目的 研究新辅助化疗联合保肢手术治疗骨肉瘤的临床效果。方法 根据既往治疗骨肉瘤方法的不同,将56例患者分为对传统保肢组（A组）和现代保肢组（B组）,各28例。A组用采用传统保肢方案,即保肢手术+术后化疗方案进行;B组采用现代保肢方案,即新辅助化疗+保肢手术+术后化疗方案进行。化疗方案均采用CTX + VCR +MTX+ ADM方案,比较两组转移/复发率、术后1 年、2年及 3 年生存率、肢体功能、临床疗效情况。结果 比较两组的转移/复发率及3年后的死亡率,B组低于A组(P<0.05);肢体功能优良率及临床疗效,B组高于A组(P<0.05)。结论 新辅助化疗联合保肢手术能够降低骨肉瘤患者转移/复发率、死亡率,改善肢体功能,提高临床疗效。

Objective To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma. Methods Based on the previous methods of treating osteosarcoma, 56 patients were divided into the traditional limb salvage group (A group) and the modern limb salvage group (B group), 28 cases for each. The traditional limb salvage surgery + postoperative chemotherapy regimen were used in group A, and modern limb salvage regimen was performed in group B, ie neoadjuvant chemotherapy + limb salvage surgery + postoperative chemotherapy. The CTX + VCR +MTX+ ADM protocol was used in the chemotherapy regimens. The metastasis/recurrence rate, the 1-year, 2-year and 3-year survival rates, limb function, and clinical efficacy were compared between the two groups. Results The metastasis/recurrence rate and the mortality rate after 3 years in the two groups were compared. The B group was lower than that of the group A (P<0.05). The excellent rate of limb function and clinical efficacy were higher in the B group than that of in the group A (P<0.05). Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery may reduce the metastasis/recurrence rate and mortality of osteosarcoma patients, improve limb function and increase clinical efficacy.

目的 了解南昌市某政府机关退休人员的健康状况,为制定有针对性的疾病防治措施提供依据。方法 根据南昌大学医院体检科常规体检项目,于2016—2018年对南昌市某政府机关退休职工进行健康体检,分析体检异常所占比例,采用χ²检验比较两样本率。结果 腹部彩超、甲状腺彩超、血脂、幽门螺杆菌（HP）、心电图、肝肾功能、宫颈刮片与白带（女）、血糖、肿瘤指标等为主要异常指标。2016—2018年的腹部彩超异常率分别高达82.98%、88.64%和82.95%,腹部彩超异常者中前列腺增生、脂肪肝和胆道系统异常所占比例较高。腹部彩超异常比例男性高于女性,甲状腺彩超和肿瘤指标异常比例女性高于男性（P<0.05）。结论 该政府机关退休职工健康体检指标异常所占比例较高,需要建立健康档案数据库进行健康管理,并对体检指标异常者安排定期复检,以实现对疾病的“早发现,早诊断,早治疗”。

Objective To understand the health status of retired people in a government agency in Nanchang city,and to provide evidence for the prevention and treatment of diseases. Methods According to the routine physical examination items of the department of physical examination of Nanchang university hospital,the health examination of retired staffs of a government agency in Nanchang city from 2016 to 2018 was carried out. The proportion of abnormal physical examination was analyzed,and the rate of two samples was compared by χ² test. Results Abdominal ultrasound,thyroid ultrasound,blood lipid,helicobacter pylori （HP）,electrocardiogram,liver and kidney function,cervical scraper and leucorrhea （female）,blood sugar,tumor index were the main abnormal indexes. The abnormal rate of color Doppler ultrasound was as high as 82.98% and 82.95%,respectively. The proportions of benign prostatic hyperplasia,fatty liver and abnormal biliary system were higher in the patients with abnormal abdominal color Doppler ultrasound. The abnormal rate of abdominal color Doppler ultrasound was higher in male than that in female,and the abnormal rate of thyroid ultrasound and tumor index were higher in female than that in male （P< 0.05）. Conclusion The proportions of abnormal health examination indexes of retired staffs in this government agency are relatively high. It is necessary to establish a health record database for health management,and arrange periodic reexamination for those who have abnormal physical examination indexes in order to realize importance of early detection and early diagnosis of diseases,and have early treatment.

目的 比较分析神经内镜和常规开颅手术在治疗高血压脑出血时的优劣。方法 回顾性分析我院神经外科2015年12月1日—2017年12月31日收治的60例高血压脑出血患者,根据治疗术式的不同,分为对照组和观察组,各30例。对照组行常规开颅手术,观察组给予神经内镜治疗,通过对比两组患者的手术时长、术中出血量、血肿清除率、住院时间、术后并发症及术后6个月随访效果,分析两组优劣。结果 观察组手术时长短于对照组,差异有统计学意义（P<0.05）;观察组术中出血量少于对照组,差异有统计学意义（P<0.05）;观察组血肿清除率高于对照组,差异有统计学意义（P<0.05）;观察组术后并发症（颅内感染、肺部感染）发生率低于对照组,差异有统计学意义（P<0.05）,而两组再次出血及死亡率差异均有统计学意义（P>0.05）;观察组患者术后预后效果优于对照组,差异有统计学意义（P<0.05）。结论 神经内镜在治疗高血压脑出血时对比常规开颅手术具有显著缩短手术时长及住院时间,提高血肿清除率,减少术中出血,降低颅内及肺部感染率等优势,值得临床推广应用。

Objective To compare and analyze the advantages and disadvantages of neuroendoscopy and conventional craniotomy in the treatment of hypertensive intracerebral hemorrhage. Methods 60 patients with hypertensive intracerebral hemorrhage admitted to our hospital from December 1,2015 to December 31,2017 were divided into the control group and the observation group,each with 30 cases. The control group underwent conventional craniotomy,and the observation group underwent neuroendoscopic treatment. The length of operation,intraoperative blood loss,hematoma clearance,length of hospital stay,postoperative complications,and follow-up after 6 months were compared between the two groups, to analysis the advantages and disadvantages of both groups. Results The duration of operation in the observation group was shorter than that in the control group （P<0.05）. The intraoperative blood loss in the observation group was less than that in the control group （P<0.05）;The hematoma clearance rate in the observation group was higher than that in the control group （P<0.05）;The incidence of postoperative complications （intracranial infection,lung infection） in the observation group was lower than that of the control group （P<0.05）. There was no statistically significant in rebleeding and mortality between the two groups （P>0.05）. The prognosis of the observation group was better than that of the control group. In the control group,the difference was statistically significant （P<0.05）. Conclusion Neuroendoscope in the treatment of hypertensive intracerebral hemorrhage compared with conventional craniotomy may shorten the length of operation and hospital stay,improve hematoma clearance rate,reduce intraoperative bleeding,reduce intracranial and pulmonary infection and other advantages. It is worthy of clinical promotion and application.

目的 分析不同性别学龄儿童行为问题影响因素,为促进儿童行为健康发展提供指导依据。方法 以儿童保健门诊就诊的学龄儿童200名,男童110例,女童90例,平均年龄为(7±15)a 为调查对象,采用儿童行为量表(CBCL)检测所有调查对象的行为问题。由男/女童父母在专业人员指导下进行问卷调查,对收集的数据使用SPSS 11.0统计软件进行资料分析。结果 本次调查中男、女童年龄差异无统计学意义,男、女童在检出儿童行为问题方面有明显的差异性(P<0.05,P<0.01)具有统计学意义。男童在强迫性、违纪方面明显高于女童,女童在抑郁、社交退缩、体诉方面高于男童。结论 儿童行为问题的发生,受多方面因素影响包括社会环境、家庭环境以及父母的教养方式,应根据男童和女童的不同行为特点,给予有效的干预让孩子的身心发展更趋稳定和健康,从而降低儿童行为问题的发生。

Objective To explore the influence factors of children's behavior problem in school-age children, and to provide the evidence for promoting healthier children's behavior. Methods The objects of our study included 200 school-aged children in health care clinic (110 boys and 90 girls ), the average age is 7(7±15)years, and we used the CBCL questionnaire to assess all the children's behavior problems. The CBCL questionnaire was finished by the parents of the children guided by the specialized investigator. The data was analyzed by the SPSS 11.0 software. Results The score of boys in compulsivity and disobey is significant higher than girls(P<0.05), and the girls have higher score in depression, social flinch and physical demands than boys(P<0.01). There is no significant difference between different genders in the age of the children. Conclusion Behavior problems of children were affected by many kinds of factors including social environment, family environment and parenting styles. We need to conduct appropriate behavior intervention according to the different behavior characteristics between boys and girls, to promote healthier children's behavior and to reduce the behavior problems of children.

目的 探讨精液白细胞和形态正常精子百分率的相关性。方法 随机选取2014年4月—2015年8月来生殖中心进行就诊的男性800例,分析患者精液中的白细胞数量以及分析患者的精子形态,比较二者的相关性。结果 正常形态精子百分率低于正常参考值的患者中有61.9％的白细胞数大于1×10⁶,精子形态正常的患者有38.9％患者的白细胞数大于1×10⁶,患者比例差异有统计学意义(P<0.05)。精子形态正常的患者(320例)和正常形态精子百分率低于正常参考值的患者(480例)相比,精子形态正常的比例远远大于正常形态精子百分率低于正常参考值的患者(P<0.05)。而正常形态精子百分率低于正常参考值的患者的头部异常、颈部和中间部分异常、尾部异常精子比例高于正常组(P<0.05)。正常形态精子百分率低于正常参考值的和正常形态的精子比例呈正相关;和大头精子百分率、锥形以及小头形态精子百分率呈负相关;和梨形以及其他形态的精子呈正相关。结论 精液中的白细胞可以影响精子的参数,使得患者精液中的颈部或中部异常形态、头部和尾部异常形态的精子比例提升,具体机制有待进一步研究。

瘦素是维持人体能量代谢平衡的蛋白质,在人体中主要由白色脂肪组织分泌,通过与瘦素受体结合发挥作用。近年来有许多与瘦素相关的研究证明高血压患者及代谢综合征患者的血清瘦素水平较健康人群明显升高。两种疾病均可出现心室肥厚,蛋白尿,动脉粥样硬化等表现,说明二者存在共同的靶器官。瘦素代谢异常可出现瘦素抵抗并通过影响肾素-血管紧张素-醛固酮系统(renin angiotensin aldosterone system, RAAS)及炎症细胞因子来损伤靶器官。本文旨在总结瘦素在高血压及代谢综合征中的作用机制,并探讨瘦素对高血压合并代谢综合征靶器官损伤作用的研究进展。

Leptin is a protein that maintains the balance of energy metabolism in human body. It is mainly secreted by white adipose tissue in human body. In recent years, many studies have shown that the serum leptin level in patients with hypertension complicated with metabolic syndrome is significantly higher than that of healthy people. Both of the diseases can lead to left ventricular hypertrophy, proteinuria, atherosclerosis and other manifestations. The abnormal metabolism of leptin may contribute to leptin resistance which damages target organs by affecting the angiotensin aldosterone system and inflammatory cytokines. The aim of this article is to summarize the mechanism of leptin in hypertension and metabolic syndrome, and to explore its effect on the target organ damage in patients with hypertension complicated with metabolic syndrome.

目的 探讨产后出血(PPH)应用一次性囊式宫颈扩张器治疗的临床效果。方法 选取我院2001年1月—2016年12月收治的50例PPH产妇,按就诊先后顺序进行分组,2001年1月—2015年12月就诊的25例为对照组(予以宫腔填塞纱布治疗);2016年1月—2016年12月就诊的25例为观察组(给予一次性囊式宫颈扩张器治疗),并按照分娩方式不同分为阴道分娩组(15例),剖宫产组(10例)。记录比较观察组和对照组的治疗与预后情况;阴道分娩组与剖宫产组的治疗情况。结果 与对照组比较,观察组在操作时间、填塞物留置时间及起效时间方面,均显著更优(P<0.01);两组放置后12 h出血量、显效率相比,差异无统计学意义(P>0.05);观察组子宫切除、子宫动脉结扎及产褥感染等发生率均低于对照组,但差异均无统计学意义(P>0.05);阴道分娩组的起效时间、留置时间、T2时间段阴道总流血量、显效率及产褥感染率,较剖宫产组比较,差异均无统计学意义(P>0.05),阴道分娩组T1时间段阴道总流血量显著低于剖宫产组(P<0.01)。结论 PPH产妇应用一次性囊式宫颈扩张器治疗操作简便,更有利于缩短操作时间,改善预后,效果切实,且对于阴道分娩与剖宫产产妇的疗效相当,适用于基层医院,具有较高临床推广价值。

目的 探讨追踪护理模式对中青年保留神经宫颈癌根治术后膀胱功能恢复的影响效果。方法 按住院先后顺序将82例患者分为对照组40例、实验组42例,对照组给予常规护理,实验组实施追踪护理模式,3个月后对两组患者的尿失禁、尿潴留发生率,膀胱功能恢复情况及尿失禁严重程度进行测评。结果 实验组尿失禁、尿潴留的发生率分别为2%、4% ,膀胱功能Ⅰ级、Ⅱ级达100%,68%患者无尿失禁,与对照组比较差异均有统计学意义(P>0.05)。结论 对中青年保留神经宫颈癌根治术实施追踪护理模式,可提高患者膀胱功能锻炼的有效性,促进膀胱功能的早日恢复,改善其生活质量。

Objective To explore the effect of follow-up nursing on the recovery of bladder function in young and middle-aged patients with cervical cancer after radical operation. Methods 82 patients were divided into control group (n = 40) and experimental group (n=42). The control group was given routine nursing care, experimental group to implement the follow-up nursing model. After 3 months, the incidence of urinary incontinence and urinary retention were observed in the two groups, including bladder function recovery and severity of urinary incontinence. Results The incidence of urinary incontinence and urinary retention in the experimental group were 2% and 4%, respectively. Bladder function level I and II reached 100%. There was no urinary incontinence in 68% patients. Compared with the control group, the difference was statistically significant (P>0.05). Conclusion It may improve the effectiveness of bladder function training, promote the early recovery of bladder function and improve the quality of life of young and middle-aged patients with cervical cancer.

目的 探讨个体化健康管理对超高龄结直肠癌患者希望水平的影响效果。方法 对66例超高龄结直肠癌患者实施个体化健康管理,3个月后对患者进行希望水平、肛门括约肌功能、生活质量的测评。结果 3个月后患者排便功能恢复良好的达90.91%,与出院前比较差异有统计学意义(P＜0.01);3个月后患者HHI各维度和SF-36各维度的得分明显提高,与干预前比较差异均有统计学意义(P＜0.01)。结论 对超高龄结直肠癌患者实施个体化健康管理,可提高其生存希望水平,改善生活质量。

Objective To explore the effect of individualized health management on the hope level of patients with advanced colorectal cancer. Methods Using individualized health management for 66 elderly patients with colorectal cancer for 3 months, the level of hope, anal sphincter function and quality of life were evaluated. Results After 3 months, the defecation function of the patients recovered well to reach 90.91%, and the difference was statistically significant (P<0.01); After 3 months, the scores of each dimension of Herth Hope Index (HHI) and SF-36 were significantly improved, and the difference was statistically significant (P<0.01). Conclusion The implementation of individualized health management for the elderly patients with colorectal cancer may improve the survival level and improve the quality of life.

目的 探讨小骨窗显微手术不同手术时机对高血压脑出血患者疗效及神经功能的影响。方法 选取我院2014年5月—2016年5月收治的80例高血压脑出血患者作为研究对象,脑出血量约30～40 mL,根据出血到手术时间不同分为两组,每组40例。从出血到手术时间<6 h者为超早期作为观察组,出血到手术时间处于6~24 h间者为早期作为对照组,比较两组患者治疗后1个月GOS(格拉斯哥预后)优良率,治疗后3周、6周的斯堪的纳维亚(SSS)评分,治疗后3个月、6个月的生存质量评分及治疗后的生存情况、再出血情况。结果 观察组治疗后1个月GOS优良率为77.50%,相对于对照组明显上升(P<0.05);观察组治疗后3周、6周的SSS评分较对照组明显降低(P<0.01);观察组治疗后3个月、6个月的生存质量评分较对照组明显升高(P<0.01);两组治疗后的生存率差异有统计学意义(P<0.05),再出血率差异无统计学意义(P>0.05)。结论 对高血压脑出血患者在超早期行小骨窗显微手术可提高疗效,明显改善患者神经功能,提高生活质量及生存率,值得临床推广。

Objective To investigate the curative effects of microsurgical treatment with small bone flap craniotomy in patients with hypertensive cerebral hemorrhage and on their nerve function in different timing of surgery. Methods To select 80 cases of hypertensive cerebral hemorrhage in our hospital from May 2014 to May 2016 as the research object. The amount of cerebral hemorrhage of the patients was about 30-40 mL. According to the different time of bleeding, they were divided into two groups, 40 cases in each group. The super early period that the time from bleeding to operation was less than 6 h was regarded as the observation group, and the early period that the time from bleeding to operation is during 6~24 h was regarded as the control group. To compare the GOS (Glasgow outcome) excellent rate of patients in two groups in 1 month after treatment, the Scandinavia (SSS) score in 3 weeks and 6 weeks after treatment, and the quality of life score and survival and re-bleeding condition after treatment in 3 months and 6 months. Results Compared with the control group, the GOS excellent rate in the observation group in 1 month after treatment was 77.50% which increased significantly (P<0.05); the SSS score in the observation group in 3 weeks and 6 weeks after treatment was significantly lower than that in the control group (P<0.01); The quality of life score in the observation group in 3 months and 6 months after treatment was significantly higher than that in the control group (P<0.01); There was statistically significant difference in survival rate between the two groups after treatment (P<0.05), and the re-bleeding rate showed no significant difference (P>0.05). Conclusion The curative effects of microsurgical treatment with small bone flap craniotomy on patients with hypertensive cerebral hemorrhage is significant, which can improve the patients' neurological function, the life quality and survival rate, thus it is worthy of clinical promotion.