. Methods One hundred and eight patients with coronary artery disease diagnosed by coronary angiography in the cardiology department of our hospital from March 2020 to July 2021 were randomly included in observation group, while 33 healthy people without coronary artery disease confirmed by coronary angiography in our hospital during the same period as the control group. The 108 patients with coronary artery disease were divided into low (n=42), medium (n=35) and high (n=31) groups by coronary Gensini score. The differences in serum HCY and HO-1 levels between observation group and control group were compared, and the correlation between serum HCY, HO-1 levels and coronary Gensini score was analyzed by Pearson correlation analysis. Results The serum HCY level of the observation group was higher than that of the control group (P<0.05); the serum HO-1 level of the observation group was lower than that of the control group (P<0.05). The serum HCY level in the high group was higher than the middle group and low group (P<0.05); the serum HO-1 level in the high group was lower than the middle group and low group (P<0.05). Serum HCY level was positively correlated with coronary Gensini score (P<0.05), and serum HO-1 level was negatively correlated with coronary Gensini score (P<0.05). Conclusions Serum HCY and HO-1 levels were closely correlated with coronary Gensini score in patients with coronary artery disease.

目的 探讨肠道病毒相关性脑炎患儿的临床特点;以期能为临床医师对该病的认识提供一定的帮助。方法 回顾性分析2018年1月—2019年12月广州市妇女儿童医疗中心感染科收治的37例肠道病毒相关性脑炎患儿的临床相关资料。结果 37例患儿男28例,女9例,男女比例3.11:1。主要临床症状体征发热(97.30%)、口腔疱疹和(或)皮疹(54.05%);常见神经系统症状呕吐(56.76%)、头痛(56.76%)、惊厥(29.72%),其中惊厥及呕吐头痛症状≤1岁组与其他年龄组差异有统计学意义;脑脊液检查白细胞升高为主;所有患儿均康复出院且无神经系统后遗症。结论 儿童肠道病毒相关性脑炎近一半患儿临床无咽部疱疹或皮疹表现,1岁以内患儿主要以发热及惊厥为主要表现,大于1岁尤其学龄前期及学龄期患者以发热呕吐伴头疼为主要表现;早期诊治预后良好。

Objective To explore the clinical characteristics of children with enterovirus associated encephalitis, in order to provide some help for clinicians to understand the disease. Methods The clinical data of 37 children with enterovirus related encephalitis treated in the infection department of Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were analyzed retrospectively. Results There were 28 males and 9 females, with a male to female ratio of 3.11:1. The main clinical symptoms and signs were fever (97.30%), oral herpes and/or rash (54.05%); the common nervous system symptoms were vomiting (56.76%), headache (56.76%) and convulsion (29.72%). There were significant differences in convulsion, vomiting and headache symptoms between ≤ 1 year old group and other age groups. The leukocytes level in cerebrospinal fluid was elevated. All children recovered and discharged without neurological sequelae. Conclusions Nearly half of children with enterovirus associated encephalitis had no clinical manifestations of pharyngeal herpes or rash. The main manifestations of children under 1 year old were fever and convulsion. The main manifestations of children over 1 year old, especially preschool and school-age patients, were fever and vomiting with headache. Early diagnosis and treatment had good prognosis.

目的 探讨健康儿童的个体因素对超声测量下腔静脉内径的影响。方法 使用超声测量210例健康儿童的下腔静脉呼气末内径及腹主动脉内径,并记录他们的个体特征,包括性别、年龄、身高、体质量、腰围、体表面积等,进行相关与回归分析。结果 年龄、身高、体质量、腰围、体表面积与下腔静脉和腹主动脉内径呈正相关。年龄是女性儿童下腔静脉内径唯一的独立影响因素,身高是男性儿童下腔静脉内径唯一的独立影响因素。无论男性或女性,年龄是儿童腹主动脉内径的独立影响因素,而下腔静脉和腹主动脉内径的比值不受这些个体因素的影响。结论 下腔静脉和腹主动脉内径易受个体因素影响,而它们的比值不易受个体因素影响,可以更好的用于预测儿童的容量特征。

Objective To explore the impact of individual characteristics on inferior vena cava diameter ( IVC ) in healthy children. Methods IVC_max and abdominal aorta (AO) diameters were measured by ultrasound in 210 healthy children. The individual characteristics including gender, age,height,weight, waist circumference of each child were recorded. Then the surface area(BSA) and IVC_max/AO were calculated to discuss the relationship between them with multivariate analysis. Results Age, height, weight,waist circumference, and BSA were positively correlated with IVC_max and AO. Multivariate linear regression showed that age was the only independent variable for IVC_max in female children, height was the only independent variable for IVC_max in male children, and age was the only independent variable for AO in both females and males. IVC_max/AO was not significantly influenced by the subjects' characteristics. Conclusion IVC_max and AO were more susceptible to subjects' characteristics than IVC_max/AO. IVC_max/AO could be a reliable and practical parameter in children as it was independent of age, height, and weight.

目的 探讨应用超声心动图评价肺动脉高压(PAH)致心肌损伤的临床价值及氧化应激损伤的相关性。方法 12周龄SD大鼠48只。随机均分为4组:空白对照组、NaCl对照组、PAH 2周组及PAH 4周组。建模后,采用超声检测相关参数。HE及Masson染色观察右心室的心肌细胞及胶原纤维分布情况,测定超氧化物歧化酶(SOD)活力,还原型谷胱甘肽(GSH)和丙二醛(MDA)水平,并评价其与超声参数的相关性。结果 PAH组大鼠超声相关参数均变化明显,且逐渐加重。HE及Masson染色显示心肌细胞增大,心肌间隙中的胶原纤维明显增多,且4周组较明显。PAH组大鼠心肌组织中的SOD活力及GSH水平较低,而MDA水平较高,有变化趋势,且与超声参数有显著相关性,差异均有统计学意义(P<0.05)。结论 PAH导致大鼠右心室心肌组织结构改变,同时引起氧化应激相关指标的变化。

Objective To explore the clinical value of echocardiographic evaluation of myocardial injury caused by pulmonary hypertension (PAH) and the correlation of oxidative stress injury. Methods Forty-eight 12-week-old SD rats were collected. They were randomly divided into 4 groups: blank control group, NaCl control group, PAH 2-week group and PAH 4-week group. After modeling, ultrasound was used to detect relevant parameters. HE and Masson staining were used to observe the distribution of myocardial cells and collagen fibers in the right ventricle. Superoxide dismutase (SOD) activity, reduced glutathione (GSH) and malondialdehyde (MDA) levels were measured, and their correlations with ultrasound parameters were evaluated. Results The ultrasound-related parameters of rats in the PAH group changed significantly and gradually increased.HE and Masson staining showed that cardiac myocytes were enlarged and collagen fibers in myocardial interstices were increased, and it was more obvious in the 4-week group.In the PAH group, the SOD activity and GSH levels were lower, while the MDA levels were higher, and there was a trend of change, and there was a significant correlation with ultrasound parameters. The difference was statistically significant (P<0.05). Conclusion PAH causes changes in the myocardial tissue structure of the rat right ventricle, as well as changes in oxidative stress-related indicators.

目的 检索和分析新生儿医用粘胶相关性皮肤损伤(MARSI)预防及管理的相关证据,并对最佳证据进行总结,为临床提供参考,以预防住院新生儿MARSI的发生。方法 利用PIPOST公式,对新生儿MARSI的预防和管理构建循证问题并进行计算机检索。检索时限为建库至2020年3月31日。由2名已接受过系统循证培训的研究者对纳入的证据文献进行独立评价,从符合标准的文献中提取证据,并由临床审查小组对证据进行FAME论证,最终总结出最佳证据。结果 最终纳入文献2篇,包括一篇专家共识和一篇系统评价,汇总了17条证据,经过FAME论证后最终总结出11条最佳证据,包括患者评估、MARSI预防和MARSI处理三个方面。结论 新生儿MARSI的发生与诸多内外因素相关,临床主要以预防为主,建议医疗机构根据实际情况制定住院新生儿MARSI的预防和管理规范,加强医护人员培训,提升新生儿照护质量。

Objective To retrieve,appraise and summarize the best evidence of the prevention of medical adhesive related skin injury(MARSI) in neonates, and provide references for clinical practice. Methods We systematically searched for evidence on prevention of neonatal MARSI. The retrieval period was from the inception of databases to March 31,2020. Two researchers independently evaluated the quality of the literature and extracted evidence. Results Two literatures were included, including an expert consensus and a systematic review. Three categories (patient evaluation, MARSI prevention and MARSI management) and totally 11 items of best evidence were summarized. Conclusion The occurrence of neonatal MARSI is related to many internal and external factors, and prevention is the most important. Medical institutions should establish principles and practice guidelines of the management of neonatal MARSI, strengthen the training of medical staffs, and improve the quality of newborn care.

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.