Autoimmune thyroid disease (AITD) is a T lymphocytes-mediated autoimmune disorder affecting pregnant women. The current study sought to determine the correlations between T helper-1 (Th1)/T helper-2 (Th2) cytokines and regulatory T cells (Tregs) and T cell subsets and pregnancy outcomes in AITD patients during early pregnancy (T1), middle pregnancy (T2), late pregnancy (T3), and postpartum period (PP). A total of 60 patients with Graves’ disease, 60 patients with Hashimoto’s thyroiditis, and 30 healthy pregnant women were initially enrolled in the study. Thyroid hormones and antibodies, Th1 or Th2 cytokines, transforming growth factor-β, Tregs, CD4+ T helper cells (CD4+), CD8+ T helper cells (CD8+) levels were determined by means of Maglumi2000 automatic chemiluminescence instrument, enzyme-linked immunosorbent assay, and flow cytometry. Our findings demonstrated higher IFN-γ and IL-2 levels, along with lower IL-4, IL-10, TGF-β, Treg, and CD4+/CD8+ levels in AITD patients during T1, T2, T3, and PP. Furthermore, the TGF-β, Treg, and CD4+/CD8+ levels were lower in the IFN-γ/IL-2 high expression group but higher in the IL-4/IL-10 high expression group. The IFN-γ and IL-2 levels were higher, while IL-4 and IL-10 level were lower in AITD patients with adverse pregnancy outcomes. Lastly, Th1 cytokines were higher and Th2 cytokines were lower in AITD patients and elicited correlation with Tregs and CD4+/CD8+ levels. Collectively, our findings highlighted that up-regulation of Th1 cytokines may increase the percentage of adverse pregnancy outcomes in AITD patients.

目的 探讨妊娠早期合并自身免疫性甲状腺疾病(AITD)患者的调节性T细胞(Treg)和T细胞亚群水平变化及不良妊娠结局的影响因素.方法 选取 2018 年 12 月至 2021 年 12 月在广西壮族自治区人民医院产前检查的合并 AITD妊娠早期患者 124 例为观察组,另选取同期健康的妊娠早期孕妇 80 例为对照组.比较两组患者Treg细胞和T细胞亚群水平,采用多因素Logistic回归分析妊娠早期合并 AITD患者不良妊娠结局的影响因素.结果 观察组 Treg、CD3+、CD4+、CD4+/CD8+显著低于对照组,CD8+显著高于对照组(t值分别为 3.542、4.259、5.192、8.499、5.090,P<0.05).多因素 Logistic 回归分析发现,年龄、孕前体质量指数(BMI)、CD8+是妊娠早期合并 AITD患者不良妊娠结局的危险因素,OR值及其 95%CI 分别为 1.232(1.058～2.614)、2.493(1.181～3.429)、2.368(1.269～3.558);Treg、CD3+、CD4+、CD4+/CD8+是其保护因素,OR值及其 95%CI分别为0.886(0.327～0.935)、0.717(0.518～0.972)、0.935(0.764～0.993)、0.848(0.406～0.946),P<0.05.结论 妊娠早期合并AITD患者的Treg、CD3+、CD4+、CD4+/CD8+水平下降,CD8+水平升高,更容易发生不良妊娠结局.

目的 观察甲状腺滤泡癌中是否存在血管包绕的肿瘤细胞巢(VETC)结构,分析其特点.方法 选取甲状腺滤泡癌患者10例、乳头状癌患者21例,收集患者年龄、肿瘤大小等资料,通过免疫组化染色检测CD31、血管生成素-2(Ang-2)和CXCR4蛋白表达;通过公共数据库资料分析蛋白表达与患者预后关系;通过超声造影影像学分析VETC结构对超声造影表现的影响;采用t检验进行2组间数据的统计学比较.结果 甲状腺滤泡癌组织中均存在VETC结构,乳头状癌中均不存在VETC结构;甲状腺滤泡癌的VETC结构可整体发生淋巴结、血管转移.Ang-2蛋白在甲状腺滤泡癌中呈高表达.甲状腺滤泡癌超声造影表现为"全肿瘤均匀式快速充盈"的灌注方式,乳头状癌则为"非均匀式充盈"的方式;与甲状腺乳头状癌〔(2.82±0.23)s〕比较,滤泡癌〔(2.02±0.07)s〕患者其始增至达峰时间在单位距离内时间更短,t=5.708,P=0.005.结论 甲状腺滤泡癌具有VETC结构,且其超声造影具有"全肿瘤均匀式快速充盈"的特点,Ang-2蛋白是甲状腺滤泡癌的潜在治疗靶点.

医院自主研发双向转诊信息网络平台开展转诊工作,以此推动分级诊疗制度建设.通过在医联体成员单位开展平台转诊试点工作,一定程度上规范了转诊流程、优化转诊绿色通道,缓解了基层医院转诊的压力,改善患者就医体验,解决了转诊记录不完善、数据缺失等问题.各级医院应重视双向转诊的宣传工作、提高双向转诊意识,充分发挥医保杠杆作用,优化医保一站式结算功能、优化平台转诊功能,实现"基层首诊、双向转诊、急慢分治、上下联动"的分级诊疗模式.

甲状腺结节的良恶性鉴别对于制定治疗方案及手术方式至关重要.细针穿刺细胞学检查是术前明确甲状腺结节性质的首选检查,然而仍有部分甲状腺结节即使经过穿刺细胞学检查仍不能明确诊断.基于美国甲状腺协会风险分级的甲状腺超声检查对于甲状腺结节的恶性风险评估具有重要的临床价值;此外,超声造影或其结合弹性成像、分子病理检查等方法均进一步提高了对细胞学检查不能明确甲状腺结节的诊断准确性.本文主要针对超声检查在细针穿刺细胞学检查不能明确甲状腺结节的良恶性鉴别中应用价值的研究进展进行综述.

目的 探讨超微血管成像(Super Micro-vascular Imaging,SMI)评估颈动脉斑块内新生血管的价值,并对相关危险因素进行分析.方法 选取常规超声发现颈动脉粥样硬化斑块患者46例,所有患者均接受SMI及超声造影(Con-trast Enhanced Ultrasound,CEUS)检查,评价SMI与CEUS检查结果的一致性,并详细记录患者的基线临床资料及检查结果.结果 SMI与CEUS评分有较好的一致性(Kappa=0.508,P<0.05).SMI和CEUS检测到的大部分新生血管位于同一位置.以CEUS评分为诊断标准,SMI评分的受试者工作特征(Receiver Operating Characteristic curve,ROC)曲线下面积达0.895,P<0.05,SMI评分诊断斑块内新生血管的敏感度88％,特异度80％.对可能的相关危险因素进行Logistic回归分析发现:脑梗病史、高水平总胆固醇、三酰甘油、低密度脂蛋白胆固醇、同型半胱氨酸是斑块内新生血管形成的危险因素(P<0.05);根据Spearman秩相关分析发现SMI评分与总胆固醇、三酰甘油、低密度脂蛋白胆固醇、同型半胱氨酸呈正相关(P<0.05).结论 SMI是检测颈动脉斑块内新生血管便捷、有效的技术;脑梗病史、高水平总胆固醇、三酰甘油、低密度脂蛋白胆固醇、同型半胱氨酸是斑块内新生血管形成的危险因素.

目的 观察氯胺酮联合丙泊白酚在食蟹猴动物实验中的麻醉效果.方法 选取24只4～7岁雄性食蟹猴,按随机数字表法分为小牛血清组、四氯化碳组、酒精组及对照组,每组6只,造模18周后采用氯胺酮基础麻醉+丙泊酚静脉麻醉对食蟹猴行枪式肝穿活检进行麻醉,术中监测生命体征和观察麻醉效果,并对其进行统计学分析.结果 造模18周后,3个造模组食蟹猴均出现肝纤维化,但以四氯化碳组肝纤维化明显;24例食蟹猴氯胺酮肌注起效时间为(4.20±1.55) min,各组氯胺酮肌注起效时间比较差异无统计学意义(P＞0.05);24例食蟹猴刺激睁眼时间为(6.50 ±2.84) min,各组刺激睁眼时间比较差异无统计学意义(P＞0.05);在氯胺酮联合丙泊酚麻醉实验中,四组心率、呼吸均平稳,肝穿前后呼吸末CO2分压、心率在组内比较及3个造模组与对照组比较差异均无统计学意义(P＞0.05);四组肝穿前后血糖均变化明显,组内肝穿前后比较差异有统计学意义(P＜0.05),但3个造模组与对照组比较差异均无统计学意义(P＞0.05).四组食蟹猴麻醉过程中均无无躁动、嚎叫表现,且苏醒迅速,术后无呕吐、抽搐等不良反应.结论 四氯化碳可有效地进行食蟹猴肝纤维化模型造模,氯胺酮基础麻醉+丙泊酚静脉麻醉在食蟹猴动物实验中应用麻醉效果良好,具有推广意义.

目的 探讨超微血管成像(Superb Micro-vascular Imaging,SMI)评估颈动脉斑块内新生血管的价值.方法 选取常规超声发现颈动脉粥样硬化斑块患者46例,所有患者均接受SMI及超声造影(CEUS)检查.评价SMI与CEUS检查结果的一致性.结果 SMI评分与CEUS评分有较好的一致性,差异无统计学意义(Kappa=0.508,P<0.05).多数SMI检查发现的新生血管与CEUS检查发现的新生血管位于同一平面.以CEUS评分为诊断标准,SMI评分的受试者工作特征(ROC)曲线下面积达0.895,P<0.05.SMI评分诊断斑块内新生血管的敏感性88％,特异性80％.结论 SMI是检测颈动脉斑块内新生血管便捷、有效的技术,对评价颈动脉斑块的稳定性具有重要的意义.

目的:探讨纤维性囊性乳腺病的声像图特征、超声分型与临床病理表现的关系.资料与方法:回顾性分析经病理证实的91例纤维性囊性乳腺病的声像图特征并进行超声分型,将超声表现与病理进行对照分析.结果:按声像图特征将纤维性囊性乳腺病分为V型:单纯液性暗区型、极低回声型、囊实混合型、低回声型及钙化型.本组病例中1例囊实混合型、1例低回声型及1例钙化性纤维性囊性乳腺病误诊为乳腺癌.2例囊实混合型纤维性囊性乳腺病误诊为导管内乳头状瘤.超声对肿块的检出率100％,超声和病理诊断符合率为94.51％(86/91),误诊率5.49％,Kappa值0.82,P=0.006.结论:纤维性囊性乳腺病的超声诊断及分型是一种简便、适用、易行的方法,能提高纤维性囊性乳腺病的诊断准确性.

Objective: To detect the possible molecular mechanisms of the formation of vessels that encapsulated tumor clusters (VETC) and identify the relationship between vimentin protein expression in endothelial cells and contrast-enhanced ultrasound characters in VETC (+ ) hepatocellular carcinoma (HCC). Methods: A total of 64 paraffin embedded HCC tissue samples were collected, all of which the tumor diameters were between 2 cm and 5 cm measured by the preoperative ultrasound. Immunohistochemistry staining for CD34 was used to detect the formation of VETC and the expressions of angiopoietin-2 (Ang-2) and vimentin were also determined. Human umbilical vein endothelial cells (HUVECs) were treated with 150 ng/ml recombinant human Ang-2 protein (rhAng-2) at various times and the protein expression of vimentin was detected by western blot assay. The contrast-enhanced ultrasound characters were also analyzed in both VETC (+ ) and VETC (-) HCC. Results: Tumor clusters encapsulated by vessels to form cobweb-like networks, which were identified as VETC phenotype, were observed in 27 HCC tissues (42.18%). In VETC (+ ) HCC tissues, Ang-2 was overexpressed in tumor cells and endothelial cells while vimentin was only upregulated in endothelial cells. With the treatment of 150 ng/ml rhAng-2 protein, the expression of vimentin in HUVECs was 0.878±0.102 and 0.918±0.092 at 12 h and 36 h, significantly upregulated when compared to the 0.322±0.061 at 6 h (P<0.01). In contrast-enhanced ultrasound, a crack and tendon-like filling character was observed in VETC (+ ) HCC during the arterial-phase, while the large scale and diffuse-like filling character was observed in VETC (-) HCC. The filling time of unit diameter in VETC (+ ) HCC was (3.95±0.22)s, significantly longer than (2.28±0.27)s of VETC (-) HCC (P<0.01). Conclusions: The overexpressions of Ang-2 and vimentin are positively correlated with the formation of VETC and considered as potential therapeutic targets of VETC (+ ) HCC. The crack and tendon-like filling characters in arterial-phase of contrast-enhanced ultrasound indicates the VETC (+ ) HCC.

Objective To investigate the awareness and demands for medical association construction in medical staff from cross-regional medical association.Methods A total of 1 153 medical staffs from 10 member hospitals and one core hospital,in a Guangxi cross-regional medical association,were enrolled using stratified random sampling method.A questionnaire survey was conducted on the awareness,willingness to join,demands and suggestion for medical association.Further interv iew was performed in some respondents.Results Of 1 153 respondents,32.18％ were familiar with the concept of medical association,and 71.37％ approved the co-construction of the medical association.The levels for awareness of medical association concept in the medical staff with the educational background of bachelor,graduate or above were higher than the levels in the respondents who graduated from technical secondary school or high school(P ＜ 0.05);and the levels in the doctors,medical technician and administrative staff were higher than the levels in the nurses (P ＜ 0.05).The staff who graduated from technical secondary school had lower willingness to join the medical association compared to the staff with other education background (P ＜ 0.05).In the core hospital,more than half of the respondents considered that the medical association construction might raise the hospital profile,contribute to member hospitals' getting expert guidance from the core hospital more conveniently,and improve the professional skills of grassroots medical staff;the demands for construction included sending experts to member hospitals for technical guidance,receiving the staff from member hospitals for further study in the core hospital,and receiving referral patients from member hospitals.In the member hospitals,more than half of the respondents considered that the medical association construction might raise the hospital profile,improve the professional skills of medical staff,and increase outpatient visits and surgery quantity;the demands for help mainly consisted of technical guidance,new techniques or projects,and training courses or lectures,supplied by the experts from the core hospital.Conclusion Medical staff from this cross-regional medical association has a lower level for awareness of medical association concept,and it is necessary to enhance propaganda,especially in the staff with poor education background or nursing staff.It is suggested to establish the medical association regional information platform,increase the supports by the government,and further promote the implementation of hierarchical diagnosis and treatment,which is centered on mobile telemedicine technology.

医源性假性动脉瘤(iatrogenic pseudoaneurysms,IPSA)是动脉穿刺和介入性诊断治疗的主要并发症之一.随着介入技术的广泛开展,IPSA的发生率呈逐年上升的趋势,该文就彩色多普勒超声(color Doppler ultrasound,CDU)在诊治IPSA应用价值方面的研究进展进行综述.

目的 乳腺超声成像是乳腺疾病诊断不可或缺的主要技术,造影技术又克服了传统超声的局限性,极大提高了检测肿块低速血流的敏感性.本研究观察乳腺良恶性肿块的超声图像及超声造影表现,探讨其超声图像及超声造影的特征.方法 对2013 01-01-2015-06-30在广西壮族自治区人民医院就诊及手术治疗的451例乳腺肿块患者的超声图像特征、血流情况进行观察及实时超声造影,选用SonoVue超声造影剂,对肿块的高频超声图像、造影增强形态、强度和造影时间强度曲线特征进行观察,并与病理进行对照分析.结果 经病理确诊451例乳腺肿块中,恶性肿块240例,良性肿块211例,超声造影有其特征性表现.(1)恶性肿块表现为进入丰富,分布尚均及不均.其造影强度分别为高增强188例(78.3％),中等增强43例(17.9％),极少至低增强9例(3.8％).(2)进入肿块的增强范围常超过二维超声图像,周围可见多条粗大的血管进入肿块,恶性肿块范围增大、放射状增强、穿支血管均较良性明显增加,良性肿块可见环状增强,并为特征性改变,共59例(28.0％).(3)本组恶性肿块超声造影敏感度92.45％,特异度95.91％,阳性预测值96.66％,阴性预测值90.82％.本组恶性肿块二维超声检查敏感度82.63％,特异度65.02％,阳性预测值60.40％,阴性预测值85.29％.结论 通过系统地对乳腺恶性肿决超声图像及超声造影表现进行观察,进一步发现了不同乳腺肿块,尤其是恶性肿块的超声造影特征表现,认为超声造影可提高对乳腺肿块低速血流显示的敏感度,并有其特征性表现,有助于乳腺良恶性病变的鉴别诊断及提高诊断准确率.

目的:探讨三级医院对口帮扶县级医院的实践活动,提高县级医院综合服务能力.方法:通过对2006-2008年和2010-2012年两个周期的整体帮扶(协作医院模式)对口县级医院,比较帮扶前后的经济效益及社会效益.结果:经过两个周期帮扶,县级医院的人力资源配置得到优化,门急诊人数、出院人数、手术人数、业务收入帮扶前后对比均有明显提高(P＜0.05).结论:三级医院运用协作医院模式对县级医院进行对口帮扶,可明显提高县级医院医疗卫生服务体系的经济效益及社会效益,值得推广应用.

Objective To study the skill of fetal umbilical blood sampling guided by ultrasound and summa-rize the experience of sampling, and to improve the success rate and reduce complications.Methods One hundred and seventy-six clinically suspected abnormal pregnant women were performed the umbilical blood sampling guided by ultrasound.All the data were statistically analyzed.Results The success rate of the first attempt was 79.5%(140/176), and the final success rate was 94.3%(166/176).Conclusion Real-time ultrasound guidance in umbilical&nbsp;blood sampling has the advantage of positioning accuracy, which plays a decisive role in improving the success rate of first attempt and reducing complications of umbilical blood sampling.Umbilical blood sampling is an effective remedy of prenatal diagnosis during the middle-late pregnancy.

目的:探讨个性化号表在门诊全预约就诊模式的应用效果.方法:采用回顾性分析法对本院实施全预约就诊模式、建立个性化号表等加以分析和总结,并对效果加以评价.结果:随着个性化号表的建立及全预约就诊模式在我院的铺开,兼顾城市患者及农村患者的就医习惯,多种的预约方式,方便了患者就诊,缩短了患者及陪人的非诊疗的等待时间,缓解了候诊区人群拥挤现象,优化了就诊环境,为患者提供了优质的医疗服务.结论:全预约就诊模式的实施,个性化号表的建立,有效控制了患者在门诊就诊过程中的随机性和盲目性,节省了患者大量的就诊等候时间,一定程度上缓解了医院的拥挤现象,改善了门诊的就诊环境,提高了服务质量,使医院资源的配置和使用更趋合理,在提高社会效益的同时也提高了经济效益.

目的 探讨彩超引导技术在无积水肾结石经皮肾镜取石术(PNL)中的应用价值.方法 66例无积水肾结石患者随机分为彩超引导组(A组)与二维超声引导组(B组),每组33例,比较两组患者的手术效果及出血情况等指标.结果 两组患者的手术时间、血清肌酐(SCR)、一期清石率差异均无统计学意义(P＞0.05);B组术后血红蛋白(Hb)下降程度为(21.1±12.4)g/L,明显高于A组(15.0±7.9)g/L(P ＜0.05),B组手术输血率18.2％,明显高于A组3.0％(P＜0.05);B组发生需选择性肾动脉栓塞治疗的严重出血1例.结论 彩超组与二维超声组的PNL疗效相似,但彩超引导技术能明显降低无积水肾结石经皮肾镜手术严重出血的发生,值得在临床工作中推广使用.

目的 探讨二维超声联合CEUS对良恶性甲状腺结节的鉴别诊断价值.方法 对94例甲状腺结节患者(共99个结节)行常规超声、CEUS检查,观察甲状腺结节的二维超声、CEUS特征.分析比较良、恶性甲状腺病变超声特征的差异.对存在统计学意义的观察指标进行赋值后、比较各分值的鉴别诊断效能.结果 99个甲状腺结节中,30个为恶性结节,69个为良性结节.良、恶性病灶二维声像图特征中,回声、纵横比、形态、边界、钙化、回声均匀度的差异均有统计学意义(P均＜0.05);CEUS特征中,相对始入时间、环状增强、后期低增强的差异均有统计学意义(P均＜0.05).二维超声与CEUS参数的总评分≥4分时,可获得较好的敏感度及特异度、分别为86.67％(26/30)、78.26％ (54/69).结论 二维超声联合CEUS是鉴别诊断甲状腺结节良、恶性的一种可行、有效的方法.

Objective To explore the value of color Doppler ultrasound( CDU) in the diagnosis and treatment of radial artery pseudoaneurysm( PSA) after cardiac catheterization. Methods Eleven cases of radial artery PSA after cardiac catheterization underwent the unarmed compression repair under the surveillance of real-time CDU. Results Among 11 cases of radial artery PSA,4 cases of PSA proximal to cubital fossa muscle underwent the unarmed compression repair once and then achieved successful repair; Among 7 cases of PSA proximal to subcutaneous tissue of wrist side,1 case underwent the unarmed compression repair 3 times and then achieved successful repair,the remaining 6 cases who had undergone the 4-time unarmed compression repair but acquired unsuccessful repair received surgical procedures. Conclusion Real-time CDU had a certain value in the diagnosis and treatment of radial artery PSA. The unarmed compression repair might have better effects on the case of PSA proximal to cubital fossa muscle compared with that proximal to subcutaneous tissue of wrist side.