目的 探究孕中期体力活动与血糖水平及妊娠期糖尿病(gestational diabetes mellitus,GDM)的关联.方法 采用横断面调查的方法,于2017-2018年在广州市纳入孕周在20～28周的孕妇1 083人.采用面对面调查收集一般人口学和生活方式等资料,采用国际体力活动问卷调查过去一周的体力活动,通过口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)测量孕妇血糖和诊断GDM.运用多重线性回归和Logistic回归分析模型分别探讨不同类型体力活动和静坐行为与血糖及GDM的关联.结果 36.57％的孕妇体力活动达到推荐值(中高体力活动≥150 min/week).多重线性回归结果表明,孕中期妇女总体力活动强度与OGTT-2 h血糖水平呈负相关关系(β3=-0.10,P=0.017);运动锻炼和休闲体力活动强度与OGTT-1 h血糖呈负相关(β=-0.11,P=0.042),未发现其他类型体力活动或静坐时间与血糖之间的关联.Logistic回归分析模型分析未发现各类型体力活动或静坐时间与GDM风险之间的关联.结论 孕中期妇女体力活动水平较低,近2/3妇女未达到推荐值.孕中期妇女总体力活动、运动锻炼和休闲体力活动有助于降低餐后血糖.

目的 探讨基层医院收集、统计护理质量指标数据的举措,建立适用于基层医院的护理质量评价方法,促进护理质量持续提升.方法 通过建立公共信息平台结合Excel表格同步自动统计及自动上报等手段,将使用信息化平台前后的护理质量各项指标进行比较,比较各指标数据准确率、节省护士时间情况、区护士长满意度.结果 使用信息化平台后的护理质量各项指标统计数据准确率为97.61％,高于使用信息化平台前的43.15％;使用信息化平台前护士进行护理质量各项指标统计的时间为(22.41±10.19)min,而使用后护士花费的时间减少到(14.52±7.22)min,大大节省了护士的时间;护理部、护士长和管床护士《临床护理质量指标月报表》结果满意度从0上升到99％,差异均具有统计学意义(P<0.05).结论 通过利用信息化手段大大减少了可能出错的环节,同时也便于护理部及时了解各临床科室护理质量情况.基层医院也可利用信息化手段对护理质量指标进行数据收集及汇总,减轻了临床护士工作量,提高了数据的准确率、可信度.

目的 探讨应用PDCA循环法提高ICU血标本合格率的效果.方法 应用PDCA循环法建立和完善各种血标本采集的标准流程,组织护士进行采集血标本标准流程的理论学习;以工作坊的形式从核对、采集、确认、流转、运送等环节对ICU全体护士进行操作培训,对比分析培训前、后ICU各类血标本合格率的差异.结果 实施PDCA循环法后,ICU转送的各种血标本合格率得到显著的提高(P<0.01).结论 应用PDCA循环法能有效提高ICU血标本合格率.

Objective To investigate the clinical characteristics and surgical strategy of low rectal gastrointestinal stromal tumor (GIST).Methods Thirty-one low rectal GIST patients treated in the Sixth Affiliated Hospital of Sun Yat-sen University between April 2007 and December 2014 were involved.Clinical and survival data were retrospectively analyzed.According to surgical approach,patients were divided into local resection group(n=21) and extended resection group(n=7).The clinical features,operation data and prognosis,also the curative effect of imatinib therapy in 14 patients preoperatively were analyzed.Results Among the 31 patients,there were 21 males and 10 females patients.The average age was (54.3± 14.2)years old.The average distance from the tumor was (3.3± 1.5)cm.The average tumor size at initial was (5.4±2.6) cm.There were no differences in tumor size [(4.8±2.4) vs.(5.1 ± 1.0)cm,t=0.509,P=0.615),distance from anal verge [(3.6± 1.5) cm vs.(3.4-±0.8)] cm,t =0.218,P=0.829] and the distribution in modified National Institutes of Health (NIH) classification system (Z=0.637,P =0.615)between local resection group and extended resection group.Local resection group had shorter surgical time [(151.2± 104.3) min vs.(245.8±52.8)min,t=2.626,P=0.018]and less blood loss during the surgery [50 (20,100)mL vs 300 (275,400) mL,Z=2.241,P=0.025].than the extended resection group Postoperative complications were comparable in two groups,7 (33.3％) vs.3(42.9％),P =0.674.After following up 58 (23-106)months,the local recurrence rate[3(14.3％) vs.0,P=0.551)]and distant metastasis rate[1(4.8％) vs.0,P=1.000] were not significantly different in two groups.Fourteen patients received imatinib mesylate treatment before surgery.After 4(2-12)months' treatment,the average tumor size shrinked from(6.7-±2.3)cm to (4.2±2.2)cm,t=2.611,P=0.026.Histopathological analysis failed to reveal a notable decrease in mitotic count [3(2,3) vs.1(0,3)/50HPF,Z=0.677,P=0.498].Distances from anal verge of the tumor did not change significantly,(3.0± 1.7)cm vs.(3.1± 1.7)cm,t=1.393,P=0.191.Conclusion Compared with extended resection,local resection achieves comparable recurrence and metastasis outcome while significantly reduces the operation time and blood loss.Imatinib mesylate followed by local resection is an effective and safe treatment strategy for low rectal GISTs.Further study is warranted with long-term clinical efficacy.

Objective To observe the early effect of organ donation after pancreas-kidney transplantation.Methods Eight cases of diabetic nephropathy received combined pancreas kidney transplantation.There were 8 donors,including 6 males and 2 females,with an average age of (26 10) years old (range from 15 to 42 years).There were 4 cases of donors with China during the transition period of brain heart double death organ donation (C-Ⅲ) standard,3 cases of donors in line with the international standard of brain death organ donation (C-Ⅰ) standard,1 case of international standard of heart death organ donation (C-lⅡ M-Ⅲ) citizen donors.There were 6 men and 2 women for recipients of the same blood type.Results Eight cases were awake 4-6 h postoperation and the ventilator was removed 8-14 h after operation.The rehabilitation therapy began 2 days postoperation from surgery intensive care unit (SICU) to the common wards.Serum C-peptide and insulin levels achieved normal range in 1-2 weeks after transplant.Blood glucose returned to the normal level in 2-3 weeks,and the creatinine level decreased to the normal level in 2 weeks postoperation.Duodenal intramural hematoma occurred in one patient intraoperatively,and the pancreatic graft was removed for safe consideration.Other patients had no serious surgical complications within 2 weeks after transplantation.Conclusion For organ donation after death of pancreas kidney transplantation,early organ function recovered well.Under the strict preoperative evaluation,the young donors can be safely used in combined pancreas and kidney transplantation.

目的 探讨合并门静脉血栓(portal vein thrombosis,PVT)的终末期肝硬化病人行肝移植手术的处理方法及其疗效.方法 回顾性分析2010年1月至2015年12月在中山大学附属第一医院器官移植中心接受肝移植手术的152例终末期肝硬化病人的临床资料.32例合并PVT的病人作为PVT组,其中Ⅰ级10例、Ⅱ级13例、Ⅲ级8例、Ⅳ级1例.其余120例无PVT的病人作为对照组.结果 PVT组术前脾切除史的比例明显高于对照组(46.8％比18.3％,P＜0.05),差异有统计学意义.PVT组较对照组明显延长无肝期时间[(72.5±25.3)min比(57.6±18.4) min,P＜0.05]和总手术时间[(622.4±183.5) min比(503.2±123.6) min],差异均有统计学意义.2组病人在术中出血量、ICU住院时间、术后并发症发生率、围手术期病死率、1年及3年生存率的比较上差异均无统计学意义(P＞0.05).PVT组术后再栓塞率高于对照组(9.4％比1.7％,P＜0.05).结论 门静脉血栓一定程度上增加了终末期肝硬化病人肝移植手术的难度,Ⅰ～Ⅲ级PVT不影响病人的预后,仍可通过肝移植手术取得良好的疗效.Ⅳ级PVT肝移植手术的难度和风险会明显增加,应谨慎对待.

目的:研究细胞外基质磷酸化糖蛋白(Matrix Extracellular Phosphoglycoprotein,MEPE)基因沉默对人牙髓细胞(Human Dental Pulp Cells,hDPCs)增殖和成牙本质分化能力的影响,探讨其在牙髓损伤修复中的功能.方法:酶消化组织块法分离培养hDPCs,以lipo2000介导siRNA-hMEPE转染hDPCs,以阴性对照组和未转染组设为对照,l、3、5、7d后,CCK-8法检测细胞增殖情况;转染hDPCs后以矿化诱导液培养5、7、10d后,实时荧光定量RT-PCR检测骨涎蛋白(bone sialoprotein,BSP)、牙本质涎磷蛋白(Dentin Sialophos-phoprotein,DSPP)、骨钙蛋白(osteocalcin,OCN)、Collagen I mRNA表达水平.结果:CCK-8结果显示Si-h-MEPE转染hDPCsld后OD值下降,3d时到达最低值,且均低于未转染组与阴性对照组,3d时差异有统计学差异(P＜0.05),未转染组与阴性对照组中,OD值持续升高,7d时到达峰值,与各自组内其他时间点比较有统计学差异(P＜0.05);ALP活性检测结果显示,Si-h-MEPE转染hDPCs3d细胞OD值最低,且明显低于未转染组与阴性对照组(P＜0.05),未转染组与阴性对照组hDPCsOD值呈现逐渐升高趋势,在7d时达到最大值(P＜0.05).Si-h-MEPE转染hDPCs3d时BSP、DSPP、OCN、Collagen Ⅰ mRNA的表达量均较未转染组与阴性对照组下调(P＜0.05).在未转染组中,BSP、DSPP、OCN、Collagen Ⅰ mRNA水平持续升高,在7d时达最高值,与3d比较差异有统计学意义(P＜0.05).结论:MEPE基因瞬时沉默抑制hDPCs增殖、使BSP、DSPP、OCN、Collagen Ⅰ基因表达下调,ALP活性降低,与未转染组与阴性对照组比较结果提示MEPE可能通过调控hDPCs的增殖和成牙本质分化能力,在牙髓损伤修复中发挥重要作用.

A defining property of side population cells(SP cell) is low fluorescence after staining with Hoechst33342.Adenosine triphosphate binding cassette superfamily G member-2 of transport protein(ABCG-2) is an important determinant of the SP phenotype,and have biofunctions on SP cells.SP cells have now been isolated from a wide variety of mammalian tissues,most of which,including the dental pulp SP cells,showed a stem-cell like potential of self-renewal and multilineage differentiation.Due to its unique anatomy and poor blood circulation,dental pulp is vulnerable to external stimulates,however hardly inreversible.Dental pulp SP cells as newly discovered stem-like cells may illustrate a good prospect of application and extension in dental pulp damage repair.This article intended to give an review on formation of the phenotype of SP cells,expression of stem cell-related antigens of SP cells,stem-like cells' potential and the differences between SP and stem cells.Most of all,the statues and prospects of research on dental SP cells.